インスリノーマの非侵襲診断に成功~新開発のPET/CT検査が高精度検出を実現~

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2025-05-21 京都大学

インスリノーマの非侵襲診断に成功~新開発のPET/CT検査が高精度検出を実現~

京都大学の研究チームは、稀なホルモン産生腫瘍であるインスリノーマの非侵襲的診断法として、新たなPET/CT検査法を開発しました。この手法では、インスリノーマ細胞に多く発現するGLP-1受容体を標的とした新規PETプローブ([^18F]FB(ePEG12)12-exendin-4)を用いて、高感度な画像診断を実現しました。12名の患者に対する臨床試験では、腫瘍の存在部位を100%の感度で特定し、従来のCTやMRI検査では発見が難しかった腫瘍も含め、全例で手術による根治が達成されました。この研究成果は、2025年5月20日に国際学術誌「The Journal of Clinical Endocrinology & Metabolism」にオンライン掲載され、インスリノーマ診断における画期的な非侵襲的検査法として期待されています。

<関連情報>

18F]FB(ePEG12)12-Exendin-4 PET/CTを用いたインスリノーマの非侵襲的診断の定性的および定量的解析 Qualitative and Quantitative Analyses of Noninvasive Diagnosis of Insulinoma Using [18F]FB(ePEG12) 12-Exendin-4 PET/CT

Takaaki Murakami , Hayao Yoshida , Kentaro Sakaki , Daisuke Otani , Kanae Kawai Miyake , Yoichi Shimizu , Hiroyuki Fujimoto , Daisuke Yabe , Yuji Nakamoto , Nobuya Inagaki
The Journal of Clinical Endocrinology & Metabolism  Published:20 May 2025
DOI:https://doi.org/10.1210/clinem/dgaf253

Abstract

Context

This study represents the first interim report from a phase 2 clinical trial. Accurate localization of insulinomas remains a clinical challenge despite the availability of various imaging modalities.

Objective

The current study aimed to evaluate the efficacy of positron emission tomography/computed tomography (PET/CT) using [18F]FB(ePEG12)12-exendin-4 (18F-exendin-4), a novel 18F-labeled PEGylated glucagon-like peptide 1 (GLP-1) receptor-targeted imaging probe, for the noninvasive detection of insulinomas.

Methods

This prospective single-center study enrolled patients with biochemically confirmed hyperinsulinemic hypoglycemia suggestive of insulinoma. All patients underwent 18F-exendin-4 PET/CT, with scans performed at 60 and 120 minutes after injection. The findings of 18F-exendin-4 PET/CT were then compared with those of conventional imaging modalities performed before and after 18F-exendin-4 PET/CT in actual clinical settings, with all findings being verified through surgical and pathological findings.

Results

18F-exendin-4 PET/CT successfully identified insulinomas in all 12 patients (100% sensitivity), showing significantly higher uptake in tumor tissues than in the surrounding pancreatic tissues and organs. The detection rate of 18F-exendin-4 PET/CT exceeded that of the conventional imaging modalities (CT, 83%; magnetic resonance imaging, 63%; endoscopic ultrasonography, 90%; selective arterial calcium stimulation, 89%). All identified lesions were surgically confirmed to be insulinomas, with complete clinical resolution of hypoglycemia after resection.

Conclusion

18F-exendin-4 PET/CT demonstrated effective sensitivity for noninvasive insulinoma detection, offering a reliable and practical diagnostic alternative to invasive procedures for precise and prompt preoperative localization with functional evaluation. This novel imaging approach may therefore improve the management of patients with suspected insulinomas.

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