Insulinoma other diagnostic studies: Difference between revisions
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==Overview== | ==Overview== | ||
[ | [[Arterial]] [[calcium]] stimulation with [[hepatic]] [[venous]] sampling (ASVS) is an invasive diagnostic study which is used when all other imaging studies are inconclusive. ASVS is also the [[diagnostic]] test of choice for endogenous [[hyperinsulinism]]. Findings are noted after [[Calcium-activated potassium channel|calcium]] stimulation of [[tumor]] supplying [[arteries]] and in the [[Hepatic veins|hepatic ve<nowiki/>nous]] samples which show the positive response of a two-fold or greater increase in [[insulin]] levels. | ||
==Arterial Calcium Stimulation with Hepatic Venous Sampling== | |||
*[[Arterial]] [[calcium]] stimulation with [[hepatic]] [[venous]] sampling (ASVS) may be helpful in the diagnosis of insulinoma when all other non-invasive methods and even invasive test such as [[endoscopic ultrasound]] have failed to localize the [[tumor]]. ASVS is also the [[diagnostic]] test of choice for endogenous [[hyperinsulinism]]. It provides a more accurate localization and reduces the risk of repeating surgeries. It has a greater [[Sensitivity (tests)|sensitivity]] of 100% but the [[specificity]] of 20-50%. <ref name="pmid27795707">{{cite journal |vauthors=Moreno-Moreno P, Alhambra-Expósito MR, Herrera-Martínez AD, Palomares-Ortega R, Zurera-Tendero L, Espejo Herrero JJ, Gálvez-Moreno MA |title=Arterial Calcium Stimulation with Hepatic Venous Sampling in the Localization Diagnosis of Endogenous Hyperinsulinism |journal=Int J Endocrinol |volume=2016 |issue= |pages=4581094 |year=2016 |pmid=27795707 |pmc=5066019 |doi=10.1155/2016/4581094 |url=}}</ref><ref name="pmid16360384">{{cite journal |vauthors=Grover AC, Skarulis M, Alexander HR, Pingpank JF, Javor ED, Chang R, Shawker T, Gorden P, Cochran C, Libutti SK |title=A prospective evaluation of laparoscopic exploration with intraoperative ultrasound as a technique for localizing sporadic insulinomas |journal=Surgery |volume=138 |issue=6 |pages=1003–8; discussion 1008 |year=2005 |pmid=16360384 |doi=10.1016/j.surg.2005.09.017 |url=}}</ref><ref name="pmid9426437">{{cite journal |vauthors=Brown CK, Bartlett DL, Doppman JL, Gorden P, Libutti SK, Fraker DL, Shawker TH, Skarulis MC, Alexander HR |title=Intraarterial calcium stimulation and intraoperative ultrasonography in the localization and resection of insulinomas |journal=Surgery |volume=122 |issue=6 |pages=1189–93; discussion 1193–4 |year=1997 |pmid=9426437 |doi= |url=}}</ref><ref name="pmid17431724">{{cite journal |vauthors=Tseng LM, Chen JY, Won JG, Tseng HS, Yang AH, Wang SE, Lee CH |title=The role of intra-arterial calcium stimulation test with hepatic venous sampling (IACS) in the management of occult insulinomas |journal=Ann. Surg. Oncol. |volume=14 |issue=7 |pages=2121–7 |year=2007 |pmid=17431724 |doi=10.1245/s10434-007-9398-4 |url=}}</ref><ref name="pmid10741793">{{cite journal |vauthors=Baba Y, Miyazono N, Nakajo M, Kanetsuki I, Nishi H, Inoue H |title=Localization of insulinomas. Comparison of conventional arterial stimulation with venous sampling (ASVS) and superselective ASVS |journal=Acta Radiol |volume=41 |issue=2 |pages=172–7 |year=2000 |pmid=10741793 |doi= |url=}}</ref> | |||
*'''Arteries commonly used in Arterial calcium stimulation''' | |||
**[[Splenic artery]] | |||
**[[Gastroduodenal artery]] | |||
**[[Superior mesenteric artery]] | |||
**[[Hepatic artery proper|Proper hepatic artery]] | |||
===Basis of ASVS=== | |||
**[ | * Intra-arterial administration of a [[hyperosmolar]] concentration of [[calcium]] in the [[vessels]] supplying the [[tumor]] will cause [[degranulation]] of [[cells]] within the [[neoplasm]] which releases [[insulin]] into the [[portal venous system]]. This results in a detectable rise in [[insulin]] levels in [[venous]] samples obtained from the [[hepatic vein]]. It is visualized under early [[arterial]] phase. | ||
**[ | * Findings diagnostic of insulinoma include: | ||
**Well-defined, round or oval blushes of hyper-vascularity as compared to the parenchyma of the [[pancreas]]. | |||
**Positive response is determined by an increase in [[insulin]] concentration from baseline to two-fold peak or greater. | |||
==References== | ==References== | ||
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[[Category:Gastroenterology]] | |||
[[Category:Surgery]] | |||
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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
Arterial calcium stimulation with hepatic venous sampling (ASVS) is an invasive diagnostic study which is used when all other imaging studies are inconclusive. ASVS is also the diagnostic test of choice for endogenous hyperinsulinism. Findings are noted after calcium stimulation of tumor supplying arteries and in the hepatic venous samples which show the positive response of a two-fold or greater increase in insulin levels.
Arterial Calcium Stimulation with Hepatic Venous Sampling
- Arterial calcium stimulation with hepatic venous sampling (ASVS) may be helpful in the diagnosis of insulinoma when all other non-invasive methods and even invasive test such as endoscopic ultrasound have failed to localize the tumor. ASVS is also the diagnostic test of choice for endogenous hyperinsulinism. It provides a more accurate localization and reduces the risk of repeating surgeries. It has a greater sensitivity of 100% but the specificity of 20-50%. [1][2][3][4][5]
- Arteries commonly used in Arterial calcium stimulation
Basis of ASVS
- Intra-arterial administration of a hyperosmolar concentration of calcium in the vessels supplying the tumor will cause degranulation of cells within the neoplasm which releases insulin into the portal venous system. This results in a detectable rise in insulin levels in venous samples obtained from the hepatic vein. It is visualized under early arterial phase.
- Findings diagnostic of insulinoma include:
References
- ↑ Moreno-Moreno P, Alhambra-Expósito MR, Herrera-Martínez AD, Palomares-Ortega R, Zurera-Tendero L, Espejo Herrero JJ, Gálvez-Moreno MA (2016). "Arterial Calcium Stimulation with Hepatic Venous Sampling in the Localization Diagnosis of Endogenous Hyperinsulinism". Int J Endocrinol. 2016: 4581094. doi:10.1155/2016/4581094. PMC 5066019. PMID 27795707.
- ↑ Grover AC, Skarulis M, Alexander HR, Pingpank JF, Javor ED, Chang R, Shawker T, Gorden P, Cochran C, Libutti SK (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.
- ↑ Brown CK, Bartlett DL, Doppman JL, Gorden P, Libutti SK, Fraker DL, Shawker TH, Skarulis MC, Alexander HR (1997). "Intraarterial calcium stimulation and intraoperative ultrasonography in the localization and resection of insulinomas". Surgery. 122 (6): 1189–93, discussion 1193–4. PMID 9426437.
- ↑ Tseng LM, Chen JY, Won JG, Tseng HS, Yang AH, Wang SE, Lee CH (2007). "The role of intra-arterial calcium stimulation test with hepatic venous sampling (IACS) in the management of occult insulinomas". Ann. Surg. Oncol. 14 (7): 2121–7. doi:10.1245/s10434-007-9398-4. PMID 17431724.
- ↑ Baba Y, Miyazono N, Nakajo M, Kanetsuki I, Nishi H, Inoue H (2000). "Localization of insulinomas. Comparison of conventional arterial stimulation with venous sampling (ASVS) and superselective ASVS". Acta Radiol. 41 (2): 172–7. PMID 10741793.