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. 2017 Jan 1;102(1):195-199.
doi: 10.1210/jc.2016-3445.

Localization of Insulinoma Using 68Ga-DOTATATE PET/CT Scan

Pavel Nockel  1 , Bruna Babic  1 , Corina Millo  2 , Peter Herscovitch  2 , Dhaval Patel  1 , Naris Nilubol  1 , Samira M Sadowski  3 , Craig Cochran  4 , Phillip Gorden  4 , Electron Kebebew  1
Affiliations

Localization of Insulinoma Using 68Ga-DOTATATE PET/CT Scan

Pavel Nockel et al. J Clin Endocrinol Metab. .

Abstract

Context: Reliable localization of insulinoma is critical for successful treatment.

Objective: This study compared the accuracy of 68Gallium DOTA-(Tyr3)-octreotate (Ga-DOTATATE) positron emission tomography (PET)/computed tomography (CT) to anatomic imaging modalities, selective arterial secretagogue injection (SASI), and intraoperative ultrasound (IO ultrasound) and palpation for localizing insulinoma in patients who were biochemically cured.

Design, setting, and patients: We conducted a retrospective analysis of 31 patients who had an insulinoma. The results of CT, magnetic resonance imaging (MRI), ultrasound, IO ultrasound, 68Ga-DOTATATE PET/CT, SASI, and operative findings were analyzed.

Intervention, main outcome measures, and results: The insulinomas were correctly localized in 17 out of 31 (55%) patients by CT, in 17 out of 28 (61%) by MRI, in 6 out of 28 (21%) by ultrasound, and in 9 out of 10 (90%) by 68Ga-DOTATATE. In 29 of 31 patients (93.5%) who had IO ultrasound, an insulinoma was successfully localized. Thirty patients underwent SASI, and the insulinoma was regionalized in 28 out of 30 patients (93%). In 19 out of 23 patients (83%), manual palpation identified insulinoma. In patients who had all 4 noninvasive imaging studies, CT was concordant with 68Ga-DOTATATE in 6 out of 9 patients (67%), MRI in 8 out of 9 (78%), ultrasound in 0 out of 9; the lesion was only seen by 68Ga-DOTATATE in 1 out of 9 (11%).

Conclusions: 68Ga-DOTATATE PET/CT identifies most insulinomas and may be considered as an adjunct imaging study when all imaging studies are negative and when a minimally invasive surgical approach is planned.

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Figures

Figure 1.
Figure 1.
Representative images of an insulinoma. (A) Axial 68Ga-DOTATATE fused PET/CT arrow pointing to the uptake in the pancreas. (B) 68Ga-DOTATATE anterior 3-dimensional maximum intensity projection; arrow pointing to the uptake in the pancreas. (C) Axial arterial phase CT; arrow pointing to the arterially enhancing lesion in the tail of the pancreas. (D) MRI axial 3-dimensional with arterial contrast imaging; arrow localizing an arterially enhancing lesion in the tail of the pancreas.
See this image and copyright information in PMC

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