Accuracy of PET/CT Scan in the diagnosis of the focal form of congenital hyperinsulinism

• Published in: Journal of pediatric surgery Vol. 48; no. 2; pp. 388 - 393
• Main Authors: Laje, Pablo, States, Lisa J, Zhuang, Hongming, Becker, Susan A, Palladino, Andrew A, Stanley, Charles A, Adzick, N. Scott
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2013
• Subjects: Congenital hyperinsulinism; Congenital Hyperinsulinism - diagnostic imaging; Humans; Hypoglycemia; Infant; Multimodal Imaging; Pancreatectomy; Pediatrics; Positron Emission Tomography; Reproducibility of Results; Retrospective Studies; Surgery; Tomography, X-Ray Computed; Congenital hyperinsulinism; Hypoglycemia; Positron Emission Tomography; Pancreatectomy
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2012.11.025

Abstract Purpose The purpose of the study was to determine the sensitivity of the18 fluoro-dihydroxyphenylalanine positron emission tomography/computed tomography scan (18 F-PET/CT) in the diagnosis of focal congenital hyperinsulinism (HI). Methods A retrospective review of children with HI who underwent a preoperative 18 F-PET/CT scan was performed. Results Between 1/2008 and 2/2012 we performed 105 consecutive 18 F-PET/CT scans on infants with HI. Fifty-three patients had focal HI. Of those fifty-three patients, eight had a preoperative 18 F-PET/CT scan read as “diffuse disease”. The sensitivity of the study in the diagnosis of focal HI was 85%. The location of the eight missed focal lesions was: head (3), body (2), and tail (3). The 18 F-PET/CT of the missed head lesions showed homogeneous tracer uptake (n = 2) or heterogeneous uptake throughout the pancreas (n = 1). The 18 F-PET/CT of the 2 missed body lesions and 1 missed tail lesion showed heterogeneous uptake throughout the pancreas. The 18 F-PET/CT of the other 2 missed tail lesions showed lesions adjacent to and obscured by the signal of the upper renal pole, identified retrospectively by closer observation. Fifty-two of the 105 patients had diffuse HI. Two of them had 18 F-PET/CT studies read as “focal disease”. Therefore, the specificity of the study was 96%. Of the forty-seven 18 F-PET/CT studies read as “focal disease”, forty-five had true focal HI. Therefore, the positive predictive value of the study in the diagnosis of focal HI was 96%. Conclusion The sensitivity and specificity of 18 F-PET/CT can be affected by certain anatomic features of the pancreas, by the location of the lesion, and by the reader's experience.