TY - JOUR
T1 - 68Ga-NODAGA-Exendin-4 PET/CT Improves the Detection of Focal Congenital Hyperinsulinism
AU - Boss, Marti
AU - Rottenburger, Christof
AU - Brenner, Winfried
AU - Blankenstein, Oliver
AU - Prasad, Vikas
AU - Prasad, Sonal
AU - de Coppi, Paolo
AU - Kühnen, Peter
AU - Buitinga, Mijke
AU - Nuutila, Pirjo
AU - Otonkoski, Timo
AU - Hussain, Khalid
AU - Brom, Maarten
AU - Eek, Annemarie
AU - Bomanji, Jamshed
AU - Shah, Pratik
AU - Gotthardt, Martin
N1 - Publisher Copyright:
COPYRIGHT © 2022 by the Society of Nuclear Medicine and Molecular Imaging.
PY - 2022/2/1
Y1 - 2022/2/1
N2 - 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.
AB - 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.
KW - F-DOPA PET/CT
KW - Ga-NODAGA-exendin-4 PET/CT
KW - congenital hyperinsulinism
KW - diagnostic imaging
KW - focal CHI
UR - http://www.scopus.com/inward/record.url?scp=85123969972&partnerID=8YFLogxK
U2 - 10.2967/JNUMED.121.262327
DO - 10.2967/JNUMED.121.262327
M3 - Article
C2 - 34215672
AN - SCOPUS:85123969972
SN - 0161-5505
VL - 63
SP - 310
EP - 315
JO - Journal of Nuclear Medicine
JF - Journal of Nuclear Medicine
IS - 2
ER -