PET scans accurate in diagnosis of congenital hyperinsulinism
NEW YORK (Reuters Health) - In infants with congenital hyperinsulinism, positron-emission tomography (PET) scans can accurately differentiate between focal and diffuse disease, and pinpoint focal lesions, according to a study published in the February issue of the Journal of Pediatrics.
Dr. Charles A. Stanley, of Children's Hospital of Philadelphia, and colleagues assessed the accuracy of 18F-fluoro-L-dihydroxyphenylalanine ([18F]-DOPA) PET scans in 24 infants with hyperinsulinism unresponsive to medical therapy.
After intravenous injection of [18F]-DOPA, PET scans were obtained for approximately one hour and were co-registered with abdominal CT scans.
The diagnosis of focal or diffuse disease was correct in 23 cases (96%) and equivocal in one case. The PET scan identified focal areas of high uptake of isotope in 11 of the 12 cases of focal disease. Pathology results confirmed focal adenomatosis in all 11 patients, at the locations indicated.
"These encouraging results suggest that [18F]-DOPA PET imaging should be strongly considered in all infants with congenital hyperinsulinism who fail medical therapy and need to have pancreatectomy," Stanley's team concludes.
In a related editorial, Dr. Mark A. Sperling, of the University of Pittsburgh School of Medicine, notes that "distinguishing focal from diffuse forms is of importance in guiding the extent of surgical resection, which may result in a cure and prevent unnecessary hyperglycemia or frank diabetes mellitus in later life."
He adds: "If these results are replicated in a cohort of 100 or so patients in independent centers, they herald a new era in managing HHI (hyperinsulinemic hypoglycemia of infancy) in newborn infants."
J Pediatr 2007;150:140-145.