Visual interpretation, not SUV ratios, is the ideal method to interpret 18F-DOPA PET scans to aid in the cure of patients with focal congenital hyperinsulinism

Autor: Irene Sanchez, John K Uffman, Jonathan Nedrelow, Rachid Nazih, Courtney Reynolds, Stephen J. Lokitz, Pradeep K. Garg, Paul S. Thornton, Lisa Truong, Sudha Garg, Burton Putegnat
Rok vydání: 2020
Předmět:
Male
Biopsy
Health Care Providers
Diagnostic Radiology
030218 nuclear medicine & medical imaging
Medical Conditions
0302 clinical medicine
Medicine and Health Sciences
Medical Personnel
Child
Tomography
Multidisciplinary
medicine.diagnostic_test
Radiology and Imaging
Dihydroxyphenylalanine
Professions
medicine.anatomical_structure
Positron emission tomography
Child
Preschool
Medicine
Female
Radiology
Anatomy
Pancreas
Research Article
medicine.medical_specialty
Imaging Techniques
Science
Neuroimaging
Endocrine System
Surgical and Invasive Medical Procedures
030209 endocrinology & metabolism
Standardized uptake value
Hypoglycemia
Research and Analysis Methods
03 medical and health sciences
Signs and Symptoms
Exocrine Glands
Diagnostic Medicine
Physicians
Genetics
medicine
Humans
Surgeons
business.industry
Hypoketotic hypoglycemia
Infant
Newborn
Biology and Life Sciences
Infant
Human Genetics
medicine.disease
Health Care
Metabolic Disorders
Positron-Emission Tomography
People and Places
Lesions
Congenital hyperinsulinism
Population Groupings
Congenital Hyperinsulinism
Clinical Medicine
business
Hyperinsulinism
Positron Emission Tomography
Neuroscience
Zdroj: PLoS ONE
PLoS ONE, Vol 15, Iss 10, p e0241243 (2020)
ISSN: 1932-6203
DOI: 10.1371/journal.pone.0241243
Popis: IntroductionCongenital hyperinsulinism is characterized by abnormal regulation of insulin secretion from the pancreas causing profound hypoketotic hypoglycemia and is the leading cause of persistent hypoglycemia in infants and children. The main objective of this study is to highlight the different mechanisms to interpret the 18F-DOPA PET scans and how this can influence outcomes.Materials and methodsAfter 18F-Fluoro-L-DOPA was injected intravenously into 50 subjects' arm at a dose of 2.96-5.92 MBq/kg, three to four single-bed position PET scans were acquired at 20, 30, 40 and 50-minute post injection. The radiologist interpreted the scans for focal and diffuse hyperinsulinism using a visual interpretation method, as well as determining the Standard Uptake Value ratios with varying cut-offs.ResultsVisual interpretation had the combination of the best sensitivity and positive prediction values.ConclusionsIn patients with focal disease, SUV ratios are not as accurate in identifying the focal lesion as visual inspection, and cases of focal disease may be missed by those relying on SUV ratios, thereby denying the patients a chance of cure. We recommend treating patients with diazoxide-resistant hyperinsulinism in centers with dedicated multidisciplinary team comprising of at least a pediatric endocrinologist with a special interest in hyperinsulinism, a radiologist experienced in interpretation of 18F-Fluoro-L-DOPA PET/CT scans, a histopathologist with experience in frozen section analysis of the pancreas and a pancreatic surgeon experienced in partial pancreatectomies in patients with hyperinsulinism.
Databáze: OpenAIRE
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