[68Ga] labelled Exendin for radioguided surgery of intrapancreatic insulin producing lesions in patients with congenital hyperinsulinism
Abstract Background Congenital hyperinsulinism (CHI) is a life threatening disease. Localization of affected intrapancreatic beta cells responsible for focal forms during surgery can be challenging. In this study we investigated a new radioguided surgical (RGS) approach using [68Ga]Exendin to facili...
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SpringerOpen
2025-08-01
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| Online Access: | https://doi.org/10.1186/s13550-025-01294-8 |
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| author | Peter Kühnen Sonal Prasad Karin Rothe Kai Huang Kathrin Hauptmann Marti Boss Nicola Beindorff Erwin Lankes Steven W. Warmann Miriam Schneider Paniz Akbarzadeh Taghavi Lara Lechner Catharina Lange Christian Furth Martin Gotthardt Winfried Brenner Oliver Blankenstein Vikas Prasad |
| author_facet | Peter Kühnen Sonal Prasad Karin Rothe Kai Huang Kathrin Hauptmann Marti Boss Nicola Beindorff Erwin Lankes Steven W. Warmann Miriam Schneider Paniz Akbarzadeh Taghavi Lara Lechner Catharina Lange Christian Furth Martin Gotthardt Winfried Brenner Oliver Blankenstein Vikas Prasad |
| author_sort | Peter Kühnen |
| collection | DOAJ |
| description | Abstract Background Congenital hyperinsulinism (CHI) is a life threatening disease. Localization of affected intrapancreatic beta cells responsible for focal forms during surgery can be challenging. In this study we investigated a new radioguided surgical (RGS) approach using [68Ga]Exendin to facilitate intraoperative focus detection. All patients were scanned initially with [18F]-DOPA-PET followed by [68Ga]Exendin PET to differentiate between focal and non-focal forms. Focal CHI patients were then operated. At the beginning of standard surgical dissection of the pancreas in CHI patients (n = 12), 46 MBq of [68Ga]Exendin were injected intravenously. Intrapancreatic localization of the foci was determined by using a hand-held positron- and gamma-radiation probe. RGS was carried out as enucleation of CHI foci. Duration of surgery (defined as the time lapse from first incision until final suture placement) for RGS was compared with historical data of patients operated on without RGS. Long term follow-up data on euglycemic control were retrieved from patient´s medical files. Results [18F]-DOPA- and [68Ga]Exendin PET findings were concordant in all patients. Overall, 12 CHI patients underwent RGS. In 11/12 children (92%) the CHI foci localized pre-operatively by [68Ga]Exendin PET could be detected intraoperatively using the hand-held positron probe. There was a high correlation between PET imaging results and positron probe findings in respect to the identification of the affected pancreatic region. One pancreatic lesion in close proximity to the left kidney could not be detected by the positron probe. Histopathology confirmed all resected lesions as CHI foci. Intraoperatively, the signal of the focus was > 10 times higher than the signal of normal adjacent pancreatic tissue. Median duration of surgery was 4.7 h (CI 3.5–6.7) in RGS patients compared to 5.5 h (CI 4-6.7) in patients undergoing surgery without radio guidance. All patients remained euglycemic after surgery (median follow-up 3 years, range 2 to 4.5). Conclusions In this study, we demonstrated the use of [68Ga]Exendin for intraoperative localization of intrapancreatic CHI foci. RGS facilitates localization of intrapancreatic CHI focus and thus potentially reduces duration of surgery and perioperative complications. |
| format | Article |
| id | doaj-art-8fe5937f816f4d97a4c64db9807f9cd8 |
| institution | Kabale University |
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| publishDate | 2025-08-01 |
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| spelling | doaj-art-8fe5937f816f4d97a4c64db9807f9cd82025-08-20T03:43:36ZengSpringerOpenEJNMMI Research2191-219X2025-08-011511910.1186/s13550-025-01294-8[68Ga] labelled Exendin for radioguided surgery of intrapancreatic insulin producing lesions in patients with congenital hyperinsulinismPeter Kühnen0Sonal Prasad1Karin Rothe2Kai Huang3Kathrin Hauptmann4Marti Boss5Nicola Beindorff6Erwin Lankes7Steven W. Warmann8Miriam Schneider9Paniz Akbarzadeh Taghavi10Lara Lechner11Catharina Lange12Christian Furth13Martin Gotthardt14Winfried Brenner15Oliver Blankenstein16Vikas Prasad17Department of Pediatric Endocrinology and Diabetology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu BerlinDepartment of Nuclear Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu BerlinDepartment of Pediatric Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu BerlinDepartment of Nuclear Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu BerlinDepartment of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu BerlinDepartment of Medical Imaging, Radboud university medical centerBerlin Experimental Radionuclide Imaging Center (BERIC), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu BerlinDepartment of Pediatric Endocrinology and Diabetology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu BerlinDepartment of Pediatric Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu BerlinDepartment of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu BerlinDepartment of Nuclear Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu BerlinDepartment of Pediatric Endocrinology and Diabetology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu BerlinDepartment of Nuclear Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu BerlinDepartment of Nuclear Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu BerlinDepartment of Medical Imaging, Radboud university medical centerDepartment of Nuclear Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu BerlinDepartment of Pediatric Endocrinology and Diabetology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu BerlinDepartment of Nuclear Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu BerlinAbstract Background Congenital hyperinsulinism (CHI) is a life threatening disease. Localization of affected intrapancreatic beta cells responsible for focal forms during surgery can be challenging. In this study we investigated a new radioguided surgical (RGS) approach using [68Ga]Exendin to facilitate intraoperative focus detection. All patients were scanned initially with [18F]-DOPA-PET followed by [68Ga]Exendin PET to differentiate between focal and non-focal forms. Focal CHI patients were then operated. At the beginning of standard surgical dissection of the pancreas in CHI patients (n = 12), 46 MBq of [68Ga]Exendin were injected intravenously. Intrapancreatic localization of the foci was determined by using a hand-held positron- and gamma-radiation probe. RGS was carried out as enucleation of CHI foci. Duration of surgery (defined as the time lapse from first incision until final suture placement) for RGS was compared with historical data of patients operated on without RGS. Long term follow-up data on euglycemic control were retrieved from patient´s medical files. Results [18F]-DOPA- and [68Ga]Exendin PET findings were concordant in all patients. Overall, 12 CHI patients underwent RGS. In 11/12 children (92%) the CHI foci localized pre-operatively by [68Ga]Exendin PET could be detected intraoperatively using the hand-held positron probe. There was a high correlation between PET imaging results and positron probe findings in respect to the identification of the affected pancreatic region. One pancreatic lesion in close proximity to the left kidney could not be detected by the positron probe. Histopathology confirmed all resected lesions as CHI foci. Intraoperatively, the signal of the focus was > 10 times higher than the signal of normal adjacent pancreatic tissue. Median duration of surgery was 4.7 h (CI 3.5–6.7) in RGS patients compared to 5.5 h (CI 4-6.7) in patients undergoing surgery without radio guidance. All patients remained euglycemic after surgery (median follow-up 3 years, range 2 to 4.5). Conclusions In this study, we demonstrated the use of [68Ga]Exendin for intraoperative localization of intrapancreatic CHI foci. RGS facilitates localization of intrapancreatic CHI focus and thus potentially reduces duration of surgery and perioperative complications.https://doi.org/10.1186/s13550-025-01294-8[68Ga]Exendin-NODAGACongenital hyperinsulinismRadioguided surgery |
| spellingShingle | Peter Kühnen Sonal Prasad Karin Rothe Kai Huang Kathrin Hauptmann Marti Boss Nicola Beindorff Erwin Lankes Steven W. Warmann Miriam Schneider Paniz Akbarzadeh Taghavi Lara Lechner Catharina Lange Christian Furth Martin Gotthardt Winfried Brenner Oliver Blankenstein Vikas Prasad [68Ga] labelled Exendin for radioguided surgery of intrapancreatic insulin producing lesions in patients with congenital hyperinsulinism EJNMMI Research [68Ga]Exendin-NODAGA Congenital hyperinsulinism Radioguided surgery |
| title | [68Ga] labelled Exendin for radioguided surgery of intrapancreatic insulin producing lesions in patients with congenital hyperinsulinism |
| title_full | [68Ga] labelled Exendin for radioguided surgery of intrapancreatic insulin producing lesions in patients with congenital hyperinsulinism |
| title_fullStr | [68Ga] labelled Exendin for radioguided surgery of intrapancreatic insulin producing lesions in patients with congenital hyperinsulinism |
| title_full_unstemmed | [68Ga] labelled Exendin for radioguided surgery of intrapancreatic insulin producing lesions in patients with congenital hyperinsulinism |
| title_short | [68Ga] labelled Exendin for radioguided surgery of intrapancreatic insulin producing lesions in patients with congenital hyperinsulinism |
| title_sort | 68ga labelled exendin for radioguided surgery of intrapancreatic insulin producing lesions in patients with congenital hyperinsulinism |
| topic | [68Ga]Exendin-NODAGA Congenital hyperinsulinism Radioguided surgery |
| url | https://doi.org/10.1186/s13550-025-01294-8 |
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