68Ga-NODAGA-Exendin-4 PET/CT Improves the Detection of Focal Congenital Hyperinsulinism

Marti Boss, Christof Rottenburger, Winfried Brenner, Oliver Blankenstein, Vikas Prasad, Sonal Prasad, Paolo de Coppi, Peter Kühnen, Mijke Buitinga, Pirjo Nuutila, Timo Otonkoski, Khalid Hussain, Maarten Brom, Annemarie Eek, Jamshed Bomanji, Pratik Shah, Martin Gotthardt

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Surgery with curative intent can be offered to congenital hyperinsulinism (CHI) patients, provided that the lesion is focal. Radiolabeled exendin-4 specifically binds the glucagonlike peptide 1 receptor on pancreatic b-cells. In this study, we compared the performance of 18F-DOPA PET/CT, the current standard imaging method for CHI, and PET/CT with the new tracer 68Ga-NODAGA-exendin-4 in the preoperative detection of focal CHI. Methods: Nineteen CHI patients underwent both 18F-DOPA PET/CT and 68Ga-NODAGA-exendin-4 PET/CT before surgery. The images were evaluated in 3 settings: a standard clinical reading, a masked expert reading, and a joint reading. The target (lesion)-to-nontarget (normal pancreas) ratio was determined using SUVmax. Image quality was rated by pediatric surgeons in a questionnaire. Results: Fourteen of 19 patients having focal lesions underwent surgery. On the basis of clinical readings, the sensitivity of 68Ga-NODAGA-exendin-4 PET/CT (100%; 95% CI, 77%-100%) was higher than that of 18F-DOPA PET/CT (71%; 95% CI, 42%-92%). Interobserver agreement between readings was higher for 68Ga-NODAGA-exendin-4 than for 18F-DOPA PET/CT (Fleiss k 5 0.91 vs. 0.56). 68Ga-NODAGA-exendin-4 PET/CT provided significantly (P 5 0.021) higher target-to-nontarget ratios (2.02 6 0.65) than did 18F-DOPA PET/CT (1.40 6 0.40). On a 5-point scale, pediatric surgeons rated 68Ga-NODAGA-exendin-4 PET/CT as superior to 18F-DOPA PET/CT. Conclusion: For the detection of focal CHI, 68Ga-NODAGA-exendin-4 PET/CT has higher clinical sensitivity and better interobserver correlation than 18F-DOPA PET/CT. Better contrast and image quality make 68Ga-NODAGA-exendin-4 PET/CT superior to 18F-DOPA PET/CT in surgeons' intraoperative quest for lesion localization.

Original languageEnglish
Pages (from-to)310-315
Number of pages6
JournalJournal of Nuclear Medicine
Issue number2
StatePublished - Feb 1 2022


  • Ga-NODAGA-exendin-4 PET/CT
  • congenital hyperinsulinism
  • diagnostic imaging
  • focal CHI


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