摘要
目的探讨基于^68Ga-exendin-4 PET-CT的胰高血糖素样肽-1受体显像在胰腺灌注CT阴性的隐匿性胰岛素瘤定位诊断中的价值。方法本研究为前瞻性队列研究。研究筛选2014年2月至2018年6月在北京协和医院内分泌科住院的临床怀疑胰岛素瘤的内源性高胰岛素血症性低血糖且胰腺灌注CT阴性患者纳入研究。入组患者行^68Ga-exendin-4 PET-CT、MRI、超声内镜，明确诊断胰岛素瘤者行择期手术。计算^68Ga-exendin-4 PET-CT、MRI、超声内镜诊断隐匿性胰岛素瘤的灵敏度、特异度、准确性、阳性预测值和阴性预测值。结果研究共入组69例患者，男性37例，女性32例，年龄（43.2±17.9）岁。32例经手术或活检病理确诊为胰岛素瘤，4例^68Ga-exendin-4 PET-CT发现阳性病灶但暂未手术；28例临床确诊为非胰岛素瘤所致的高胰岛素血症性低血糖，5例原因未明。^68Ga-exendin-4 PET-CT诊断隐匿性胰岛素瘤的灵敏度、特异度、准确性、阳性预测值、阴性预测值分别为96.9%（31/32）、100%（30/30）、98.3%（59/60）、100%（29/29）、96.8%（30/31），MRI的灵敏度、特异度、准确性、阳性预测值、阴性预测值分别为74.1%（20/27）、9/11、76.3%（29/38）、90.9%（20/22）、9/16，超声内镜的灵敏度、特异度、准确性、阳性预测值、阴性预测值分别为75.0%（15/20）、2/2、77.3%（17/22）、15/15、2/7。结论^68Ga-exendin-4 PET-CT在胰腺灌注CT阴性的隐匿性胰岛素瘤定位诊断中具有非常高的诊断效能，优于MRI和超声内镜。
ObjectiveTo explore the accuracy in localizing occult insulinomas with Glucagon-like peptide-1 receptor（GLP-1R） PET-CT with ^68Ga-exendin-4.MethodsIn this prospective cohort study, patients with biochemically proven endogenous hyperinsulinemic hypoglycemia and negative contrast-enhanced CT with pancreatic perfusion scans were enrolled consecutively at Department of Nuclear Medicine, Peking Union Medical College Hospital from February 2014 to June 2018.There were 37 males and 32 females, with age of （43.2±17.9）years. ^68Ga-exendin-4 PET-CT, MRI and endoscopic ultrasound（EUS） were done before elective surgery. Sensitivity, specificity, accuracy, positive predictive value（PPV） and negative predictive value（NPV） of the above imaging modalities were calculated.ResultsA total of 69 patients were recruited. Thirty-two patients were diagnosed with insulinomas at histology. Four patients with positive ^68Ga-exendin-4 PET-CT findings did not undergo surgery so far. Twenty-eight patients were proven to be noninsulinoma induced hyperinsulinemic hypoglycemia. Five patients were unknown of etiology of hypoglycemia. The sensitivity, specificity, accuracy, PPV and NPV of 68Ga-exendin-4 in localizing occult insulinomas were 96.9%（31/32）, 100%（30/30）, 98.3%（59/60）, 100%（29/29）, 96.8%（30/31）, respectively.The sensitivity, specificity, accuracy, PPV and NPV of MRI were 74.1%（20/27）, 9/11, 76.3%（29/38）, 90.9%（20/22）, 9/16, respectively. The sensitivity, specificity, accuracy, PPV and NPV of EUS were 75.0% （15/20）, 2/2, 77.3%（17/22）, 15/15, and 2/7.Conclusion ^68Ga-exendin-4 PET-CT has a high sensitivity, specificity and accuracy for detection of occult insulinoma, which shows superiority to MRI and EUS.
作者
罗亚平
潘青青
李方
于淼
邢小平
张太平
赵玉沛
Lno Yaping;Pan Qingqing;Li Fang;Yu Miao;Xing Xiaoping;Zhang Taiping;Zhao Yupei(Department of Nuclear Medicine,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine,Beijing 100730,China)
出处
《中华外科杂志》
CAS
CSCD
北大核心
2018年第11期837-842,共6页
Chinese Journal of Surgery
基金
国家自然科学基金（81501515）
