Glucagon-like peptide-1 receptor imaging for localization of insulinomas.
- Christ E Division of Endocrinology, Inselspital, University Hospital of Bern, CH-3010 Bern, Switzerland.
- Wild D
- Forrer F
- Brändle M
- Sahli R
- Clerici T
- Gloor B
- Martius F
- Maecke H
- Reubi JC
- 2009-10-13
Published in:
- The Journal of clinical endocrinology and metabolism. - 2009
Adult
Aged
Female
Glucagon-Like Peptide-1 Receptor
Humans
Indium Radioisotopes
Insulinoma
Isotope Labeling
Male
Middle Aged
Pancreatic Neoplasms
Radionuclide Imaging
Receptors, Glucagon
Sensitivity and Specificity
English
CONTEXT
The surgical removal of insulinomas is hampered by difficulties to localize it using conventional radiological procedures. Recently these tumors were shown to exhibit a very high density of glucagon-like peptide-1 receptors (GLP-1R) in vitro that may be used as specific targets for in vivo receptor radiolabeling.
OBJECTIVE
The objective of the study was to test the 111In-labeled GLP-1R agonist 111In-DOTA-exendin-4 in localizing insulinomas using single photon emission computed tomography in combination with computed tomography images.
DESIGN
This was a prospective open-label investigation.
SETTING
The study was conducted at three tertiary referral centers in Switzerland.
PATIENTS
Patients included six consecutive patients with proven clinical and biochemical endogenous hyperinsulinemic hypoglycemia.
INTERVENTION
(111)In-DOTA-exendin-4 was administered iv at a dose of about 90 MBq (30 microg peptide) over 5 min. Whole-body planar images of the abdomen were performed at 20 min, 4 h, 23 h, 96 h, and up to 168 h after injection. After surgical removal of the insulinomas, GLP-1R expression was assessed in the tumor tissue in vitro by GLP-1R autoradiography.
MAIN OUTCOME MEASURE
The detection rate of insulinomas was measured.
RESULTS
In all six cases, the GLP-1R scans successfully detected the insulinomas identified using conventional methods in four cases. By using a gamma-probe intraoperatively, GLP-1R detection permitted a successful surgical removal of the tumors in all patients, diagnosed histopathologically as five pancreatic and one extrapancreatic insulinomas. In vitro GLP-1R autoradiography showed a high density of GLP-1R in all tested insulinomas.
CONCLUSION
In vivo GLP-1R imaging is an innovative, noninvasive diagnostic approach that successfully localizes small insulinomas pre- and intraoperatively and that may in the future affect the strategy of insulinoma localization.
The surgical removal of insulinomas is hampered by difficulties to localize it using conventional radiological procedures. Recently these tumors were shown to exhibit a very high density of glucagon-like peptide-1 receptors (GLP-1R) in vitro that may be used as specific targets for in vivo receptor radiolabeling.
OBJECTIVE
The objective of the study was to test the 111In-labeled GLP-1R agonist 111In-DOTA-exendin-4 in localizing insulinomas using single photon emission computed tomography in combination with computed tomography images.
DESIGN
This was a prospective open-label investigation.
SETTING
The study was conducted at three tertiary referral centers in Switzerland.
PATIENTS
Patients included six consecutive patients with proven clinical and biochemical endogenous hyperinsulinemic hypoglycemia.
INTERVENTION
(111)In-DOTA-exendin-4 was administered iv at a dose of about 90 MBq (30 microg peptide) over 5 min. Whole-body planar images of the abdomen were performed at 20 min, 4 h, 23 h, 96 h, and up to 168 h after injection. After surgical removal of the insulinomas, GLP-1R expression was assessed in the tumor tissue in vitro by GLP-1R autoradiography.
MAIN OUTCOME MEASURE
The detection rate of insulinomas was measured.
RESULTS
In all six cases, the GLP-1R scans successfully detected the insulinomas identified using conventional methods in four cases. By using a gamma-probe intraoperatively, GLP-1R detection permitted a successful surgical removal of the tumors in all patients, diagnosed histopathologically as five pancreatic and one extrapancreatic insulinomas. In vitro GLP-1R autoradiography showed a high density of GLP-1R in all tested insulinomas.
CONCLUSION
In vivo GLP-1R imaging is an innovative, noninvasive diagnostic approach that successfully localizes small insulinomas pre- and intraoperatively and that may in the future affect the strategy of insulinoma localization.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1210/jc.2009-1082
- PMID 19820010
- Persistent URL
- https://sonar.ch/global/documents/9519
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