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Purpose <p>Accurate preoperative localization is particularly important for surgical treatment of insulinomas. Current imaging methods, including <sup>18</sup>F-FDG (FDG) PET/CT, <sup>68</sup>Ga-DOTATATE (TATE) PET/CT, CE-CT, and CE-MRI, have limitations. This prospective study provides a direct comparison of <sup>68</sup>Ga-NOTA-Exendin-4 (Ex4) PET/CT with other imaging techniques.</p> Method <p>47 patients with biochemically proven endogenous hyperinsulinemic hypoglycemia underwent Ex4 PET/CT and other imaging methods. Sensitivity and accuracy of all imaging procedures for localizing insulinoma were calculated at the patient level and lesion level. Both clinical (&gt;10 years experience) and junior (&lt; 2 years experience) nuclear medicine physician readings were used to assess the diagnostic efficacy. We compared the SUV<sub>max</sub> and tumor-to-background ratio (TBR) of three tracers and analyzed the values with Ki-67, maximum tumor diameter, and glucose metabolism indicators.</p> Results <p>In patient level, the sensitivity and accuracy of Ex4 PET/CT (94.11% and 95.74%) were higher than TATE PET/CT (70.59%, <i>p</i> = 0.026; 78.72%, <i>p</i> = 0.030), FDG PET/CT (50.00%, <i>p</i> &lt; 0.001; 63.83%, <i>p</i> &lt; 0.001), CE-CT (77.77%, <i>p</i> = 0.135; 72.22%, <i>p</i> = 0.007), and CE-MRI (63.64%, <i>p</i> = 0.135; 43.75%, <i>p</i> &lt; 0.001), respectively. Interobserver agreement was higher for Ex4 PET/CT than TATE PET/CT and FDG PET/CT (Cohen κ, 0.839 vs. 0.707 and 0.784, respectively). SUV<sub>max</sub> and TBR of Ex4 and TATE PET/CT were significantly higher than FDG PET/CT (<i>p</i> &lt; 0.01). Negative correlations of tumor Ki-67 with TATE PET/CT were observed with SUV<sub>max</sub> (<i>r</i> = -0.637, <i>p</i> &lt; 0.001). SUV<sub>max</sub> and TBR of three molecular imaging methods had positive correlations with the maximum tumor diameter (<i>p</i> &lt; 0.05), except TBR of FDG PET/CT. Semi-quantitative values of the three tracers showed no correlation with the lowest blood glucose level, corresponding insulin, and C-peptide level. TBR of TATE PET/CT showed a positive correlation with C-peptide (<i>r</i> = 0.393, <i>p</i> = 0.043).</p> Conclusion <p>Ex4 PET/CT showed superior characteristics in localization compared to routine imaging modalities in benign insulinomas. Ex4 PET/CT demonstrates better imaging quality and interpretability than FDG PET/CT and TATE PET/CT. Combined Ex4 and TATE PET/CT could provide a comprehensive evaluation/localization of insulinoma.</p> Trial registration <p>The trial was retrospectively registered at ClinitalTrial.gov (NCT06690957 and NCT06725693) on November 14, 2024 and December 5, 2024.</p>

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Comparison of PET/CT using 68Ga-NOTA-Exendin-4 with 68Ga-DOTATATE, 18F-FDG, and conventional imaging in the localization of insulinomas

  • 期刊论文

  • 发表日期：

    2025年4月22日

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  • Haonan Yu,
  • Xiangyuan Bao,
  • Yian Gu,
  • Meijie Pan,
  • Qing He,
  • Dong Li,
  • Qiusong Chen,
  • Shaobo Yao

摘要

Purpose

Accurate preoperative localization is particularly important for surgical treatment of insulinomas. Current imaging methods, including 18F-FDG (FDG) PET/CT, 68Ga-DOTATATE (TATE) PET/CT, CE-CT, and CE-MRI, have limitations. This prospective study provides a direct comparison of 68Ga-NOTA-Exendin-4 (Ex4) PET/CT with other imaging techniques.

Method

47 patients with biochemically proven endogenous hyperinsulinemic hypoglycemia underwent Ex4 PET/CT and other imaging methods. Sensitivity and accuracy of all imaging procedures for localizing insulinoma were calculated at the patient level and lesion level. Both clinical (>10 years experience) and junior (< 2 years experience) nuclear medicine physician readings were used to assess the diagnostic efficacy. We compared the SUVmax and tumor-to-background ratio (TBR) of three tracers and analyzed the values with Ki-67, maximum tumor diameter, and glucose metabolism indicators.

Results

In patient level, the sensitivity and accuracy of Ex4 PET/CT (94.11% and 95.74%) were higher than TATE PET/CT (70.59%, p = 0.026; 78.72%, p = 0.030), FDG PET/CT (50.00%, p < 0.001; 63.83%, p < 0.001), CE-CT (77.77%, p = 0.135; 72.22%, p = 0.007), and CE-MRI (63.64%, p = 0.135; 43.75%, p < 0.001), respectively. Interobserver agreement was higher for Ex4 PET/CT than TATE PET/CT and FDG PET/CT (Cohen κ, 0.839 vs. 0.707 and 0.784, respectively). SUVmax and TBR of Ex4 and TATE PET/CT were significantly higher than FDG PET/CT (p < 0.01). Negative correlations of tumor Ki-67 with TATE PET/CT were observed with SUVmax (r = -0.637, p < 0.001). SUVmax and TBR of three molecular imaging methods had positive correlations with the maximum tumor diameter (p < 0.05), except TBR of FDG PET/CT. Semi-quantitative values of the three tracers showed no correlation with the lowest blood glucose level, corresponding insulin, and C-peptide level. TBR of TATE PET/CT showed a positive correlation with C-peptide (r = 0.393, p = 0.043).

Conclusion

Ex4 PET/CT showed superior characteristics in localization compared to routine imaging modalities in benign insulinomas. Ex4 PET/CT demonstrates better imaging quality and interpretability than FDG PET/CT and TATE PET/CT. Combined Ex4 and TATE PET/CT could provide a comprehensive evaluation/localization of insulinoma.

Trial registration

The trial was retrospectively registered at ClinitalTrial.gov (NCT06690957 and NCT06725693) on November 14, 2024 and December 5, 2024.