18F-labeled PEGylated exendin-4 imaging noninvasively differentiates insulinoma from an accessory spleen: the first case report of [18F]FB(ePEG12)12-exendin-4 positron emission tomography/computed tomography for insulinoma
BackgroundInsulinomas are the most common functioning pancreatic neuroendocrine neoplasms, and these tumors induce hypoglycemia due to hyperinsulinemia. Hypoglycemia caused by insulinomas can cause seizures, coma or death due to the delayed diagnosis. The only curative treatment is surgical resectio...
| Main Authors: | , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2023-08-01
|
| Series: | Frontiers in Endocrinology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2023.1245573/full |
| _version_ | 1797730305041235968 |
|---|---|
| author | Kentaro Sakaki Takaaki Murakami Hiroyuki Fujimoto Yoichi Shimizu Kanae Kawai Miyake Daisuke Otani Sakura Kiyobayashi Takuya Okada Masakazu Fujimoto Takuro Hakata Ichiro Yamauchi Kotaro Shimada Hironori Shimizu Kazuyuki Nagai Yuji Nakamoto Nobuya Inagaki |
| author_facet | Kentaro Sakaki Takaaki Murakami Hiroyuki Fujimoto Yoichi Shimizu Kanae Kawai Miyake Daisuke Otani Sakura Kiyobayashi Takuya Okada Masakazu Fujimoto Takuro Hakata Ichiro Yamauchi Kotaro Shimada Hironori Shimizu Kazuyuki Nagai Yuji Nakamoto Nobuya Inagaki |
| author_sort | Kentaro Sakaki |
| collection | DOAJ |
| description | BackgroundInsulinomas are the most common functioning pancreatic neuroendocrine neoplasms, and these tumors induce hypoglycemia due to hyperinsulinemia. Hypoglycemia caused by insulinomas can cause seizures, coma or death due to the delayed diagnosis. The only curative treatment is surgical resection. To perform curative surgical resection of insulinomas, preoperative localization is crucial. However, localization of insulinomas is often challenging using conventional imaging methods such as computed tomography (CT) and magnetic resonance imaging. Although endoscopic ultrasound (EUS) fine-needle aspiration and selective arterial calcium stimulation test, which can reflect the endocrine character of the tumor, are performed in such cases, these modalities are invasive and require operator-dependent techniques. Additionally, somatostatin receptor (SSTR)-targeted imaging has a relatively low sensitivity for detecting insulinomas due to its low SSTR type 2 expression. Thus, there is an urgent need for developing a noninvasive diagnostic technique which is specific for detecting insulinomas. Consequently, glucagon-like peptide-1 receptor-targeted imaging has recently emerged and gained a wide interest. Recently, we have developed a novel 18F-labeled exendin-4-based probe conjugated with polyethylene glycol, [18F]FB(ePEG12)12-exendin-4 (18F-exendin-4), for positron emission tomography (PET) imaging. Here we report a case of insulinoma in which 18F-exendin-4 PET/CT noninvasively provided critical information for localization.Case descriptionThis is a case of a 58-year-old male with symptomatic hypoglycemia for 10 years; however, a preoperative diagnosis of insulinoma was not established due to the difficulty in differentiating it from an accessory spleen using conventional imaging. Moreover, the patient requested to avoid invasive diagnostic procedures including EUS. 18F-exendin-4 PET/CT revealed significant uptakes in the pancreatic tail whereas no apparent uptakes were observed in the spleen; thus, curative laparoscopic enucleation of the pancreatic tail was performed. The diagnosis of insulinoma was confirmed via histopathological examination. This is the first case report of insulinoma diagnosed using 18F-exendin-4 PET/CT.ConclusionIn this case, PET information led to curative resection through enucleation of the pancreas. 18F-exendin-4 PET/CT may serve as a useful noninvasive clinical tool for insulinoma localization. |
| first_indexed | 2024-03-12T11:42:21Z |
| format | Article |
| id | doaj.art-3237cc1ca0a0480fb3b0b551073a4ebe |
| institution | Directory Open Access Journal |
| issn | 1664-2392 |
| language | English |
| last_indexed | 2024-03-12T11:42:21Z |
| publishDate | 2023-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Endocrinology |
| spelling | doaj.art-3237cc1ca0a0480fb3b0b551073a4ebe2023-08-31T13:45:10ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922023-08-011410.3389/fendo.2023.1245573124557318F-labeled PEGylated exendin-4 imaging noninvasively differentiates insulinoma from an accessory spleen: the first case report of [18F]FB(ePEG12)12-exendin-4 positron emission tomography/computed tomography for insulinomaKentaro Sakaki0Takaaki Murakami1Hiroyuki Fujimoto2Yoichi Shimizu3Kanae Kawai Miyake4Daisuke Otani5Sakura Kiyobayashi6Takuya Okada7Masakazu Fujimoto8Takuro Hakata9Ichiro Yamauchi10Kotaro Shimada11Hironori Shimizu12Kazuyuki Nagai13Yuji Nakamoto14Nobuya Inagaki15Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, JapanDepartment of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, JapanRadioisotope Research Center, Agency for Health, Safety and Environment, Kyoto University, Kyoto, JapanDepartment of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, JapanDepartment of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, JapanDepartment of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, JapanDepartment of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, JapanDepartment of Diagnostic Pathology, Graduate School of Medicine, Kyoto University, Kyoto, JapanDepartment of Diagnostic Pathology, Graduate School of Medicine, Kyoto University, Kyoto, JapanDepartment of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, JapanDepartment of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, JapanDepartment of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, JapanDepartment of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, JapanDivision of Hepatobiliary Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, JapanDepartment of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, JapanMedical Research Institute Kitano HospitalPIIF Tazuke-kofukai, Osaka, JapanBackgroundInsulinomas are the most common functioning pancreatic neuroendocrine neoplasms, and these tumors induce hypoglycemia due to hyperinsulinemia. Hypoglycemia caused by insulinomas can cause seizures, coma or death due to the delayed diagnosis. The only curative treatment is surgical resection. To perform curative surgical resection of insulinomas, preoperative localization is crucial. However, localization of insulinomas is often challenging using conventional imaging methods such as computed tomography (CT) and magnetic resonance imaging. Although endoscopic ultrasound (EUS) fine-needle aspiration and selective arterial calcium stimulation test, which can reflect the endocrine character of the tumor, are performed in such cases, these modalities are invasive and require operator-dependent techniques. Additionally, somatostatin receptor (SSTR)-targeted imaging has a relatively low sensitivity for detecting insulinomas due to its low SSTR type 2 expression. Thus, there is an urgent need for developing a noninvasive diagnostic technique which is specific for detecting insulinomas. Consequently, glucagon-like peptide-1 receptor-targeted imaging has recently emerged and gained a wide interest. Recently, we have developed a novel 18F-labeled exendin-4-based probe conjugated with polyethylene glycol, [18F]FB(ePEG12)12-exendin-4 (18F-exendin-4), for positron emission tomography (PET) imaging. Here we report a case of insulinoma in which 18F-exendin-4 PET/CT noninvasively provided critical information for localization.Case descriptionThis is a case of a 58-year-old male with symptomatic hypoglycemia for 10 years; however, a preoperative diagnosis of insulinoma was not established due to the difficulty in differentiating it from an accessory spleen using conventional imaging. Moreover, the patient requested to avoid invasive diagnostic procedures including EUS. 18F-exendin-4 PET/CT revealed significant uptakes in the pancreatic tail whereas no apparent uptakes were observed in the spleen; thus, curative laparoscopic enucleation of the pancreatic tail was performed. The diagnosis of insulinoma was confirmed via histopathological examination. This is the first case report of insulinoma diagnosed using 18F-exendin-4 PET/CT.ConclusionIn this case, PET information led to curative resection through enucleation of the pancreas. 18F-exendin-4 PET/CT may serve as a useful noninvasive clinical tool for insulinoma localization.https://www.frontiersin.org/articles/10.3389/fendo.2023.1245573/fullexendin-4PETinsulinomaGLP-1 receptorβ-cell imaging |
| spellingShingle | Kentaro Sakaki Takaaki Murakami Hiroyuki Fujimoto Yoichi Shimizu Kanae Kawai Miyake Daisuke Otani Sakura Kiyobayashi Takuya Okada Masakazu Fujimoto Takuro Hakata Ichiro Yamauchi Kotaro Shimada Hironori Shimizu Kazuyuki Nagai Yuji Nakamoto Nobuya Inagaki 18F-labeled PEGylated exendin-4 imaging noninvasively differentiates insulinoma from an accessory spleen: the first case report of [18F]FB(ePEG12)12-exendin-4 positron emission tomography/computed tomography for insulinoma Frontiers in Endocrinology exendin-4 PET insulinoma GLP-1 receptor β-cell imaging |
| title | 18F-labeled PEGylated exendin-4 imaging noninvasively differentiates insulinoma from an accessory spleen: the first case report of [18F]FB(ePEG12)12-exendin-4 positron emission tomography/computed tomography for insulinoma |
| title_full | 18F-labeled PEGylated exendin-4 imaging noninvasively differentiates insulinoma from an accessory spleen: the first case report of [18F]FB(ePEG12)12-exendin-4 positron emission tomography/computed tomography for insulinoma |
| title_fullStr | 18F-labeled PEGylated exendin-4 imaging noninvasively differentiates insulinoma from an accessory spleen: the first case report of [18F]FB(ePEG12)12-exendin-4 positron emission tomography/computed tomography for insulinoma |
| title_full_unstemmed | 18F-labeled PEGylated exendin-4 imaging noninvasively differentiates insulinoma from an accessory spleen: the first case report of [18F]FB(ePEG12)12-exendin-4 positron emission tomography/computed tomography for insulinoma |
| title_short | 18F-labeled PEGylated exendin-4 imaging noninvasively differentiates insulinoma from an accessory spleen: the first case report of [18F]FB(ePEG12)12-exendin-4 positron emission tomography/computed tomography for insulinoma |
| title_sort | 18f labeled pegylated exendin 4 imaging noninvasively differentiates insulinoma from an accessory spleen the first case report of 18f fb epeg12 12 exendin 4 positron emission tomography computed tomography for insulinoma |
| topic | exendin-4 PET insulinoma GLP-1 receptor β-cell imaging |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2023.1245573/full |
| work_keys_str_mv | AT kentarosakaki 18flabeledpegylatedexendin4imagingnoninvasivelydifferentiatesinsulinomafromanaccessoryspleenthefirstcasereportof18ffbepeg1212exendin4positronemissiontomographycomputedtomographyforinsulinoma AT takaakimurakami 18flabeledpegylatedexendin4imagingnoninvasivelydifferentiatesinsulinomafromanaccessoryspleenthefirstcasereportof18ffbepeg1212exendin4positronemissiontomographycomputedtomographyforinsulinoma AT hiroyukifujimoto 18flabeledpegylatedexendin4imagingnoninvasivelydifferentiatesinsulinomafromanaccessoryspleenthefirstcasereportof18ffbepeg1212exendin4positronemissiontomographycomputedtomographyforinsulinoma AT yoichishimizu 18flabeledpegylatedexendin4imagingnoninvasivelydifferentiatesinsulinomafromanaccessoryspleenthefirstcasereportof18ffbepeg1212exendin4positronemissiontomographycomputedtomographyforinsulinoma AT kanaekawaimiyake 18flabeledpegylatedexendin4imagingnoninvasivelydifferentiatesinsulinomafromanaccessoryspleenthefirstcasereportof18ffbepeg1212exendin4positronemissiontomographycomputedtomographyforinsulinoma AT daisukeotani 18flabeledpegylatedexendin4imagingnoninvasivelydifferentiatesinsulinomafromanaccessoryspleenthefirstcasereportof18ffbepeg1212exendin4positronemissiontomographycomputedtomographyforinsulinoma AT sakurakiyobayashi 18flabeledpegylatedexendin4imagingnoninvasivelydifferentiatesinsulinomafromanaccessoryspleenthefirstcasereportof18ffbepeg1212exendin4positronemissiontomographycomputedtomographyforinsulinoma AT takuyaokada 18flabeledpegylatedexendin4imagingnoninvasivelydifferentiatesinsulinomafromanaccessoryspleenthefirstcasereportof18ffbepeg1212exendin4positronemissiontomographycomputedtomographyforinsulinoma AT masakazufujimoto 18flabeledpegylatedexendin4imagingnoninvasivelydifferentiatesinsulinomafromanaccessoryspleenthefirstcasereportof18ffbepeg1212exendin4positronemissiontomographycomputedtomographyforinsulinoma AT takurohakata 18flabeledpegylatedexendin4imagingnoninvasivelydifferentiatesinsulinomafromanaccessoryspleenthefirstcasereportof18ffbepeg1212exendin4positronemissiontomographycomputedtomographyforinsulinoma AT ichiroyamauchi 18flabeledpegylatedexendin4imagingnoninvasivelydifferentiatesinsulinomafromanaccessoryspleenthefirstcasereportof18ffbepeg1212exendin4positronemissiontomographycomputedtomographyforinsulinoma AT kotaroshimada 18flabeledpegylatedexendin4imagingnoninvasivelydifferentiatesinsulinomafromanaccessoryspleenthefirstcasereportof18ffbepeg1212exendin4positronemissiontomographycomputedtomographyforinsulinoma AT hironorishimizu 18flabeledpegylatedexendin4imagingnoninvasivelydifferentiatesinsulinomafromanaccessoryspleenthefirstcasereportof18ffbepeg1212exendin4positronemissiontomographycomputedtomographyforinsulinoma AT kazuyukinagai 18flabeledpegylatedexendin4imagingnoninvasivelydifferentiatesinsulinomafromanaccessoryspleenthefirstcasereportof18ffbepeg1212exendin4positronemissiontomographycomputedtomographyforinsulinoma AT yujinakamoto 18flabeledpegylatedexendin4imagingnoninvasivelydifferentiatesinsulinomafromanaccessoryspleenthefirstcasereportof18ffbepeg1212exendin4positronemissiontomographycomputedtomographyforinsulinoma AT nobuyainagaki 18flabeledpegylatedexendin4imagingnoninvasivelydifferentiatesinsulinomafromanaccessoryspleenthefirstcasereportof18ffbepeg1212exendin4positronemissiontomographycomputedtomographyforinsulinoma |