Evaluation of [18F]Fluoro-L-DOPA positron emission tomography-computed tomography for surgery in focal congenital hyperinsulinism

Context: In congenital hyperinsulinism (CHI), the identification and precise localization of a focal lesion is essential for successful surgery. Objective: Our objective was to evaluate the predictive value and accuracy of integrated [F-18] fluoro-L-DOPA ([F-18]FDOPA) positron emission tomography (PET)-computed tomography (CT) for the surgical therapy of CHI. Design: This was an observational study. Setting: The study was performed in the Department of Pediatric Surgery at a university hospital. Patients: From February 2005 to September 2007, 10 children with the clinical signs of CHI and an increased radiotracer uptake in a circumscribed area of the pancreas in the [F-18]FDOPA PET-CT were evaluated. Interventions: Guided by the [F-18]FDOPA PET-CT report, all children underwent partial pancreatic resection, in two cases twice. Main Outcome Measures: Correlation of the anatomical findings at surgery with the report of the [F-18] FDOPA PET-CT, and the results of surgery and clinical outcome were determined. Results: In nine children the intraoperative situation corresponded exactly to the description of the [F-18] FDOPA PET-CT. A limited resection of the pancreas was curative in eight cases at the first surgery, in one case at the second intervention. We observed no diabetes mellitus or exocrine insufficiency in the follow up so far. In one child, hypoglycemia persisted even after two partial resections of the pancreatic head. Histological analysis finally revealed an atypical intermediate form of CHI. Conclusions: The integrated [F-18]FDOPA PET-CT is accurate to localize the lesion in focal CHI and is a valuable tool to guide the surgeon in limited pancreatic resection.