目的:这项回顾性研究评估了68Ga-DOTATATEPET/CT在胰岛素瘤诊断和定位中的价值,无论是零星的,恶性或MEN-1相关胰岛素瘤。
方法:该研究包括43例患者,具有临床(症状性低血糖)和/或实验室怀疑患有胰岛素瘤(72小时空腹试验,血清胰岛素≥18pmol/L),与可用的术前68Ga-DOTATATEPET/CT和CE-CT,并经术后组织病理学证实诊断为胰岛素瘤。术前影像学由两名放射科医师进行回顾性分析,他们对最终诊断和其他影像学检查的结果一无所知。标本的组织病理学被认为是参考标准,术前CE-CT和PET影像学检查结果的头对头比较。结果被归类为真阳性(TP),正负(TN),假阳性(FP),和每个模态的假阴性(FN)。基于这些结果,灵敏度,特异性,CE-CT的阳性预测值(PPV)和阴性预测值(NPV),计算了68Ga-DOTATATEPET/CT用于检测胰岛素瘤。
结果:43名患者(N=43名患者,L=56个病灶),从这些中,良性散发性胰岛素瘤37例(N=37,L=42),只有3例患者患有恶性散发性胰岛素瘤(N=2,L=9),3例患者患有MEN-1综合征相关胰岛素瘤(N=3,L=5)。在使用68Ga-DOTATATEPET/CT的整个队列中,胰岛素瘤定位的敏感性(P=0.3058)和PPV(P=0.5533)没有显着统计学差异(87.5%,90.74%)与CE-CT(80.36%,93.75%)。
结论:68Ga-DOTATATEPET/CT是一种非侵入性成像模式,可以识别大多数胰岛素瘤。尽管如此,当肿瘤被其他解剖成像研究定位时,它提供了有限的额外信息,因此,当影像学研究无法定位胰岛素瘤患者的肿瘤时,应用作辅助手段,特别是当微创手术的目的。
OBJECTIVE: This retrospective study evaluates the value of 68Ga-DOTATATE PET/CT in the diagnosis and localization of insulinomas, whether sporadic, malignant or MEN-1 associated insulinoma.
METHODS: The study included 43 patients, having clinical (symptomatic hypoglycemia) and/or laboratory suspicion of having insulinoma (72 h fasting test with serum insulin ≥18 pmol/L), with available pre-operative 68Ga-DOTATATE PET/CT and CE-CT, and diagnosed with insulinoma confirmed by post-operative histopathology. Preoperative imaging was retrospectively analyzed by two radiologists who were blinded to the final diagnosis and to the results of other imaging modalities. Histopathology of specimen was considered the reference standard, and head-to-head comparison of preoperative CE-CT and PET imaging findings. Findings were classified as true positive (TP), true negative (TN), false positive (FP), and false negative (FN) for each modality. Based on these results, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of CE-CT, and 68Ga-DOTATATE PET/CT for the detection of insulinoma were calculated.
RESULTS: 43 patients (N = 43 patients, L = 56 lesions), out of these, 37 patients had benign sporadic insulinoma (N = 37, L = 42), only 3 patients had malignant sporadic insulinoma (N = 2, L = 9), and 3 patients had MEN-1 syndrome associated insulinoma (N = 3, L = 5). There was no significant statistical difference in sensitivity (P = 0.3058) and PPV (P = 0.5533) for insulinoma localization in the overall cohort with 68Ga-DOTATATE PET/CT (87.5 %, 90.74 %) compared to CE-CT (80.36 %, 93.75 %).
CONCLUSIONS: 68Ga-DOTATATE PET/CT is a non-invasive imaging modality that can identify most insulinomas. Still, it offers limited additional information when the tumor is localized by other anatomic imaging studies, so should be used as an adjunct when imaging studies fail to localize the tumor in insulinoma patients, especially when minimally invasive surgical is intended.