Top

Molecular Imaging and Biology

Published in:

Open Access 01-02-2013 | Research Article

The Value of Radiologic Interventions and ¹⁸F-DOPA PET in Diagnosing and Localizing Focal Congenital Hyperinsulinism: Systematic Review and Meta-Analysis

Authors: Björn A. Blomberg, Mateen C. Moghbel, Babak Saboury, Charles A. Stanley, Abass Alavi

Published in: Molecular Imaging and Biology | Issue 1/2013

Abstract

Purpose

This systematic review and meta-analysis aimed to quantify the diagnostic performance of pancreatic venous sampling (PVS), selective pancreatic arterial calcium stimulation with hepatic venous sampling (ASVS), and ¹⁸F-DOPA positron emission tomography (PET) in diagnosing and localizing focal congenital hyperinsulinism (CHI).

Procedures

This systematic review and meta-analysis was conducted according to the PRISMA statement. PubMed, EMBASE, SCOPUS and Web of Science electronic databases were systematically searched from their inception to November 1, 2011. Using predefined inclusion and exclusion criteria, two blinded reviewers selected articles. Critical appraisal ranked the retrieved articles according to relevance and validity by means of the QUADAS-2 criteria. Pooled data of homogeneous study results estimated the sensitivity, specificity, likelihood ratios and diagnostic odds ratio (DOR).

Results

¹⁸F-DOPA PET was superior in distinguishing focal from diffuse CHI (summary DOR, 73.2) compared to PVS (summary DOR, 23.5) and ASVS (summary DOR, 4.3). Furthermore, it localized focal CHI in the pancreas more accurately than PVS and ASVS (pooled accuracy, 0.82 vs. 0.76, and 0.64, respectively). Important limitations comprised the inclusion of studies with small sample sizes, high probability of bias and heterogeneity among their results. Studies with small sample sizes and high probability of bias tended to overestimate the diagnostic accuracy.

Conclusions

This systematic review and meta-analysis found evidence for the superiority of ¹⁸F-DOPA PET in diagnosing and localizing focal CHI in patients requiring surgery for this disease.

Arnoux JB, Verkarre V, Saint-Martin C et al (2011) Congenital hyperinsulinism: current trends in diagnosis and therapy. Orphanet J Rare Dis 6:63PubMedCrossRef

Cosgrove KE, Shepherd RM, Fernandez EM et al (2004) Genetics and pathophysiology of hyperinsulinism in infancy. Horm Res 61:270–288PubMedCrossRef

Hussain K (2007) Insights in congenital hyperinsulinism. Endocr Dev 11:106–121PubMedCrossRef

Lovvorn HN 3rd, Nance ML, Ferry RJ Jr et al (1999) Congenital hyperinsulinism and the surgeon: lessons learned over 35 years. J Pediatr Surg 34:786–792, discussion 792-793PubMedCrossRef

de Lonlay P, Poggi-Travert F, Fournet JC et al (2002) Heterogeneity of persistant hyperinsulinaemic hypoglycemia. a series of 175 cases. Eur J Pediatr 161:37–48PubMed

Hussain K (2008) Diagnosis and management of hyperinsulinaemic hypoglycaemia of infancy. Horm Res 69:2–13PubMedCrossRef

de Lonlay-Debeney P, Poggi-Travert F, Fournet JC et al (1999) Clinical features of 52 neonates with hyperinsulinism. N Engl J Med 340:1169–1175PubMedCrossRef

Fekete CN, de Lonlay P, Jaubert F et al (2004) The surgical management of congenital hyperinsulinemic hypoglycemia in infancy. J Pediatr Surg 39:267–269PubMedCrossRef

Lyonnet S, Bonnefont JP, Saudubray JM, Nihoule-Fekete C, Brunelle F (1989) Localisation of focal lesion permitting partial pancreatectomy in infants. Lancet 2:671PubMedCrossRef

10.

Pierro A, Nah SA (2011) Surgical management of congenital hyperinsulinism of infancy. Semin Pediatr Surg 20:50–53PubMedCrossRef

11.

Beltrand J, Caquard M, Arnoux JB et al (2012) Glucose metabolism in 105 children and adolescents after pancreatectomy for congenital hyperinsulinism. Diabetes Care 35:198–203PubMedCrossRef

12.

Adzick NS, Thornton PS, Stanley CA, Kaye RD, Ruchelli E (2004) A multidisciplinary approach to the focal form of congenital hyperinsulinism leads to successful treatment by partial pancreatectomy. J Pediatr Surg 39:270–275PubMedCrossRef

13.

Brunelle F, Negre V, Barth MO et al (1989) Pancreatic venous sampling in infants and children with primary hyperinsulinism. Pediatr Radiol 19:100–103PubMedCrossRef

14.

Dubois J, Brunelle F, Touati G et al (1995) Hyperinsulinism in children - diagnostic-value of pancreatic venous sampling correlated with clinical, pathological and surgical outcome in 25 cases. Pediatr Radiol 25:512–516PubMedCrossRef

15.

Ferry RJ Jr, Kelly A, Grimberg A et al (2000) Calcium-stimulated insulin secretion in diffuse and focal forms of congenital hyperinsulinism. J Pediatr 137:239–246PubMedCrossRef

16.

Stanley CA, Thornton PS, Ganguly A et al (2004) Preoperative evaluation of infants with focal or diffuse congenital hyperinsulinism by intravenous acute insulin response tests and selective pancreatic arterial calcium stimulation. J Clin Endocrinol Metab 89:288–296PubMedCrossRef

17.

Hardy OT, Hernandez-Pampaloni M, Saffer JR et al (2007) Diagnosis and localization of focal congenital hyperinsulinism by ¹⁸F-fluorodopa PET scan. J Pediatr 150:140–145PubMedCrossRef

18.

Ribeiro MJ, De Lonlay P, Delzescaux T et al (2005) Characterization of hyperinsulinism in infancy assessed with PET and 18F-fluoro-L-DOPA. J Nucl Med 46:560–566PubMed

19.

Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535PubMedCrossRef

20.

Cohen J (1960) A coefficient of agreement for nominal scales. Educ Psychol Meas 20:37–46CrossRef

21.

Whiting PF, Rutjes AW, Westwood ME et al (2011) QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 155:529–536PubMed

22.

Hussain K, Blankenstein O, De Lonlay P, Christesen HT (2007) Hyperinsulinaemic hypoglycaemia: biochemical basis and the importance of maintaining normoglycaemia during management. Arch Dis Child 92:568–570PubMedCrossRef

23.

Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560PubMedCrossRef

24.

Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634PubMedCrossRef

25.

Zamora J, Abraira V, Muriel A, Khan K, Coomarasamy A (2006) Meta-DiSc: a software for meta-analysis of test accuracy data. BMC Med Res Methodol 6:31PubMedCrossRef

26.

Giurgea I, Laborde K, Touati G et al (2004) Acute insulin responses to calcium and tolbutamide do not differentiate focal from diffuse congenital hyperinsulinism. J Clin Endocrinol Metab 89:925–929PubMedCrossRef

27.

Capito C, Khen-Dunlop N, Ribeiro MJ et al (2009) Value of ¹⁸F-fluoro-l-dopa PET in the preoperative localization of focal lesions in congenital hyperinsulinism. Radiology 253:216–222PubMedCrossRef

28.

Cretolle C, Fekete CN, Jan D et al (2002) Partial elective pancreatectomy is curative in focal form of permanent hyperinsulinemic hypoglycaemia in infancy: a report of 45 cases from 1983 to 2000. J Pediatr Surg 37:155–158PubMedCrossRef

29.

de Lonlay P, Simon-Carre A, Ribeiro MJ et al (2006) Congenital hyperinsulinism: pancreatic [18F]fluoro-l-dihydroxyphenylalanine (DOPA) positron emission tomography and immunohistochemistry study of DOPA decarboxylase and insulin secretion. J Clin Endocrinol Metab 91:933–940PubMedCrossRef

30.

Ribeiro MJ, Boddaert N, Bellanne-Chantelot C et al (2007) The added value of [18F]fluoro-l-DOPA PET in the diagnosis of hyperinsulinism of infancy: a retrospective study involving 49 children. Eur J Nucl Med Mol Imaging 34:2120–2128PubMedCrossRef

31.

Chigot V, De Lonlay P, Nassogne MC et al (2001) Pancreatic arterial calcium stimulation in the diagnosis and localisation of persistent hyperinsulinemic hypoglycaemia of infancy. Pediatr Radiol 31:650–655PubMedCrossRef

32.

Barthlen W, Blankenstein O, Mau H et al (2008) Evaluation of [18F]fluoro-l-DOPA positron emission tomography-computed tomography for surgery in focal congenital hyperinsulinism. J Clin Endocrinol Metab 93:869–875PubMedCrossRef

33.

Hardy OT, Hernandez-Pampaloni M, Saffer JR et al (2007) Accuracy of [18F]fluorodopa positron emission tomography for diagnosing and localizing focal congenital hyperinsulinism. J Clin Endocrinol Metab 92:4706–4711PubMedCrossRef

34.

Masue M, Nishibori H, Fukuyama S et al (2011) Diagnostic accuracy of [18F]-fluoro-L-dihydroxyphenylalanine positron emission tomography scan for persistent congenital hyperinsulinism in Japan. Clin Endocrinol (Oxf) 75:342–346CrossRef

35.

Otonkoski T, Nanto-Salonen K, Seppanen M et al (2006) Noninvasive diagnosis of focal hyperinsulinism of infancy with [(18)F]-DOPA positron emission tomography. Diabetes 55:13–18PubMedCrossRef

36.

Zani A, Nah SA, Ron O et al (2011) The predictive value of preoperative fluorine-18-l-3,4-dihydroxyphenylalanine positron emission tomography-computed tomography scans in children with congenital hyperinsulinism of infancy. J Pediatr Surg 46:204–208PubMedCrossRef

37.

Balan KK (2005) Visualization of the gall bladder on F-18 FDOPA PET imaging: a potential pitfall. Clin Nucl Med 30:23–24PubMedCrossRef

38.

Hussain K, Seppanen M, Nanto-Salonen K et al (2006) The diagnosis of ectopic focal hyperinsulinism of infancy with [18F]-dopa positron emission tomography. J Clin Endocrinol Metab 91:2839–2842PubMedCrossRef

39.

Peranteau WH, Bathaii SM, Pawel B et al (2007) Multiple ectopic lesions of focal islet adenomatosis identified by positron emission tomography scan in an infant with congenital hyperinsulinism. J Pediatr Surg 42:188–192PubMedCrossRef

40.

Connolly B, Racadio J, Towbin R (2006) Practice of ALARA in the pediatric interventional suite. Pediatr Radiol 36(Suppl 2):163–167PubMedCrossRef

41.

Brenner D, Elliston C, Hall E, Berdon W (2001) Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 176:289–296PubMed

42.

Fahey FH, Treves ST, Adelstein SJ (2011) Minimizing and communicating radiation risk in pediatric nuclear medicine. J Nucl Med 52:1240–1251PubMed

43.

Shah NB, Platt SL (2008) ALARA: is there a cause for alarm? Reducing radiation risks from computed tomography scanning in children. Curr Opin Pediatr 20:243–247PubMedCrossRef

44.

Zaidi H, Montandon ML, Alavi A (2010) The clinical role of fusion imaging using PET, CT, and MR imaging. Magn Reson Imaging Clin N Am 18:133–149PubMedCrossRef

45.

Irwig L, Tosteson AN, Gatsonis C et al (1994) Guidelines for meta-analyses evaluating diagnostic tests. Ann Intern Med 120:667–676PubMed

46.

Ioannidis JP, Trikalinos TA (2007) The appropriateness of asymmetry tests for publication bias in meta-analyses: a large survey. CMAJ 176:1091–1096PubMedCrossRef

47.

Terrin N, Schmid CH, Lau J, Olkin I (2003) Adjusting for publication bias in the presence of heterogeneity. Stat Med 22:2113–2126PubMedCrossRef

Title: The Value of Radiologic Interventions and 18F-DOPA PET in Diagnosing and Localizing Focal Congenital Hyperinsulinism: Systematic Review and Meta-Analysis
Authors: Björn A. Blomberg
Mateen C. Moghbel
Babak Saboury
Charles A. Stanley
Abass Alavi
Publication date: 01-02-2013
Publisher: Springer-Verlag
Published in: Molecular Imaging and Biology / Issue 1/2013
Print ISSN: 1536-1632
Electronic ISSN: 1860-2002
DOI: https://doi.org/10.1007/s11307-012-0572-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The Value of Radiologic Interventions and ¹⁸F-DOPA PET in Diagnosing and Localizing Focal Congenital Hyperinsulinism: Systematic Review and Meta-Analysis

Abstract

Purpose

Procedures

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Procedures

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2013

In Vivo Magnetic Resonance Imaging of Transgenic Mice Expressing Human Ferritin

Reproducibility of Static and Dynamic 18F-FDG, 18F-FLT, and 18F-FMISO MicroPET Studies in a Murine Model of HER2+ Breast Cancer

Positron Emission Tomography with [18F]-3′-Deoxy-3′fluorothymidine (FLT) as a Predictor of Outcome in Patients with Locally Advanced Resectable Rectal Cancer: a Pilot Study

Differentiation of Reactive and Tumor Metastatic Lymph Nodes with Diffusion-weighted and SPIO-Enhanced MRI

Positron Emission Tomography Imaging of Endometrial Cancer Using Engineered Anti-EMP2 Antibody Fragments

β-Cell Mass Imaging with DTBZ Positron Emission Tomography: Is it Possible?