68Ga-DOTA-exendin-4 PET/CT for Insulinoma Localization in Patients with Negative or Inconclusive Conventional...

Area of Science:

• Endocrinology
• Nuclear Medicine
• Surgical Oncology

Background:

• Insulinomas cause endogenous hyperinsulinemic hypoglycemia (EHH), requiring surgery for cure.
• Precise preoperative localization is essential for pancreas-preserving surgery.
• GLP-1 receptor (GLP-1R)-targeted imaging, specifically [68Ga]Ga-DOTA-exendin-4 PET/CT, shows superior performance for insulinoma localization compared to other methods.

Purpose of the Study:

• To evaluate the performance of [68Ga]Ga-DOTA-exendin-4 PET/CT in detecting insulinomas.
• To assess the clinical impact of this imaging modality in patients with EHH and prior negative or inconclusive conventional imaging.

Main Methods:

• A retrospective, dual-center study included 101 patients with biochemically proven EHH.
• Primary analysis focused on 58 patients with prior negative or inconclusive conventional imaging.
• [68Ga]Ga-DOTA-exendin-4 PET/CT was performed between April 2017 and March 2024.

Main Results:

• [68Ga]Ga-DOTA-exendin-4 PET/CT detected insulinomas in 42 out of 58 patients (72% detection rate).
• Thirty patients proceeded to PET/CT-guided surgery.
• Histological verification in 32 patients confirmed a 93.8% sensitivity for the imaging modality.

Conclusions:

• [68Ga]Ga-DOTA-exendin-4 PET/CT demonstrates a high real-world detection rate (72%) for insulinomas in EHH patients with prior inconclusive imaging.
• This GLP-1R-targeted PET/CT facilitates PET/CT-guided surgical approaches.
• The findings highlight the significant clinical impact of [68Ga]Ga-DOTA-exendin-4 PET/CT on patient management and prognosis.