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. Author manuscript; available in PMC: 2017 Jan 10.
Published in final edited form as: Eur J Nucl Med Mol Imaging. 2014 Nov 15;42(3):531–532. doi: 10.1007/s00259-014-2946-9

68Ga-NOTA-exendin-4 PET/CT in detection of occult insulinoma and evaluation of physiological uptake

Yaping Luo 1, Miao Yu 2, QingQing Pan 3, Wenming Wu 4, Taiping Zhang 5, Dale O Kiesewetter 6, Zhaohui Zhu 7, Fang Li 8, Xiaoyuan Chen 9,✉, Yupei Zhao 10,✉
PMCID: PMC5223098  NIHMSID: NIHMS840396  PMID: 25398421

A 52-year-old man who had hypoglycaemia for 8 years was found to have endogenous hyperinsulinism indicating an insulinoma. Abdominal MRI, CT perfusion, endoscopic ultrasonography, and 99mTc-HYNIC-TOC SPECT/CT were negative. Thus, the patient was referred for 68Ga-NOTA-exendin-4 PET/CT with the approval of the Institutional Review Board of our hospital.

As well as the intense physiological distribution in the kidneys and bladder due to urinary excretion, moderately elevated uptake is apparent in the proximal duodenum (a–c long arrows, SUVmax 5.2) and pancreas (SUVmax 2.9) at 1 h after injection of 68Ga-NOTA-exendin-4. Because visualization of the pancreas tail was significantly influenced by the intense radioactivity in the left kidney, the patient was reimaged at 2 h after injection. A lesion with intense uptake (SUVmax 20.7) was clearly seen in the pancreas tail (d, e short arrows). Interestingly, radioactivity in the proximal duodenum significantly decreased (d, e long arrows, SUVmax 2.3) while the appearance of the normal pancreas remained unchanged.

The patient recovered from hypoglycemia after surgical removal of the pancreas tail insulinoma (WHO grade 1). Intraoperative ultrasonography excluded a duodenal tumor.

Glucagon-like peptide-1 receptor (GLP-1R) is highly overexpressed in insulinoma [1, 2]. SPECT/CT imaging of GLP-1R using 111In-labelled or 99mTc-labelled exendin-4 has been shown to be highly accurate in the detection of insulinoma [2–4]. However, PET/CT imaging of GLP-1R has rarely been reported [5]. We present the first successful use of 68Ga-NOTA-exendin-4 PET/CT for the identification of an occult insulinoma that could not be detected by other standard imaging methods. 68Ga-NOTA-exendin-4 also shows great potential for evaluation of pancreatic physiology due to its uptake, presumably, by islet cells.

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Acknowledgments

This work was partly supported by a Special Scientific Research Fund for Public Welfare Professions of China (201402001) and NIBIB intramural research program.

Footnotes

Conflicts of interest: None.

Contributor Information

Yaping Luo, Department of Nuclear Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, People’s Republic of China.

Miao Yu, Department of Endocrinology, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, People’s Republic of China.

QingQing Pan, Department of Nuclear Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, People’s Republic of China.

Wenming Wu, Department of General Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Wangfujing, Dongcheng District, Beijing 100730, People’s Republic of China.

Taiping Zhang, Department of General Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Wangfujing, Dongcheng District, Beijing 100730, People’s Republic of China.

Dale O. Kiesewetter, Laboratory of Molecular Imaging and Nanomedicine, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD 20892, USA

Zhaohui Zhu, Department of Nuclear Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, People’s Republic of China.

Fang Li, Department of Nuclear Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, People’s Republic of China.

Xiaoyuan Chen, Laboratory of Molecular Imaging and Nanomedicine, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD 20892, USA.

Yupei Zhao, Department of General Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Wangfujing, Dongcheng District, Beijing 100730, People’s Republic of China.

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