Insulinoma ultrasound

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2]

Overview

Transabdominal ultrasound has low sensitivity varying between 0 to 66% in detecting insulinoma. The sensitivity increases with the use of more invasive technique including endoscopic ultrasound (93%) and intra-operative ultrasound (86%). Hypo-echoic lesions and hypervascular mass are seen on the ultrasound.

Transabdominal Ultrasound

Invasive Ultrasound

Endoscopic Ultrasound

This is an invasive ultrasound which can be done pre-operatively. The use has been increased with the increase in sensitivities from 40 to 93%, more accurate in diagnosing pancreatic head insulinomas. It is supported as the primary diagnostic modality for the diagnosis of pancreatic neuroendocrine tumors (which includes insulinoma). The advantages include:[1][2][3]

  • Visualization of smaller tumors (2mm)
  • Detection of invasion and local metastasis
  • Higher spatial resolutions

The disadvantages are:

  • Invasiveness
  • High cost
  • Availabilty and expertise

Intra-operative Ultrasound

The use was introduced in 1981 and used to localize non-palpable lesions and tumors which are in close proximity to pancreatic and bile ducts. They can localize the tumors in 86% of cases when performed during an open or laparoscopic surgery. [4][5]

References

  1. 1.0 1.1 McAuley, G.; Delaney, H.; Colville, J.; Lyburn, I.; Worsley, D.; Govender, P.; Torreggiani, W.C. (2005). "Multimodality preoperative imaging of pancreatic insulinomas". Clinical Radiology. 60 (10): 1039–1050. doi:10.1016/j.crad.2005.06.005. ISSN 0009-9260.
  2. Sotoudehmanesh R, Hedayat A, Shirazian N, Shahraeeni S, Ainechi S, Zeinali F; et al. (2007). "Endoscopic ultrasonography (EUS) in the localization of insulinoma". Endocrine. 31 (3): 238–41. PMID 17906369.
  3. Anderson MA, Carpenter S, Thompson NW, Nostrant TT, Elta GH, Scheiman JM (2000). "Endoscopic ultrasound is highly accurate and directs management in patients with neuroendocrine tumors of the pancreas". Am J Gastroenterol. 95 (9): 2271–7. doi:10.1111/j.1572-0241.2000.02480.x. PMID 11007228.
  4. Brown CK, Bartlett DL, Doppman JL, Gorden P, Libutti SK, Fraker DL; et al. (1997). "Intraarterial calcium stimulation and intraoperative ultrasonography in the localization and resection of insulinomas". Surgery. 122 (6): 1189–93, discussion 1193-4. PMID 9426437.
  5. Grover AC, Skarulis M, Alexander HR, Pingpank JF, Javor ED, Chang R; et al. (2005). "A prospective evaluation of laparoscopic exploration with intraoperative ultrasound as a technique for localizing sporadic insulinomas". Surgery. 138 (6): 1003–8, discussion 1008. doi:10.1016/j.surg.2005.09.017. PMID 16360384.

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