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Ga-68-NODAGA-Exendin-4 PET/CT Improves the Detection of Focal Congenital Hyperinsulinism

Boss, Marti; Rottenburger, Christof; Brenner, Winfried; Blankenstein, Oliver; Prasad, Vikas; Prasad, Sonal; de Coppi, Paolo; ... Gotthardt, Martin; + view all (2022) Ga-68-NODAGA-Exendin-4 PET/CT Improves the Detection of Focal Congenital Hyperinsulinism. Journal of Nuclear Medicine , 63 (2) pp. 310-315. 10.2967/jnumed.121.262327. Green open access

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Abstract

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.

Type: Article
Title: Ga-68-NODAGA-Exendin-4 PET/CT Improves the Detection of Focal Congenital Hyperinsulinism
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.2967/jnumed.121.262327
Publisher version: https://doi.org/10.2967/jnumed.121.262327
Language: English
Additional information: © 2022 by the Society of Nuclear Medicine and Molecular Imaging. Immediate Open Access: Creative Commons Attribution 4.0 International License (CC BY) allows users to share and adapt with attribution, excluding materials credited to previous publications. License: https://creativecommons.org/licenses/by/4.0/. Details: http://jnm.snmjournals.org/site/misc/permission.xhtml.
Keywords: Science & Technology, Life Sciences & Biomedicine, Radiology, Nuclear Medicine & Medical Imaging, congenital hyperinsulinism, focal CHI, diagnostic imaging, Ga-68-NODAGA-exendin-4 PET/CT, F-18-DOPA PET/CT, 11P15 IMPRINTED GENES, DIAGNOSIS, LOCALIZATION, MANAGEMENT, MUTATION, CHILDREN, INFANCY, DIFFUSE, FORMS
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Developmental Biology and Cancer Dept
URI: https://discovery.ucl.ac.uk/id/eprint/10179131
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