Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2010 May;162(5):971-8.
doi: 10.1530/EJE-10-0056. Epub 2010 Mar 5.

Diagnosis and localisation of insulinoma: the value of modern magnetic resonance imaging in conjunction with calcium stimulation catheterisation

Maralyn R Druce  1 , Vasantha M Muthuppalaniappan, Benjamin O'Leary, Shern L Chew, William M Drake, John P Monson, Scott A Akker, Michael Besser, Anju Sahdev, Andrea Rockall, Soumil Vyas, Satya Bhattacharya, Matthew Matson, Daniel Berney, R H Reznek, Ashley B Grossman
Affiliations

Diagnosis and localisation of insulinoma: the value of modern magnetic resonance imaging in conjunction with calcium stimulation catheterisation

Maralyn R Druce et al. Eur J Endocrinol. 2010 May.

Erratum in

  • Eur J Endocrinol. 2010 Jun;162(6):1165. Reznek, R H [added]

Abstract

Context: Preoperative localisation of insulinoma improves cure rate and reduces complications, but may be challenging.

Objective: To review diagnostic features and localisation accuracy for insulinomas.

Design: Cross-sectional, retrospective analysis.

Setting: A single tertiary referral centre.

Patients: Patients with insulinoma in the years 1990-2009, including sporadic tumours and those in patients with multiple endocrine neoplasia syndromes.

Interventions: Patients were identified from a database, and case notes and investigation results were reviewed. Tumour localisation by computed tomography (CT), magnetic resonance imaging (MRI), octreotide scanning, endoscopic ultrasound (EUS) and calcium stimulation was evaluated.

Main outcome measure(s): Insulinoma localisation was compared to histologically confirmed location following surgical excision.

Results: Thirty-seven instances of biochemically and/or histologically proven insulinoma were identified in 36 patients, of which seven were managed medically. Of the 30 treated surgically, 25 had CT (83.3%) and 28 had MRI (90.3%), with successful localisation in 16 (64%) by CT and 21 (75%) by MRI respectively. Considered together, such imaging correctly localised 80% of lesions. Radiolabelled octreotide scanning was positive in 10 out of 20 cases (50%); EUS correctly identified 17 lesions in 26 patients (65.4%). Twenty-seven patients had calcium stimulation testing, of which 6 (22%) did not localise, 17 (63%) were correctly localised, and 4 (15%) gave discordant or confusing results.

Conclusions: Preoperative localisation of insulinomas remains challenging. A pragmatic combination of CT and especially MRI predicts tumour localisation with high accuracy. Radionuclide imaging and EUS were less helpful but may be valuable in selected cases. Calcium stimulation currently remains useful in providing an additional functional perspective.

PubMed Disclaimer