Essentials of Insulinoma Localization with Selective Arterial Calcium Stimulation and Hepatic Venous Sampling
Abstract
:1. Introduction
2. Non-Invasive Pre-Operative Localization
3. Invasive Pre-Operative Localization
4. Intraoperative Localization
5. Selective Arterial Calcium Stimulation and Hepatic Venous Sampling
6. Pancreatic Vascular Anatomy
7. Pre-Procedural Workup
8. Procedural Description
9. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Method | Detection Rate | Pros | Cons |
---|---|---|---|
Transabdominal US [19,20,21] | 9–63% | Inexpensive. Widely available. | Limited by body habitus and bowel gas. Poor visualization of pancreatic tail and small tumors. |
Contrast Enhanced CT [22,23,24] | 63–94% | Rapid imaging. High spatial resolution. Visualizes anatomy and potential metastatic disease. | Ionizing radiation. Iodinated contrast. |
Contrast-Enhanced MRI [25,26] | 60–90% | No ionizing radiation. No iodinated contrast. | Expensive. Confined space. Prone to motion artifact. |
Somatostatin Receptor Imaging [27,28,29,30] | 47–60% or 32–90%, per radiotracer | Useful for troubleshooting when other imaging is negative or equivocal. | Ionizing radiation. Long image acquisition time. Poor spatial resolution. |
Endoscopic Ultrasound [31] | 40–93%, per pancreatic region | Excellent visualization of pancreatic head. May obtain concurrent biopsies. | Invasive. Poor visualization of pancreatic tail. |
SACST [14,16,17,32,33] | 67–100% | High sensitivity. | Invasive. Ionizing radiation. Requires technical expertise. |
Operative Inspection and Palpation [16,17] | 77–91% | Highly effective when performed by expert surgeon. | Requires open surgery and operative experience. |
Hepatic Venous Sampling |
6 Fr short sheath (right internal jugular vein), no flush |
6 Fr 65 cm Cobra catheter, with added side hole |
42 labeled 10 cc syringes |
Selective Arterial Calcium Stimulation |
5 Fr short sheath (right common femoral artery), normal saline flush |
5 Fr 100 cm Sim 1 catheter |
130 cm Progreat microcatheter and Fathom microwire |
10% calcium gluconate solution (940 mg/10 cc) diluted to 5 cc aliquots of 1 mg/kg (0.025 mEq Ca/kg) |
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Zhao, K.; Patel, N.; Kulkarni, K.; Gross, J.S.; Taslakian, B. Essentials of Insulinoma Localization with Selective Arterial Calcium Stimulation and Hepatic Venous Sampling. J. Clin. Med. 2020, 9, 3091. https://doi.org/10.3390/jcm9103091
Zhao K, Patel N, Kulkarni K, Gross JS, Taslakian B. Essentials of Insulinoma Localization with Selective Arterial Calcium Stimulation and Hepatic Venous Sampling. Journal of Clinical Medicine. 2020; 9(10):3091. https://doi.org/10.3390/jcm9103091
Chicago/Turabian StyleZhao, Ken, Nihal Patel, Kopal Kulkarni, Jonathan S. Gross, and Bedros Taslakian. 2020. "Essentials of Insulinoma Localization with Selective Arterial Calcium Stimulation and Hepatic Venous Sampling" Journal of Clinical Medicine 9, no. 10: 3091. https://doi.org/10.3390/jcm9103091