The Value of Radiologic Interventions and 18F-DOPA PET in Diagnosing and Localizing Focal Congenital Hyperinsulinism: Systematic Review and Meta-Analysis

Abstract

PurposeThis systematic review and meta-analysis aimed to quantify the diagnostic performance of pancreatic venous sampling (PVS), selective pancreatic arterial calcium stimulation with hepatic venous sampling (ASVS), and 18F-DOPA positron emission tomography (PET) in diagnosing and localizing focal congenital hyperinsulinism (CHI).ProceduresThis systematic review and meta-analysis was conducted according to the PRISMA statement. PubMed, EMBASE, SCOPUS and Web of Science electronic databases were systematically searched from their inception to November 1, 2011. Using predefined inclusion and exclusion criteria, two blinded reviewers selected articles. Critical appraisal ranked the retrieved articles according to relevance and validity by means of the QUADAS-2 criteria. Pooled data of homogeneous study results estimated the sensitivity, specificity, likelihood ratios and diagnostic odds ratio (DOR).Results18F-DOPA PET was superior in distinguishing focal from diffuse CHI (summary DOR, 73.2) compared to PVS (summary DOR, 23.5) and ASVS (summary DOR, 4.3). Furthermore, it localized focal CHI in the pancreas more accurately than PVS and ASVS (pooled accuracy, 0.82 vs. 0.76, and 0.64, respectively). Important limitations comprised the inclusion of studies with small sample sizes, high probability of bias and heterogeneity among their results. Studies with small sample sizes and high probability of bias tended to overestimate the diagnostic accuracy.ConclusionsThis systematic review and meta-analysis found evidence for the superiority of 18F-DOPA PET in diagnosing and localizing focal CHI in patients requiring surgery for this disease.

Clinical and histological heterogeneity of congenital hyperinsulinism due to paternally inherited heterozygous ABCC8/KCNJ11 mutations

“…Fernandez-Marmiesse et al (10) reported five patients with paternally inherited K ATP mutations and whose post pancreatectomy pathology result was not consistent with that of focal lesion. Similar findings have been reported by other studies (1,21,27,30). There are a number of possible mechanisms as to how a heterozygous ABCC8/KCNJ11 mutation can lead to diffuse disease.…”

“…Before the advent of 18 F DOPA-PET CT, pancreatic venous sampling (PVS) and selective pancreatic arterial calcium stimulation with hepatic venous sampling (ASVS) were used to differentiate between the two subtypes (25,26). A recent systematic review and meta-analysis has found 18 F DOPA-PET CT to be far superior to PVS and ASVS in diagnosing and localising focal CHI (27).…”

The Use of 18f-Dopa Pet/Ct Imaging in Congenital Hyperinsulinism

“…До недавнего времени в клинической практике для дифференциальной диагностики диффузной и фокальной форм ВГИ использова-лись методики, основанные на определении уровня инсулина в пробах крови, оттекающей от поджелудочной железы: чрескожно-чреспеченочный забор крови из ветвей ворот-ной вены (ЧЧЗКВ) и забор крови из правой пе-ченочной вены после внутриартериальной сти-муляции (АСЗК) кальцием различных отделов поджелудочной железы [16,17,18]. Чувстви-тельность ЧЧЗКВ и АСЗК составляет 87 и 71%, соответственно [16].…”

“…Чувстви-тельность ЧЧЗКВ и АСЗК составляет 87 и 71%, соответственно [16]. Специфичность данных методов варьирует в различных литературных источниках.…”

“…Специфичность данных методов варьирует в различных литературных источниках. Точность локализации фокуса ги-перинсулинемии при АСЗК (82% (95% ДИ: 72-90%)) несколько выше, чем при проведении ЧЧЗКВ (76% (95% ДИ: 65-85%)) у пациентов с фокальной формой ВГИ [16]. Однако ввиду ин-вазивности и недостаточной точности этих ис-следований [16] для решения данной задачи [20].…”