Selective pancreatic angiography, using stereoscopic filming with magnification and subtraction techniques, identifies 50% of tumors with a minimum diameter of 5 mm.23 Arteriography was formerly the gold standard of insulinoma localization and, in our experience, successfully localized 47% of the tumors. Arteriography in our patients did not demonstrate improved sensitivity with increased tumor size, probably because the hypervascularity of the tumor was equally important for tumor localization. Arteriography is useful in selected patients,24 especially those with recurrent or persistent disease. Unfortunately, arteriography is invasive and expensive (Figure 13-9).25 We therefore do not recommend it for most patients.
In our patients, transhepatic portal venous sampling (THPVS) detected 66% of the tumors < 1 cm in diameter, with an overall detection rate of 55%. In this procedure, the portal vein is catheterized using a percutaneous transhepatic needle, and the catheter is advanced by fluoroscopic guidance into the multiple small draining veins of the entire pancreas. Blood insulin level is sampled at each site, a record m ;
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Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...