Evaluation of [18F]fluoro-L-DOPA positron emission tomography-computed tomography for surgery in focal congenital hyperinsulinism.
BACKGROUND
In congenital hyperinsulinism (CHI), the identification and precise localization of a focal lesion is essential for successful surgery.


OBJECTIVE
Our objective was to evaluate the predictive value and accuracy of integrated [18F]fluoro-L-DOPA ([18F]FDOPA) positron emission tomography (PET)-computed tomography (CT) for the surgical therapy of CHI.


METHODS
This was an observational study.


METHODS
The study was performed in the Department of Pediatric Surgery at a university hospital.


METHODS
From February 2005 to September 2007, 10 children with the clinical signs of CHI and an increased radiotracer uptake in a circumscribed area of the pancreas in the [18F]FDOPA PET-CT were evaluated.


METHODS
Guided by the [18F]FDOPA PET-CT report, all children underwent partial pancreatic resection, in two cases twice.


METHODS
Correlation of the anatomical findings at surgery with the report of the [18F]FDOPA PET-CT, and the results of surgery and clinical outcome were determined.


RESULTS
In nine children the intraoperative situation corresponded exactly to the description of the [18F]FDOPA PET-CT. A limited resection of the pancreas was curative in eight cases at the first surgery, in one case at the second intervention. We observed no diabetes mellitus or exocrine insufficiency in the follow up so far. In one child, hypoglycemia persisted even after two partial resections of the pancreatic head. Histological analysis finally revealed an atypical intermediate form of CHI.


CONCLUSIONS
The integrated [18F]FDOPA PET-CT is accurate to localize the lesion in focal CHI and is a valuable tool to guide the surgeon in limited pancreatic resection.
Barthlen
Winfried
W
Clinic for Pediatric Surgery, Institute for Pathology, Charité University Medicine Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, Mittelallee 8, D-13353 Berlin, Germany. winfried.barthlen@charite.de
Blankenstein
Oliver
O
Mau
Harald
H
Koch
Martin
M
Höhne
Claudia
C
Mohnike
Wolfgang
W
Eberhard
Traugott
T
Fuechtner
Frank
F
Lorenz-Depiereux
Bettina
B
Mohnike
Klaus
K
D002675:Child, Preschool; D044903:Congenital Hyperinsulinism / Q000000981:diagnostic imaging / Q000601:surgery*; D004295:Dihydroxyphenylalanine / Q000031:analogs & derivatives*; D005260:Female; D005462:Fluorine Radioisotopes; D006801:Humans; D007223:Infant; D008297:Male; D049268:Positron-Emission Tomography / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*
D005462:Fluorine Radioisotopes; C043437:fluorodopa F 18; D004295:Dihydroxyphenylalanine