+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Glucagon-like peptide-1 receptor imaging for the localisation of insulinomas: a prospective multicentre imaging study



Glucagon-like peptide-1 receptor imaging for the localisation of insulinomas: a prospective multicentre imaging study



Lancet. Diabetes and Endocrinology 1(2): 115-122



Small benign insulinomas are hard to localise, leading to difficulties in planning of surgical interventions. We aimed to prospectively assess the insulinoma detection rate of single-photon emission CT in combination with CT (SPECT/CT) with a glucagon-like peptide-1 receptor avid radiotracer, and compare detection rates with conventional CT/MRI techniques. In our prospective imaging study, we enrolled adults aged 25-81 years at centres in Germany, Switzerland, and the UK. Eligible patients had proven clinical and biochemical endogenous hyperinsulinaemic hypoglycaemia and no evidence for metastatic disease on conventional imaging. CT/MRI imaging was done at referring centres according to standard protocols. At three tertiary nuclear medicine centres, we used whole body planar images and SPECT/CT of the abdomen up to 168 h after injection of (111)In-[Lys40(Ahx-DTPA-(111)In)NH2]-exendin-4 ((111)In-DTPA-exendin-4) to identify insulinomas. Consenting patients underwent surgery and imaging findings were confirmed histologically. Between Oct 1, 2008, and Dec 31, 2011, we recruited 30 patients. All patients underwent (111)In-DTPA-exendin-4 imaging, 25 patients underwent surgery (with histological analysis), and 27 patients were assessed with CT/MRI. (111)In-DTPA-exendin-4 SPECT/CT correctly detected 19 insulinomas and four additional positive lesions (two islet-cell hyperplasia and two uncharacterised lesions) resulting in a positive predictive value of 83% (95% CI 62-94). One true negative (islet-cell hyperplasia) and one false negative (malignant insulinoma) result was identified in separate patients by (111)In-DTPA-exendin-4 SPECT/CT. Seven patients (23%) were referred to surgery on the basis of (111)In-DTPA-exendin-4 imaging alone. For 23 assessable patients, (111)In-DTPA-exendin-4 SPECT/CT had a higher sensitivity (95% [95% CI 74-100]) than did CT/MRI (47% [27-68]; p=0.011). (111)In-DTPA-exendin-4 SPECT/CT could provide a good second-line imaging strategy for patients with negative results on initial imaging with CT/MRI. Oncosuisse, the Swiss National Science Foundation, and UK Department of Health.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 053423090

Download citation: RISBibTeXText

PMID: 24622317

DOI: 10.1016/s2213-8587(13)70049-4


Related references

Comparison of glucagon-like peptide-1 receptor (GLP-1R) PET/CT, SPECT/CT and 3T MRI for the localisation of occult insulinomas: evaluation of diagnostic accuracy in a prospective crossover imaging study. European Journal of Nuclear Medicine and Molecular Imaging 45(13): 2318-2327, 2018

Glucagon-like peptide-1 receptor imaging for localization of insulinomas. Journal of Clinical Endocrinology and Metabolism 94(11): 4398-4405, 2009

Localisation of occult extra-pancreatic insulinoma using glucagon-like peptide-1 receptor molecular imaging. Internal Medicine Journal 48(1): 97-98, 2018

Glucagon-like peptide-1 receptor expression after myocardial infarction: Imaging study using 68 Ga-NODAGA-exendin-4 positron emission tomography. Journal of Nuclear Cardiology 2018:, 2018

Glucagon-like peptide 1-receptor scans to localize occult insulinomas. New England Journal of Medicine 359(7): 766-768, 2008

Agonist-induced internalization and recycling of the glucagon-like peptide-1 receptor in transfected fibroblasts and in insulinomas. Biochemical Journal 310: 203-214, 1995

Comparison of several glucagon-like peptide -1 receptor agonists for the scintigraphic detection of insulinomas and other neuroendocrine tumors. Journal of Nuclear Medicine 42(5 Suppl.): 274P, 2001

Glucagon-like peptide-1 versus somatostatin receptor targeting reveals 2 distinct forms of malignant insulinomas. Journal of Nuclear Medicine 52(7): 1073-1078, 2011

Endoscopic ultrasonography in the localization of insulinomas Results of a multicentre prospective study. Gastroenterology 104(4 Suppl. ): A332, 1993

Non-invasive glucagon-like peptide-1 receptor imaging in pancreas with (18)F-Al labeled Cys(39)-exendin-4. Biochemical and Biophysical Research Communications 471(1): 47-51, 2016

(64)Cu labeled sarcophagine exendin-4 for microPET imaging of glucagon like peptide-1 receptor expression. Theranostics 4(8): 770-777, 2014

Insulinoma imaging with glucagon-like peptide-1 receptor targeting probe (18)F-FBEM-Cys (39)-exendin-4. Journal of Cancer Research and Clinical Oncology 140(9): 1479-1488, 2014

Evaluation of Cu-64 and Ga-68 Radiolabeled Glucagon-Like Peptide-1 Receptor Agonists as PET Tracers for Pancreatic β cell Imaging. Molecular Imaging and Biology 18(1): 90-98, 2016

Evaluation of 18 F-labeled exendin(9-39) derivatives targeting glucagon-like peptide-1 receptor for pancreatic β-cell imaging. Bioorganic and Medicinal Chemistry 26(2): 463-469, 2018

Glucagon-like peptide-1 receptor imaging with Lys40Ahx-HYNIC-99mTc/EDDANH2-exendin-4 for the detection of insulinoma. 2013