A patient with insulinoma diagnosed by clinical features and localized preoperatively using a combination of contrast-enhanced ultrasonography (CEUS), dual phase contrast enhanced spiral computed tomography (DPSCT) and arterial stimulation and venous sampling (ASVS) was reported. A 37-year-old man was admitted to our hospital because of hypoglycemic attacks, palpitations, and muscular weakness. Fajans' ratio reported to be an index for insulinoma was positive. Transabdominal computed tomography and ultrasonography failed to detect any abnormalities. CEUS showed a small low echoic lesion in the pancreatic body with blood flow and the early arterial phase of DPSCT revealed a small strengthening focus, which mimicked a pancreatic tumor in the pancreatic body. ASVS showed that the insulin levels in the hepatic vein were extremely increased by calcium injection to the gastroduodenal artery. An open intra-abdominal operation was performed and an insulinoma was confirmed in the pancreatic body. Enucleation of tumor was undertaken and histopathological examination showed an adenoma, insulin expression was positive in immunofluorescence staining. Symptomatic hypoglycemia never happened even without glucose infusion since the operation. His blood glucose level improved to within the normal range.
Adult ; Humans ; Insulinoma ; diagnosis ; diagnostic imaging ; surgery ; Male ; Radiography ; Ultrasonography

To prospectively evaluate the correlation between intravoxel incoherent motion (IVIM)-derived parameters and CT perfusion parameters as well as the pathological grade in insulinoma. A total of 55 patients with suspected insulinoma undergoing IVIM and CT perfusion scans were prospectively enrolled. The images were post-processed to obtain IVIM parameters including apparent diffusion coefficient (ADC),diffusion (D),perfusion correlated diffusion (D*),and f,and CT perfusion parameters including blood flow (BF),blood volume (BV),and permeability (PM). The pathological specimens were stained to obtain pathological parameters including the grading,ki-67 index,and the mitotic count. The IVIM derived parameters of normal pancreas including head,body,and tail as well as that of the pancreatic insulinoma were compared. The correlation between IVIM parameters and CT perfusion parameters as well as the pathological parameters was analyzed. ADC and D values of pancreatic tail were significantly lower than those of the pancreatic head and neck (all <0.001). There were significant differences in all IVIM parameters between insulinoma and normal pancreas (all <0.001). The ADC and f value of the normal pancreas was positively correlated with BF (=0.437,=0.003;=0.357,=0.010). There is no correlation between the remaining IVIM parameters and the CT perfusion parameters as well as between IVIM parameters and pathological parameters (all >0.05). IVIM parameters differ at different anatomical parts of normal pancreas. IVIM parameters can distinguish normal pancreatic parenchyma from insulinoma. The ADC value is weakly correlated with BF.
Diffusion Magnetic Resonance Imaging ; Humans ; Insulinoma ; diagnostic imaging ; Motion ; Pancreatic Neoplasms ; diagnostic imaging ; Reproducibility of Results ; Tomography, X-Ray Computed

Endocrine test data from a 13-year old intact female Maltese was indicative of the presence of an insulinoma, however ultrasonography identified a pancreatic mass only after 10 months after the first admission. Following identification of both pancreatic tumor and hepatic metastasis on computed tomography (CT), surgical excision of the mass was attempted. However, total excision failed because of tumor adhesion to adjacent large vessels. The pancreatic mass was monitored over the next 25 months via ultrasonography, CT, and positron emission tomography-computed tomography (PET-CT). Histopathological and immunohistochemical data confirmed the diagnosis of insulinoma with hepatic metastasis.
Animals ; Diagnostic Imaging ; Dogs ; Electrons ; Female ; Humans ; Insulinoma ; Neoplasm Metastasis ; Positron-Emission Tomography

OBJECTIVETo evaluate the effect and safety of enucleation of insulinoma under the Da Vinci robotic surgical system combination with intraoperative ultrasonography(IOUS) for the localization.

METHODSThe clinical materials of 50 insulinoma cases which underwent IOUS and assisted by the robotic surgical system from September 2012 to September 2014 in Peking Union Medical College Hospital were reviewed retrospectively. The patients were followed up by outpatient review and telephone until October 2014. The diagnostic accuracy rate, operation time, blood loss, complications and cure rate were analyzed by t-test.

RESULTSThe locations of tumors were 13 in the head, 21 in the body and 13 in the tail of pancreas, 2 were multiple insulinoma, 1 was ectopic to mesenterium.The average operation time was 142 minutes; the average blood loss was 165 ml.Three(6.0%) patients were transformed to open.One patient experienced postoperative bleeding about 300 ml on the 7(th) day after operation and no infection and perioperative death.Thirty-five cases were of class A and 14 of class B according to the clinical grading of postoperative pancreatic fistula.The blood glucose 60 minutes after tumor dissection was significantly elevated than that before operation ((6.2±1.8)mmol/L vs.(3.7±1.2)mmol/L)(t=-6.89, P<0.01). The cure rate was 100% as all the patients' symptoms were disappeared during follow-up time.

CONCLUSIONSCombination IOUS is a highly sensitive method for the localization of insulinoma, which is helpful in localizing tumors precisely in insulinoma cases assisted by robotic surgical system and shortening operation time.It is safe and effective for insulinoma enucleation.

Blood Glucose ; analysis ; Humans ; Insulinoma ; diagnostic imaging ; surgery ; Operative Time ; Pancreas ; diagnostic imaging ; surgery ; Pancreatic Neoplasms ; diagnostic imaging ; surgery ; Postoperative Complications ; Retrospective Studies ; Robotic Surgical Procedures ; Ultrasonography

Objective To determine the appropriate averaging strategy for pancreatic perfusion datasets to create images for routine reading of insulinoma.Methods Thirty-nine patients undergoing pancreatic perfusion CT in Peking Union Medical College Hospital and diagnosed as insulinoma by pathology were enrolled in this retrospective study.The time-density curve of abdominal aorta calculated by software dynamic angio was used to decide the timings for averaging.Five strategies,by averaging 3,5,7,9 and 11 dynamic scans in perfusion,all including peak enhancement of the abdominal aorta,were investigated in the study.The image noise,pancreas signal-to-noise ratio(SNR),lesion contrast and lesion contrast-to-noise ratio(CNR)were recorded and compared.Besides,overall image quality and insulinoma depiction were also compared.ANOVA and Friedman's test were performed.Results The image noise decreased and the SNR of pancreas increased with the increase in averaging time points(all P<0.001).The lesion contrast(69.81±41.35)averaged from 5 scans showed no significant difference compared with that(72.77±45.25)averaged from 3 scans(P=0.103),both of which were higher than that in other groups(all P≤0.001).The lesion CNRs of the last four groups showed no significant difference(all P>0.99)and were higher than that of the first group(all P<0.05).There was no significant difference in overall image quality among the 5 groups(P=0.977).Conclusions Image averaged from 5 scans showed moderate image noise,pancreas SNR and relatively high lesion contrast and lesion CNR.Therefore,it is advised to be used in image averaging to detect insulinoma.
Contrast Media ; Humans ; Insulinoma/diagnostic imaging* ; Pancreas/diagnostic imaging* ; Pancreatic Neoplasms/diagnostic imaging* ; Perfusion ; Radiographic Image Interpretation, Computer-Assisted ; Reading ; Retrospective Studies ; Signal-To-Noise Ratio

OBJECTIVETo analyze the value of intraoperative ultrasonography (IOUS) in the diagnosis and therapy of insulinoma.

METHODSFrom January 2000 to December 2007, the application of intraoperative ultrasonography used in 44 cases with insulinoma who came from department of general surgery, First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. There were 19 males and 25 females in the group. Every case accepted operation and examination of IOUS.

RESULTSTumor was accurately located and its adjacent structure was also clear by IOUS in 43 cases, the other one was islet cell hyperplasia, the detection rate of tumor was 100%. The complications: one case occurred pancreatic fistula, one occurred pancreatitis, and there was no biliary fistula and hemorrhage.

CONCLUSIONSPresently, IOUS is one simple and effective method to local insulinoma, and it could improve the success rate of operation and reduce complications.

Adolescent ; Adult ; Aged ; Female ; Humans ; Insulinoma ; diagnostic imaging ; surgery ; Intraoperative Care ; Male ; Middle Aged ; Pancreatic Neoplasms ; diagnostic imaging ; surgery ; Retrospective Studies ; Treatment Outcome ; Ultrasonography ; Young Adult

OBJECTIVETo investigate the diagnosis and treatment of pancreatic islet cell tumors.

METHODSFifty-one patients with islet cell tumors treated in our department from January 1991 to April 2011 were included in this study. The data of clinical features, diagnosis and treatment were retrospectively analyzed.

RESULTSAmong the 51 cases, 38 cases showed typical Whipple's triad, and the other 13 cases were non-functional islet cell tumors. In these 13 cases, 5 patients had no specific clinical symptoms, and 8 patients had abdominal distending pain. The positive rates of imaging were: B-ultrasound 43.1%, multi-slice spiral CT 69.8%; MRI 62.5%, endoscopic ultrasonography (EUS) 64.7% (11/17), and intraoperative ultrasound (IOUS) 96.3%, the differences among them were statistically significant (P<0.05). All patients underwent surgical treatment. Postoperative pancreatic leakage happened in 6 cases. Finally all the patients recovered after effective external drainage, anti-infection treatment and nutritional support.

CONCLUSIONSIntraoperative ultrasonography (IOUS) has a higher accuracy in the diagnosis of pancreatic islet cell tumors, compared with preoperative B-ultrasonography, CT, MRI, and endoscopic ultrasound (EUS). The most effective treatment of this disease is surgery.

Adenoma, Islet Cell ; diagnosis ; diagnostic imaging ; surgery ; Adult ; Anastomotic Leak ; etiology ; Endosonography ; Female ; Humans ; Insulinoma ; diagnosis ; diagnostic imaging ; surgery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Multidetector Computed Tomography ; Pancreatectomy ; adverse effects ; Pancreatic Neoplasms ; diagnosis ; diagnostic imaging ; surgery ; Retrospective Studies

OBJECTIVETo investigate the perfusion characteristics of normal pancreas and insulinoma on multi-slice spiral CT (MSCT).

METHODSTotally 21 subjects with suspected insulinoma were enrolled. Sixteen-slice spiral CT was used for perfusion scan following a standard contrast-enhanced scan. The surgical and pathological outcomes were collected for comparison. Perfusion characteristics, including blood flow (BF), patlak blood volume (pBV), time to peak (TTP), permeability, and peak enhancement (PE) of insulinomas and normal pancreas parenchyma were analyzed based on the MSCT data sets subsequently.

RESULTSBenign insulinoma was pathologically confirmed in 12 out of the 21 subjects, while the remaining 9 subjects were normal. Technical failures were experienced in 2 (9.5%) subjects. In both normal and tumor-suffered subjects (n = 19), perfusion parameters of normal pancreatic parachyma were measured as follows: BF (p) = 104. 9 +/- 28.9, pBV (p) = 166.4 +/- 41.8, TrP (p) = 133.3 +/- 24.4, Permeability (p) = 81.3 +/- 24.4, and peak enhancement (p) = 121.3 +/- 31.1. In subjects with insulinoma (n = 11), perfusion parameters of tumor tissue were measured as follows: F (i) = 206.5 +/- 42.2, BV (i) = 315.9 +/- 79.0, TFP (i) = 123.2 +/- 18.8, Permeability (i) = 102.5 +/- 54. 8, and peak enhancement (i) = 221.3 +/- 48.5. Results of F, BV, and peak enhancement in these two kinds of tissue showed significant differences (P < 0.01), while there were no significant difference (P > 0.05) in TTP and permeability between normal pancreatic parenchyma and insulinoma.

CONCLUSIONSBenign insulinoma has perfusion characteristics of increased blood flow and blood volume, but its TTP is consistent with normal pancreas and has normal permeability. MSCT allows further understanding of the blood flow of the normal pancreas and its benign tumor insulinoma.

Adult ; Aged ; Female ; Humans ; Insulinoma ; blood supply ; diagnostic imaging ; Male ; Middle Aged ; Pancreas ; blood supply ; diagnostic imaging ; Pancreatic Neoplasms ; blood supply ; diagnostic imaging ; Perfusion ; Regional Blood Flow ; Tomography, Spiral Computed ; methods

Multiple endocrine neoplasia type 1 (MEN1) is an inherited autosomal dominant disease presenting with pancreatic neuroendocrine tumors (pNETs), parathyroid tumors, or pituitary tumors. Using the PubMed database, we reviewed the literature on information regarding the proper diagnosis and treatment of MEN1-associated pNET. Many cases of MEN1-associated pNET are functioning pNETs. Gastrinomas and insulinomas tend to occur frequently in the duodenum and pancreas, respectively. In addition to diagnostic imaging, the selective arterial secretagogue injection test (SASI test) is useful for localizing functioning pNET. The standard treatment is surgical resection. However, in the case of a functioning pNET, the tumor should first be accurately located using the SASI test before an appropriate surgical method is selected. In cases of a MEN1-associated non-functioning pNET that exceeds 2 cm in diameter, the incidence of distant metastasis is significantly increased, and surgery is recommended. In cases of unresectable pNET, a somatostatin analog has been shown to demonstrate antitumor effects and is considered to be a promising treatment. In addition, molecular-targeted drugs have recently been found to be effective in phase III clinical trials.
Diagnostic Imaging ; Duodenum ; Gastrinoma ; Incidence ; Insulinoma ; Multiple Endocrine Neoplasia ; Multiple Endocrine Neoplasia Type 1 ; Neoplasm Metastasis ; Neuroectodermal Tumors, Primitive ; Neuroendocrine Tumors ; Pancreas ; Pituitary Neoplasms ; Somatostatin

We described a female patient with insulinoma who experienced recurrent episodes of automatism, confusion and convulsion. Furthermore, her electroencephalography (EEG) findings resembled the pattern in complex partial seizures with secondary generalization. The interictal EEG showed spikes and sharp waves, as well as focal slowing over the left temporal lobe, and the ictal EEG revealed generalized spikes and sharp waves associated with diffused slowing. She was initially misdiagnosed as pharmacoresistant epilepsy. After the insulinoma was found and surgically removed, her EEG turned normal and she was seizure-free during the 4-year follow-up. This report highlights the need for careful reassessment of all seizures refractory to medication, even for the patients associated with epileptiform discharges on EEG.
Anticonvulsants ; pharmacology ; Diagnosis, Differential ; Drug Resistance ; Electroencephalography ; Epilepsies, Partial ; diagnosis ; drug therapy ; Female ; Humans ; Insulinoma ; diagnosis ; diagnostic imaging ; Middle Aged ; Pancreatic Neoplasms ; diagnosis ; diagnostic imaging ; Tomography, X-Ray Computed