Role of of Dynamic Volume Computed Tomography in Comparison with Different Visualization Methods in the Topical Diagnosis of Insulinomas

Purpose: to compare the accuracy of preoperative detection of insulinomas between Volume Dynamic CT- tomography, percutaneous sonography, endoscopic sonography, none contrast MDCT, conventional angiography and selective arterial-stimulated blood sampling. Materials and methods. The study included 45 patients with typical clinical symptoms and the presence of Whipple's triad. All 45 patients underwent percutaneous and endoscopic sonography, non -contrast MDCT, dynamic volume computed tomography, selective angiography with arterial stimulation with calcium with simultaneous venous sampling (ASVS). Results. lintraoperatively in 45 patients it was found 66 insulinomas. During preoperative volume dynamic computed tomography was found 61 (92.42%). The degree of contrast enhancement of insulinoma in all contrast phases of the study was significantly higher than contrast enhancement of normal pancreatic parenchyma. Delectability of insulinoma in the arterial contrast phase was significantly higher compared with portal contrast phase. This kind of research has revealed early accumulation of contrast medium in small formations (up to 10 mm) of the pancreas, which allowed localize insulinomas in 92.4% of cases. The highest sensitivity of detection of insulinoma in less than 10 mm was observed with VDCT (92.4%) and ASVS (87.9%). The highest sensitivity of insulinomas detection from 10 to 20 mm was with VDCT (95.8% ), equal sensitivity was in ASVS and endoscopic sonography (83.3%) , slightly lower sensitivity showed angiography (79.2%) compared with a statistically significantly (P<0.05) less sensitive transcutaneous sonography and non-contrast MDCT . In the diagnosis of tumors larger than 20 mm are equally sensitivity (93.8%) were using VDCT, endoscopic sonography, ASVS, was less sensitivity in angiography (87,5%). Conclusion. Volume dynamic computed tomography is highly sensitive in the topical diagnosis of insulinoma, as it allows visualizing the pancreas in all contrast enhancement phases in 4D mode.

объемная динамическая томография, инсулинома, чрескожное УЗИ, эндоскопическое УЗИ, МСКТ, селективная ангиография, артериально- стимулированный забор крови, volume dynamic CT tomography, insulinoma, percutaneous sonography, MDCT, endoscopic sonography, selective angiography with arterial stimulation with calcium with simultaneous venous sampling

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