Endocrine Abstracts

Introduction: Topical diagnosis of insulinoma is an actual problem due to the low detection rate of tumors (about 75%) and conflicting data about its localization in pancreas (more than 50%) when using different imaging techniques. This is partly due to the subjectivity of visualizing diagnosis specialists when describing the location of tumor. We assumed that multimodal imaging Fusion will improve the accuracy of topical diagnosis of insulinoma.

Aim: To determine the feasibility of Fusion technology for localization of insulinoma.

Materials and methods: We include 12 patients with laboratory confirmed hypoglycemic syndrome and autonomous insulin secretion aged 31-65 years. All patients underwent standard initial imaging examination for localization of insulinomas – computer tomography (CT), magnetic resonance imaging (MRI) and ultrasonography (US). In addition, we used the Smart Fusion (S-Fusion) intelligent program for synchronization real-time ultrasonography images and CT images, as well as MRI images. We created magnetic field next to the US machine and mounted magnetic sensors at the US transducer. Then we loaded data of CT (or MRI) and displayed image with tumor on the screen of US machine. The same section was obtained using the US transducer. Then we established anatomical landmarks on CT (MRI) and US images and synchronized them. In accordance with data obtained by combining the images we made topical diagnosis in all patients and then performed surgical treatment of insulinoma.

Results: There was a discrepancy in topical diagnosis, according to the standard initial imaging examination, in 5 patients (42%). The intelligent program S-Fusion helped us to clarify the tumor localization in these patients. This study also allowed to obtain more accurate information on the location of tumor (including in relation to vessels) in those patients in whom topical diagnosis was not doubt (n=7). The duration of ultrasound with the application of S-Fusion technology increased by only 5 minutes, and the cost was not changed. Intraoperative revision in all patients (100%) confirmed the presence of tumor of pancreas in accordance with the established topical diagnosis: in the head (n=3; 25%), body (n=3; 25%), tail (n=6; 50%). Microscopic examination confirmed the immunomorphological characteristics of insulin-producing tumors in all patients. In the postoperative period none of the patients had hypoglycemia.

Conclusions: Fusion technology eliminates the subjectivity of visualizing diagnosis specialists and provides more accurate information on the location of tumor. Advantages of this method are: non-invasiveness, absence of ionizing radiation, low cost and low duration of the study.