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. 2013 Feb;48(2):388-93.
doi: 10.1016/j.jpedsurg.2012.11.025.

Accuracy of PET/CT Scan in the diagnosis of the focal form of congenital hyperinsulinism

Pablo Laje  1 , Lisa J States, Hongming Zhuang, Susan A Becker, Andrew A Palladino, Charles A Stanley, N Scott Adzick
Affiliations

Accuracy of PET/CT Scan in the diagnosis of the focal form of congenital hyperinsulinism

Pablo Laje et al. J Pediatr Surg. 2013 Feb.

Abstract

Purpose: The purpose of the study was to determine the sensitivity of the (18)fluoro-dihydroxyphenylalanine positron emission tomography/computed tomography scan (18F-PET/CT) in the diagnosis of focal congenital hyperinsulinism (HI).

Methods: A retrospective review of children with HI who underwent a preoperative 18F-PET/CT scan was performed.

Results: Between 1/2008 and 2/2012 we performed 105 consecutive 18F-PET/CT scans on infants with HI. Fifty-three patients had focal HI. Of those fifty-three patients, eight had a preoperative 18F-PET/CT scan read as "diffuse disease". The sensitivity of the study in the diagnosis of focal HI was 85%. The location of the eight missed focal lesions was: head (3), body (2), and tail (3). The 18F-PET/CT of the missed head lesions showed homogeneous tracer uptake (n =2) or heterogeneous uptake throughout the pancreas (n=1). The 18F-PET/CT of the 2 missed body lesions and 1 missed tail lesion showed heterogeneous uptake throughout the pancreas. The 18F-PET/CT of the other 2 missed tail lesions showed lesions adjacent to and obscured by the signal of the upper renal pole, identified retrospectively by closer observation. Fifty-two of the 105 patients had diffuse HI. Two of them had 18F-PET/CT studies read as "focal disease". Therefore, the specificity of the study was 96%. Of the forty-seven 18F-PET/CT studies read as "focal disease", forty-five had true focal HI. Therefore, the positive predictive value of the study in the diagnosis of focal HI was 96%.

Conclusion: The sensitivity and specificity of 18 F-PET/CT can be affected by certain anatomic features of the pancreas, by the location of the lesion, and by the reader's experience.

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Figures

Fig. 1
Fig. 1
Focal lesion at the tail of the pancreas abutting the contour of the left kidney. It was not recognized as a discrete area of tracer uptake and the study was interpreted as diffuse HI.
Fig. 2
Fig. 2
Diffuse homogeneous radiotracer distribution without evidence of a focal lesion. The uncinate process appears on the images with the same intensity as the rest of the pancreas. Patient had a focal lesion in the uncinate process (arrow) by pathology. Arrowheads: kidneys. Star: bladder.
Fig. 3
Fig. 3
18 F-PET/CT scan of focal (A) and diffuse (B) HI.
Fig. 4
Fig. 4
Heterogeneous radiotracer activity throughout the pancreas. (A) The head, body and tail showed increased patchy activity, without any area being particularly more intense than the remainder of the pancreas (black arrows). The patient had a focal lesion (by pathology) in the pancreatic body. (B) Similar heterogeneous pattern in a case of diffuse HI (black arrow). RK: right kidney. LK: left kidney. Star: bladder.
See this image and copyright information in PMC

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