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Selective intra-arterial calcium stimulation with hepatic venous sampling for preoperative localization of insulinomas.

Sung YM, Do YS, Lee MK, Shin SW, Liu WC, Choo SW, Choo IW - Korean J Radiol (2003 Apr-Jun)

Bottom Line: In all patients except one, C-peptide gradients were also analyzed.The results were compared with the preoperative findings of ultrasonography, computed tomography, arteriography and endoscopic ultrasonography, as well as with the intraoperative findings of ultrasonography and palpation at surgery.Additional C-peptide gradients seem to be helpful in assessing tumor location, but further study is needed.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Kangnam-gu, Seoul, Korea.

ABSTRACT

Objective: To determine the value of selective intra-arterial calcium stimulation with hepatic venous sampling using serum insulin and C-peptide gradients for the preoperative localization of insulinomas.

Materials and methods: Seven consecutive patients (three men and four women aged 15-77 (mean, 42.7) years) with hypoglycemia underwent selective intra-arterial calcium stimulation in conjunction with hepatic venous sampling. Insulin gradients were calculated by an individual blinded to all other preoperative imaging studies and operative findings. In all patients except one, C-peptide gradients were also analyzed. The results were compared with the preoperative findings of ultrasonography, computed tomography, arteriography and endoscopic ultrasonography, as well as with the intraoperative findings of ultrasonography and palpation at surgery.

Results: Eight insulinomas (mean diameter, 12.5 mm) were diagnosed after surgery. In six patients, the calcium stimulation test with insulin gradients allowed accurate localization of the pathologic source of insulin secretion. Both C-peptide and insulin gradients substantially increased diagnostic accuracy. In one patient, C-peptide gradients were more helpful than insulin gradients for tumor localization.

Conclusion: Selective intra-arterial calcium stimulation with hepatic venous sampling is a highly accurate and safe method for the preoperative localization of insulinomas. Additional C-peptide gradients seem to be helpful in assessing tumor location, but further study is needed.

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Related in: MedlinePlus

A 15-year-old youth (patient 3) with an insulinoma of the pancreatic tail.A. In the splenic artery, the insulin gradient peaked at 30 secs.B. In the same artery, the C-peptide gradient also peaked at 30 secs.C. Splenic arteriogram shows tumor staining (arrow) within the pancreatic tail.
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Figure 3: A 15-year-old youth (patient 3) with an insulinoma of the pancreatic tail.A. In the splenic artery, the insulin gradient peaked at 30 secs.B. In the same artery, the C-peptide gradient also peaked at 30 secs.C. Splenic arteriogram shows tumor staining (arrow) within the pancreatic tail.

Mentions: In patients 1, 2, 5 and 7, significant insulin gradients were observed after calcium injection into the GDA and in patient 6 after stimulation of the GDA and SMA, indicating the presence of insulinomas in the pancreatic head or uncinate process (Fig. 2A). In patients 2, 5, 6 and 7, C-peptide gradients were also significant (Fig. 2B), and in patient 3, both insulin and C-peptide gradients increased significantly after stimulation of the SpA, suggesting that the pathological source of insulin might be the pancreatic body or tail (Fig. 3).


Selective intra-arterial calcium stimulation with hepatic venous sampling for preoperative localization of insulinomas.

Sung YM, Do YS, Lee MK, Shin SW, Liu WC, Choo SW, Choo IW - Korean J Radiol (2003 Apr-Jun)

A 15-year-old youth (patient 3) with an insulinoma of the pancreatic tail.A. In the splenic artery, the insulin gradient peaked at 30 secs.B. In the same artery, the C-peptide gradient also peaked at 30 secs.C. Splenic arteriogram shows tumor staining (arrow) within the pancreatic tail.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2698067&req=5

Figure 3: A 15-year-old youth (patient 3) with an insulinoma of the pancreatic tail.A. In the splenic artery, the insulin gradient peaked at 30 secs.B. In the same artery, the C-peptide gradient also peaked at 30 secs.C. Splenic arteriogram shows tumor staining (arrow) within the pancreatic tail.
Mentions: In patients 1, 2, 5 and 7, significant insulin gradients were observed after calcium injection into the GDA and in patient 6 after stimulation of the GDA and SMA, indicating the presence of insulinomas in the pancreatic head or uncinate process (Fig. 2A). In patients 2, 5, 6 and 7, C-peptide gradients were also significant (Fig. 2B), and in patient 3, both insulin and C-peptide gradients increased significantly after stimulation of the SpA, suggesting that the pathological source of insulin might be the pancreatic body or tail (Fig. 3).

Bottom Line: In all patients except one, C-peptide gradients were also analyzed.The results were compared with the preoperative findings of ultrasonography, computed tomography, arteriography and endoscopic ultrasonography, as well as with the intraoperative findings of ultrasonography and palpation at surgery.Additional C-peptide gradients seem to be helpful in assessing tumor location, but further study is needed.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Kangnam-gu, Seoul, Korea.

ABSTRACT

Objective: To determine the value of selective intra-arterial calcium stimulation with hepatic venous sampling using serum insulin and C-peptide gradients for the preoperative localization of insulinomas.

Materials and methods: Seven consecutive patients (three men and four women aged 15-77 (mean, 42.7) years) with hypoglycemia underwent selective intra-arterial calcium stimulation in conjunction with hepatic venous sampling. Insulin gradients were calculated by an individual blinded to all other preoperative imaging studies and operative findings. In all patients except one, C-peptide gradients were also analyzed. The results were compared with the preoperative findings of ultrasonography, computed tomography, arteriography and endoscopic ultrasonography, as well as with the intraoperative findings of ultrasonography and palpation at surgery.

Results: Eight insulinomas (mean diameter, 12.5 mm) were diagnosed after surgery. In six patients, the calcium stimulation test with insulin gradients allowed accurate localization of the pathologic source of insulin secretion. Both C-peptide and insulin gradients substantially increased diagnostic accuracy. In one patient, C-peptide gradients were more helpful than insulin gradients for tumor localization.

Conclusion: Selective intra-arterial calcium stimulation with hepatic venous sampling is a highly accurate and safe method for the preoperative localization of insulinomas. Additional C-peptide gradients seem to be helpful in assessing tumor location, but further study is needed.

Show MeSH
Related in: MedlinePlus