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68Ga-Exendin-4 PET/CT Detects Insulinomas in Patients With Endogenous Hyperinsulinemic Hypoglycemia in MEN-1

Kwadwo Antwi1, Guillaume Nicolas1,2, Melpomeni Fani1

  • 1Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland.

The Journal of Clinical Endocrinology and Metabolism
|July 13, 2019
PubMed
Abstract

Insights

68Ga-DOTA-exendin-4 PET/CT combined with MRI improves detection of insulinomas in patients with Multiple Endocrine Neoplasia type-1 (MEN-1) and endogenous hyperinsulinemic hypoglycemia (EHH). This imaging approach aids surgical planning for EHH treatment.

Area of Science:

  • Endocrinology
  • Medical Imaging
  • Oncology

Background:

  • Surgical intervention is recommended for specific pancreatic neuroendocrine tumors (PanNETs) in Multiple Endocrine Neoplasia type-1 (MEN-1).
  • Functioning PanNETs causing endogenous hyperinsulinemic hypoglycemia (EHH) require surgery regardless of size, necessitating precise preoperative localization of insulinomas.

Purpose of the Study:

  • To assess the feasibility and sensitivity of 68Ga-DOTA-exendin-4 positron emission tomography (PET)/CT combined with MRI for detecting clinically relevant lesions in MEN-1 patients with EHH.
  • To compare the diagnostic performance of combined imaging versus individual modalities.

Main Methods:

  • A subgroup analysis of a prospective imaging study included six patients with EHH and genetically confirmed MEN-1.
  • Patients underwent 68Ga-DOTA-exendin-4 PET/CT and MRI within days, followed by surgery.
  • Lesion-based sensitivity was calculated, with surgery and histology serving as the reference standard.

Main Results:

  • Histopathology confirmed 37 PanNETs in the six patients.
  • The combined PET/CT plus MRI approach demonstrated a sensitivity of 92.3% for clinically relevant lesions, significantly outperforming MRI alone (38.5%).
  • PET/CT alone had a sensitivity of 84.6%.

Conclusions:

  • 68Ga-DOTA-exendin-4 PET/CT is a feasible imaging modality for MEN-1 patients experiencing EHH.
  • The combination of 68Ga-DOTA-exendin-4 PET/CT and MRI offers superior detection of insulinomas compared to MRI alone.
  • This integrated imaging strategy can effectively guide surgical interventions for EHH in MEN-1 patients.

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