Invasive Diagnostik bei Insulinomen des Pankreas

Abstract

Insulinomas are the most common cause for hypoglycemia with endogenous hyperinsulinism. Insulinomas are the most frequent endocrine tumor of the pancreas and 10% occur as multiple tumors (e.g. multiple endocrine neoplasia type I) or in rare cases as islet cell hyperplasia. A further 10-15% of insulinomas are malignant. Non-invasive imaging modalities, such as computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography (US) and somatoreceptor scintigraphy (SRN) show a lower sensitivity for detection and localization of tumors, because in many cases insulinomas are smaller than 2 cm in size. Invasive pre-operative diagnostic procedures, such as transhepatic peripancreatic venous blood sampling (TPVB) and the intra-arterial calcium stimulation test (ASVS) are much more time-intensive compared to CT, MRI and US with an examination time of 2-3 h but achieve a more exact pre-operative detection and localization with sensitivities mostly greater than 95% and are therefore the diagnostic methods of choice.

Preliminary evaluation of [18F]AlF-NOTA-MAL-Cys39-exendin-4 in insulinoma with PET

“…Conventional imaging technologies such as transabdominal ultrasound, computed tomography and magnetic resonance imaging have limited sensitivity in localizing the lesion successfully due to the small tumor volume [3]. Although angiography and arterial stimulation venous sampling have been shown to improve the sensitivity, these invasive procedures may accompany with a risk of complications [4][5][6]. The difficulty of tumor location hampers surgical operation which is one of the standard treatments for insulinoma.…”

Glucagon-like peptide-1 receptor imaging with [Lys40(Ahx-HYNIC-99mTc/EDDA)NH2]-exendin-4 for the detection of insulinoma

“…However, other authors reported a higher sensitivity and specificity for the localization of intrapancreatic lesions by EUS (93.0 and 95.0 %, respectively) [4]. Techniques such as selective arteriography, transhepatic peripancreatic venous blood sampling (TPVB), intra-arterial calcium stimulation test (ASVS) and intraoperative US revealed better sensitivity (95.0 %), but are much more time-consuming and of course invasive [5]. Nuclear medicine imaging, such as somatostatin receptor scintigraphy (SRS), is positive in about 50.0–60.0 % of benign insulinomas [1, 2].…”