PMID- 31298706 OWN - NLM STAT- MEDLINE DCOM- 20200604 LR - 20200604 IS - 1945-7197 (Electronic) IS - 0021-972X (Linking) VI - 104 IP - 12 DP - 2019 Dec 1 TI - 68Ga-Exendin-4 PET/CT Detects Insulinomas in Patients With Endogenous Hyperinsulinemic Hypoglycemia in MEN-1. PG - 5843-5852 LID - 10.1210/jc.2018-02754 [doi] AB - CONTEXT: Surgical intervention is advised in patients with multiple endocrine neoplasia type-1 (MEN-1) and nonfunctioning pancreatic neuroendocrine tumors (PanNETs) with a size >/=20 mm. Functioning PanNETs, such as in patients with endogenous hyperinsulinemic hypoglycemia (EHH) due to (one or multiple) insulinomas, should be treated surgically independent of size. Preoperative localization of insulinomas is critical for surgery. OBJECTIVE: To evaluate the feasibility and sensitivity of 68Ga-DOTA-exendin-4 positron emission tomography (PET)/CT in the detection of clinically relevant lesions in patients with MEN-1 and EHH in combination with MRI. DESIGN: Post hoc subgroup analysis of a larger prospective imaging study with 52 patients with EHH. PATIENTS: Six of 52 consecutive patients with EHH and genetically proven MEN-1 mutation were included. INTERVENTIONS: All patients received one 68Ga-DOTA-exendin-4 PET/CT and one MRI scan within 3 to 4 days. Thereafter, surgery was performed based on all imaging results. MAIN OUTCOME MEASURES: Lesion-based sensitivity of PET/CT and MRI for detection of clinically relevant lesions was calculated. Readers were unaware of other results. The reference standard was surgery with histology and treatment outcome. True positive (i.e., clinically relevant lesions) was defined as PanNETs >/=20 mm or insulinoma. RESULTS: In six patients, 37 PanNETs were confirmed by histopathology. Sensitivity (95% CI) in the detection of clinically relevant lesions for combined PET/CT plus MRI, MRI, and PET/CT was 92.3% (64% to 99.8%), 38.5% (13.9% to 68.4%), and 84.6% (54.6% to 98.1%), respectively (P = 0.014 for the comparison of PET/CT plus MRI vs MRI). Postsurgery, EHH resolved in all patients. CONCLUSION: 68Ga-DOTA-exendin-4 PET/CT is feasible in patients with MEN-1 and EHH. The combination with MRI is superior to MRI alone in the detection of insulinomas and may guide the surgical strategy. CI - Copyright (c) 2019 Endocrine Society. FAU - Antwi, Kwadwo AU - Antwi K AD - Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland. FAU - Nicolas, Guillaume AU - Nicolas G AD - Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland. AD - Center for Neuroendocrine and Endocrine Tumors, University Hospital Basel, Basel, Switzerland. FAU - Fani, Melpomeni AU - Fani M AD - Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland. FAU - Heye, Tobias AU - Heye T AD - Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland. FAU - Pattou, Francois AU - Pattou F AD - Department of General and Endocrine Surgery, Lille University Hospital, Lille France. FAU - Grossman, Ashley AU - Grossman A AD - Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, United Kingdom. AD - Neuroendocrine Unit, Royal Free Hospital, London, United Kingdom. FAU - Chanson, Philippe AU - Chanson P AD - Assistance Publique-Hopitaux de Paris, Service d'Endocrinologie et des Maladies de la Reproduction, Hopital Bicetre, Le Kremlin-Bicetre, France. AD - UMR S-1185, Universite Paris Sud, Universite Paris-Saclay, Le Kremlin-Bicetre, France. FAU - Reubi, Jean Claude AU - Reubi JC AD - Department of Pathology, University of Bern, Bern, Switzerland. FAU - Perren, Aurel AU - Perren A AD - Department of Pathology, University of Bern, Bern, Switzerland. FAU - Gloor, Beat AU - Gloor B AD - Department of Visceral Surgery, University Hospital of Bern, Inselspital, Bern, Switzerland. FAU - Vogt, Deborah R AU - Vogt DR AD - Clinical Trial Unit, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland. FAU - Wild, Damian AU - Wild D AD - Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland. AD - Center for Neuroendocrine and Endocrine Tumors, University Hospital Basel, Basel, Switzerland. FAU - Christ, Emanuel AU - Christ E AD - Center for Neuroendocrine and Endocrine Tumors, University Hospital Basel, Basel, Switzerland. AD - Division of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland. LA - eng SI - ClinicalTrials.gov/NCT02127541 PT - Evaluation Study PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - J Clin Endocrinol Metab JT - The Journal of clinical endocrinology and metabolism JID - 0375362 RN - 0 (68Ga-DOTA-exendin-4) RN - 0 (Organometallic Compounds) RN - 0 (Peptides) SB - IM MH - Adolescent MH - Adult MH - Congenital Hyperinsulinism/*complications/genetics MH - Feasibility Studies MH - Female MH - Humans MH - Insulinoma/*diagnostic imaging/genetics MH - Magnetic Resonance Imaging MH - Male MH - Middle Aged MH - Multiple Endocrine Neoplasia Type 1/*complications/genetics MH - *Organometallic Compounds MH - Pancreatic Neoplasms/*diagnostic imaging/genetics MH - *Peptides MH - *Positron Emission Tomography Computed Tomography MH - Prospective Studies MH - Sensitivity and Specificity MH - Young Adult EDAT- 2019/07/13 06:00 MHDA- 2020/06/05 06:00 CRDT- 2019/07/13 06:00 PHST- 2018/12/20 00:00 [received] PHST- 2019/07/08 00:00 [accepted] PHST- 2019/07/13 06:00 [pubmed] PHST- 2020/06/05 06:00 [medline] PHST- 2019/07/13 06:00 [entrez] AID - 5530989 [pii] AID - 10.1210/jc.2018-02754 [doi] PST - ppublish SO - J Clin Endocrinol Metab. 2019 Dec 1;104(12):5843-5852. doi: 10.1210/jc.2018-02754.