RT Journal Article
SR Electronic
T1 Improved Localization of Insulinomas Using <sup>68</sup>Ga-NODAGA-Exendin-4 PET/CT
JF Journal of Nuclear Medicine
JO J Nucl Med
FD Society of Nuclear Medicine
SP 1959
OP 1964
DO 10.2967/jnumed.124.268158
VO 65
IS 12
A1 Boss, Marti
A1 Eriksson, Olof
A1 Mikkola, Kirsi
A1 Eek, Annemarie
A1 Brom, Maarten
A1 Buitinga, Mijke
A1 Brouwers, Adrienne H.
A1 Velikyan, Irina
A1 Waser, Beatrice
A1 Kauhanen, Saila
A1 Solin, Olof
A1 Marciniak, Camille
A1 Eriksson, Barbro
A1 Reubi, Jean-Claude
A1 Aveline, Cyrielle
A1 Wild, Damian
A1 Pattou, Francois
A1 Talbot, Jean-Noel
A1 Hofland, Johannes
A1 Sundin, Anders
A1 Nuutila, Pirjo
A1 Hermans, John
A1 Gotthardt, Martin
YR 2024
UL http://jnm.snmjournals.org/content/65/12/1959.abstract
AB Precise anatomic localization of insulinomas is crucial for surgical treatment. Current routine noninvasive imaging techniques, including CT, MRI, and 68Ga-DOTA-somatostatin analog (DOTA-SSA) PET/CT, have limited sensitivity. Endoscopic ultrasound is highly sensitive but invasive. In this prospective multicenter study, we compared the diagnostic accuracy of 68Ga-NODAGA-exendin-4 (exendin) PET/CT with all routine imaging procedures for the localization of insulinomas. Methods: Sixty-nine adults with biochemically proven adult endogenous hyperinsulinemic hypoglycemia underwent exendin PET/CT and current routine imaging. Images were evaluated in a clinical reading and in an expert reading. Image quality was determined by quantitative analysis. Results: Based on clinical readings, the accuracy of exendin PET/CT (94.4%; 95% CI, 84.6%–98.8%) was greater than that of DOTA-SSA PET/CT (64.8%; 95% CI, 50.6%–77.3%), contrast-enhanced CT/contrast-enhanced diffusion-weighted imaging-MRI (83.3%; 95% CI, 70.7%–92.1%), and endoscopic ultrasound (82.8%; 95% CI, 64.1%–94.1%). In 13% of patients, a correct diagnosis was only reached after exendin PET/CT. Interobserver agreement between readings was higher for exendin PET/CT than for DOTA-SSA PET/CT and contrast-enhanced CT/contrast-enhanced diffusion-weighted imaging-MRI (Cohen κ, 1.0 vs. 0.5 and 0.55). Exendin PET/CT provided a higher insulinoma-to-background ratio (15.3 ± 6.7 vs. 5.2 ± 3.0) and contrast-to-noise ratio (22.6 ± 11.1 vs. 5.1 ± 3.7) than did DOTA-SSA PET/CT. Conclusion: This study demonstrates the superiority of exendin PET/CT in a unique prospective comparison to all current routine imaging modalities for preoperative localization of benign insulinomas, providing the level of evidence needed for clinical implementation.