The predictive value of preoperative fluorine-18-L-3,4-dihydroxyphenylalanine positron emission tomography-computed tomography scans in children with congenital hyperinsulinism of infancy.
OBJECTIVE
In congenital hyperinsulinism (CHI) of infancy, the use of preoperative fluorine-18-L-3,4-dihydroxyphenylalanine-positron emission tomography-computed tomography ((18)F-DOPA-PET-CT) scan has recently been reported. The aim of this study was to evaluate the accuracy of this technique in discriminating between diffuse and focal CHI and the anatomical localization of focal lesions.


METHODS
Between 2006 and 2010, (18)F-DOPA-PET scan was performed in 19 children with CHI (median age, 2 months; range, 1-12 months) who were not responding to medical therapy and underwent laparoscopic or open surgery. The findings of (18)F-DOPA-PET scan were correlated with histology.


RESULTS
In 5 children, (18)F-DOPA-PET scan showed diffuse pancreatic uptake, confirmed at histology and supporting the genetic suspicion of diffuse disease. In 14 children, (18)F-DOPA-PET scan indicated focal pancreatic uptake, which corresponded to histology. However, in 5 patients (36%), (18)F-DOPA-PET scan was inaccurate in defining the location of the lesion (n = 3), size of the lesion (n = 1), or both location and size (n = 1), leading to an inaccurate pancreatic resection.


CONCLUSIONS
Fluorine-18-L-3,4-dihydroxyphenylalanine-positron emission tomography-computed tomography scan discriminates between diffuse and focal forms of CHI. In focal forms, (18)F-DOPA-PET scan is useful in 2/3 of patients in defining the site and dimension of the focal lesion. Intraoperative histologic confirmation of complete focal lesion resection is needed.
Department of Paediatric Surgery, Institute of Child Health and Great Ormond Street Hospital for Children, Great Ormond Street, London, United Kingdom.
Augusto
A
Zani
Shireen A
SA
Nah
Ori
O
Ron
Giorgia
G
Totonelli
Dunia
D
Ismail
Virpi V
VV
Smith
Michael
M
Ashworth
Oliver
O
Blankenstein
Wolgang
W
Mohnike
Paolo
P
De Coppi
Simon
S
Eaton
Khalid
K
Hussain
Agostino
A
Pierro
D002675:Child, Preschool; D044903:Congenital Hyperinsulinism / Q000000981:diagnostic imaging* / Q000601:surgery; D003951:Diagnostic Errors; D004295:Dihydroxyphenylalanine / Q000031:analogs & derivatives*; D005260:Female; D005462:Fluorine Radioisotopes; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods; D008297:Male; D010179:Pancreas / Q000000981:diagnostic imaging / Q000601:surgery; D049268:Positron-Emission Tomography / Q000379:methods / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000706:statistics & numerical data*
D005462:Fluorine Radioisotopes; C043437:fluorodopa F 18; D004295:Dihydroxyphenylalanine