Accuracy of [18F]fluorodopa positron emission tomography for diagnosing and localizing focal congenital hyperinsulinism
Department of Pediatrics
Medical Subject Headings
Biopsy; Dihydroxyphenylalanine; Humans; Hyperinsulinism; Image Interpretation, Computer-Assisted; Infant; Infant, Newborn; Islets of Langerhans; Kidney; Multiple Endocrine Neoplasia; Pancreatectomy; Pancreatic Neoplasms; Positron-Emission Tomography; Radiopharmaceuticals; Sample Size
Endocrinology, Diabetes, and Metabolism | Pediatrics
OBJECTIVES: Focal lesions in infants with congenital hyperinsulinism (HI) represent areas of adenomatosis that express a paternally derived ATP-sensitive potassium channel mutation due to embryonic loss of heterozygosity for the maternal 11p region. This study evaluated the accuracy of 18F-fluoro-l-dihydroxyphenylalanine ([18F]DOPA) positron emission tomography (PET) scans in diagnosing focal vs. diffuse disease and identifying the location of focal lesions.
DESIGN: A total of 50 infants with HI unresponsive to medical therapy were studied. Patients were injected iv with [18F]DOPA, and PET scans were obtained for 50-60 min. Images were coregistered with abdominal computed tomography scans. PET scan interpretations were compared with histological diagnoses.
RESULTS: The diagnosis of focal or diffuse HI was correct in 44 of the 50 cases (88%). [18F]DOPA PET identified focal areas of high uptake of radiopharmaceutical in 18 of 24 patients with focal disease. The locations of these lesions matched the areas of increased [18F]DOPA uptake on the PET scans in all of the cases. PET scan correctly located five lesions that could not be visualized at surgery. The positive predictive value of [18F]DOPA in diagnosing focal adenomatosis was 100%, and the negative predictive value was 81%.
CONCLUSIONS: [18F]DOPA PET scans correctly diagnosed 75% of focal cases and were 100% accurate in identifying the location of the lesion. These results suggest that [18F]DOPA PET imaging provides a useful guide to surgical resection of focal adenomatosis and should be considered as a guide to surgery in all infants with congenital HI who have medically uncontrollable disease.
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Citation: J Clin Endocrinol Metab. 2007 Dec;92(12):4706-11. Epub 2007 Sep 25. Link to article on publisher's site
Hardy, Olga T.; Hernandez-Pampaloni, Miguel; Saffer, Janet R.; Scheuermann, Joshua S.; Ernst, Linda M.; Freifelder, Richard; Zhuang, Hongming; MacMullen, Courtney; Becker, Susan; Adzick, N. Scott; Divgi, Chaitanya; Alavi, Abass; and Stanley, Charles A., "Accuracy of [18F]fluorodopa positron emission tomography for diagnosing and localizing focal congenital hyperinsulinism" (2007). Endocrinology/Diabetes. 10.