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 - Funding Information:
This work was supported by BetaCure (FP7/2014-2018, grant 602812). PET/MRI use at CharitéUniversity Hospital was supported by Deutsche Forschungsgemeinschaft (INST 335/543-1 FUGG). Martin Gotthardt is an inventor on, and holder of, the patent “Invention Affecting GLP-1 and Exendin” (Philipps-Uni-versit€at Marburg, June 17, 2009). Paolo De Coppi is supported by NIHR BRC Great Ormond Street Hospital. No other potential conflict of interest relevant to this article was reported.
Funding Information:
We thank all patients and their parents or caretakers for participating in the study. We also thank the technical staff at the Radboud University Medical Centre, Charit? University Hospital, and University College London for their support with radiochemical preparations and PET investigations.
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 -