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Images from 18F-DOPA Scan in Congenital Hyperinsulinism: Not Always a Clue for Diagnosis
Evelina Maines1, Luca Giacomello2, Mirko D'Onofrio3
1Inherited Metabolic Diseases Unit, Department of Paediatrics, Regional Centre for Newborn Screening, Diagnosis and Treatment of Inherited Metabolic Diseases and Congenital Endocrine Diseases, Azienda Ospedaliera Universitaria Integrata, Piazzale Ludovico Antonio Scuro, 10, 37134 Verona, Italy.
Insights
Congenital hyperinsulinism (CHI) is a common cause of hypoglycemia in children. This case highlights how bowel uptake can mimic pancreatic lesions on 18F-DOPA PET/CT scans, emphasizing the role of MRI for accurate diagnosis.
Area of Science:
- Pediatric Endocrinology
- Nuclear Medicine
- Diagnostic Imaging
Background:
- Congenital hyperinsulinism (CHI) is the leading cause of persistent hypoglycemia in children.
- 18-Fluoro-L-dihydroxy-phenylalanine (18F-DOPA) positron emission tomography (PET) aids in differentiating focal from diffuse CHI by detecting pancreatic hyperactivity.
- Recurrent hypoglycemia despite prior surgery necessitates further diagnostic evaluation.
Purpose of the Study:
- To report a case of congenital hyperinsulinism where 18F-DOPA PET/CT interpretation was complicated by extra-pancreatic uptake.
- To illustrate the diagnostic utility of magnetic resonance imaging (MRI) in clarifying ambiguous 18F-DOPA PET/CT findings in CHI.
- To emphasize potential pitfalls in interpreting 18F-DOPA PET/CT in pediatric CHI patients.
Main Methods:
- Case report of a pediatric patient with recurrent severe hypoglycemia.
- 18F-DOPA positron emission tomography/computed tomography (PET/CT) imaging was performed to localize hyperinsulinemic activity.
- Abdominal magnetic resonance imaging (MRI) was utilized to correlate radiotracer uptake with anatomical structures.
Main Results:
- 18F-DOPA PET/CT indicated a focal pancreatic lesion suggestive of focal CHI.
- Abdominal MRI revealed that the observed 18F-DOPA uptake originated from a bowel loop within the surgical bed, not the pancreas.
- The imaging findings demonstrated a discrepancy between PET/CT and MRI regarding the source of abnormal uptake.
Conclusions:
- Bowel uptake of 18F-DOPA can be a significant confounding factor in interpreting PET/CT scans for pediatric CHI.
- When 18F-DOPA PET/CT results are inconsistent with the clinical presentation, MRI is crucial for accurate anatomical correlation.
- Integrating MRI with 18F-DOPA PET/CT enhances diagnostic accuracy for complex cases of congenital hyperinsulinism.
Abstract:
Congenital hyperinsulinism (CHI) is the most common cause of persistent hypoglycaemia in childhood (Horm Res 70:65-72, 2008; J Clin Endocr Metab 93:869-875, 2008). 18-Fluoro-L-dihydroxy-phenylalanine (18F-DOPA) positron emission tomography (PET) can detect areas of increased activity in the pancreas and may differentiate focal from diffuse CHI (J Clin Endocr Metab 93:869-875, 2008; Radiology 253:216-222, 2009). We here report the case of a girl who complained of recurrent episodes of severe hypoglycaemia despite previous partial pancreatectomy. To evaluate the need for additional surgical intervention, we performed 18F-DOPA PET/computed tomography (CT), which showed a focal lesion corresponding to the anatomical region of the pancreatic tail. On the other hand, abdominal magnetic resonance imaging (MRI) clearly demonstrated that the 18F-DOPA uptake was in a loop of bowel occupying the previous surgical bed. Our case highlights that bowel uptake can be a possible pitfall in the interpretation of 18F-DOPA PET/CT in children affected by CHI, suggesting that when 18F-DOPA PET/CT results do not fit the clinical picture, magnetic resonance imaging (MRI) may allow a more accurate correlation of the radiotracer activity with the underlying anatomical or pathological structure.
