68Ga-exendin-4 PET/CT显像定位诊断胰岛素瘤

摘要

目的 探讨68Ga-艾塞那肽(exendin-4) PET/CT胰高血糖素样肽-1(GLP-1)受体显像在胰岛素瘤定位诊断中的价值,并与常规影像学诊断方法进行比较.方法 该前瞻性队列研究纳入2014年3月至2016年11月间内源性高胰岛素血症性低血糖症患者,行68Ga-exendin-4 PET/CT显像、胰腺灌注CT、MRI、超声内镜和SSTR显像,并行手术.以手术病理为"金标准",计算并比较各方法诊断胰岛素瘤患者的灵敏度和对病灶的阳性预测值.采用χ2检验和广义分数统计法分析数据.结果 共纳入109例患者,男47例、女62例,平均年龄(45.1±14.8)岁.13例68Ga-exendin-4 PET/CT显像发现阳性病灶但暂未手术,将另96例经手术病理确诊为胰岛素瘤的患者纳入统计分析.68Ga-exendin-4 PET/CT显像诊断胰岛素瘤患者的灵敏度为98.96%(95/96),胰腺灌注CT、MRI、超声内镜和SSTR显像的诊断灵敏度分别为81.25%(78/96)、79.41%(54/68)、81.40%(35/43)和21.84%(19/87);68Ga-exendin-4 PET/CT显像的诊断灵敏度高于其他方法(均P<0.01).5种影像学方法对病灶的阳性预测值分别为100%(102/102)、97.56%(80/82)、95.16%(59/62)、83.72%(36/43)和90.48%(19/21);除与CT间差异无统计学意义(P>0.05)外,68Ga-exendin-4 PET/CT显像与其他方法差异均有统计学意义(均P<0.05).结论 68Ga-exendin-4 PET/CT显像在胰岛素瘤定位诊断中的灵敏度高.%Objective To determine whether glucagon-like peptide-1 (GLP-1) receptor PET/CT with 68Ga-exendin-4 is accurate in localizing insulinomas, by comparing with conventional imaging techniques.Methods In this prospective cohort study, patients with biochemically proven endogenous hyperinsulinemic hypoglycemia from March 2014 to November 2016 were recruited consecutively.68Ga-exendin-4 PET/CT, CT, MRI, endoscopic ultrasound (EUS), and SSTR imaging were performed before elective surgery.Surgical pathology results were considered as the gold standard.Sensitivity based on patient-analysis and positive predictive value (PPV) based on lesion-analysis were calculated and compared using χ2 test and generalized score test.Results A total of 109 patients were recruited (47 males, 62 females;average age (45.1±14.8) years), and 96 of them with insulinomas proved pathologically were included in the main assessment.Thirteen patients with positive 68Ga-exendin-4 PET/CT findings did not undergo surgical intervention.Based on patient-analysis, the sensitivities of 68Ga-exendin-4 PET/CT, CT, MRI, EUS and SSTR imaging for detecting insulinomas were 98.96%(95/96), 81.25%(78/96), 79.41%(54/68), 81.40%(35/43) and 21.84%(19/87), respectively.Based on lesion-analysis, the PPV of the above 5 methods were 100%(102/102), 97.56%(80/82), 95.16%(59/62), 83.72%(36/43) and 90.48%(19/21), respectively.68Ga-exendin-4 PET/CT showed the highest diagnostic sensitivity than others (all P<0.01) and higher PPV than MRI, EUS and SSTR imaging (all P<0.05).Conclusion 68Ga-exendin-4 PET/CT is a highly sensitive imaging technique for detection of insulinoma.