The Optimization Of The Medical Imaging In The Preoperative Localization Of The Insulinoma

Background: The majority of primary pancreas β cell endocrinal tumor insulinomaare benign, small and intrapancreatic. Preoperative localization is important andnecessary to plan the surgical management The purpose of this study are: to explore theadvantage of the combined approach of MRI, CT and99mTc-octreotide-SPECT/CT andthe combined approach of the Contrast-enhanced ultrasonography (CEUS) andendoscopic ultrasound (EUS) in the preoperative localization of insolinoma, to explorethe technological process of the combined approaches in preoperative detection ofinsulinoma.METHODS:1. The retrospective analysis is about the thirty-three instances betweenJanuary2007and January2010.The patients with clinical and biochemical signs ofpancreatic insulinoma underwent CT, EUS and CEUS. The accuracy of preoperativediagnoses location of the lesions were evaluated and compared between the combinedapproach of CEUS and EUS.2. The eighteen patients with clinical and biochemicallydiagnosis in our hospital between January2010and September2011were included inthis study. The SPECT scans were fused with CT scans using a vacuum fixation device.The99mTc-octreotide-SPECT/CT, contrast-enhanced CT and MRI were undertaken inpatients. The accuracy of preoperative diagnoses location of the lesions were evaluatedResults:1. Of the33patients with biochemically diagnosis treated surgically，all had CTwith successful localisation in18(54.5%) by CT.Thirty three had the combinedapproach of CEUS and EUS. Thirty patients（90.9%）was localized successful. Theanalysis showed that the accuracy had a significant difference between the combinedapproach and CT (P<0.05).2. Eighteen instances of biochemically and/or histologicallyproven insulinoma were identified and treated surgically. Of the18treated surgically, all had CT and MRI with successful localization in10(55.6%) by CT and13(72.2%)by MRI respectively. Considered together, the combined approaches of CT and MRIcorrectly localized83.3%of lesions. The combined approaches of CT、MRI andRadio labelled octreotide scanning correctly localized94.4%of lesionsCONCLUTION: the combined approach of the Contrast-enhanced ultrasonography(CEUS) and endoscopic ultrasound (EUS) and the combined approach of MRI, CTand99mTc-octreotide-SPECT/CT are helpful in the qualitaty and localization of theinsulinoma for finishing total excision. But the latter is more rational for the doctor whocan get direct-vision images from it to finish the operation successfully.