Images from 18 F-DOPA Scan in Congenital Hyperinsulinism: Not Always a Clue for Diagnosis.

Congenital hyperinsulinism (CHI) is the most common cause of persistent hypoglycaemia in childhood (Horm Res 70:65-72, 2008; J Clin Endocr Metab 93:869-875, 2008). ^18- Fluoro-L-dihydroxy-phenylalanine ( ¹⁸ F-DOPA) positron emission tomography (PET) can detect areas of increased activity in the pancreas and may differentiate focal from diffuse CHI (J Clin Endocr Metab 93:869-875, 2008; Radiology 253:216-222, 2009). We here report the case of a girl who complained of recurrent episodes of severe hypoglycaemia despite previous partial pancreatectomy. To evaluate the need for additional surgical intervention, we performed ¹⁸ F-DOPA PET/computed tomography (CT), which showed a focal lesion corresponding to the anatomical region of the pancreatic tail. On the other hand, abdominal magnetic resonance imaging (MRI) clearly demonstrated that the ¹⁸ F-DOPA uptake was in a loop of bowel occupying the previous surgical bed. Our case highlights that bowel uptake can be a possible pitfall in the interpretation of ¹⁸ F-DOPA PET/CT in children affected by CHI, suggesting that when ¹⁸ F-DOPA PET/CT results do not fit the clinical picture, magnetic resonance imaging (MRI) may allow a more accurate correlation of the radiotracer activity with the underlying anatomical or pathological structure.
Competing Interests: Compliance with Ethical StandardsEvelina Maines, Luca Giacomello, Mirko D’Onofrio, Matteo Salgarello, Rossella Gaudino, Laura Baggio and Andrea Bordugo declare that they have no conflicts of interests.The study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Written informed consent was obtained from the patient’s mother for publication of this report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. The identity of the patient has been protected.