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POSTPRANDIAL CHOLECYSTOKININ CONCENTRATIONS AND [11C]METHIONINE UPTAKE OF THE PANCREAS IN PATIENTS AFTER PANCREATICODUODENECTOMY
Emanuel Steiner*1, Lukas Kazianka1, Robert Breuer1, Wolfgang Wadsak1, Jens Rehfeld2, Johannes Miholic1, Georgios Karanikas1
1Medical University of Vienna, Wien, Austria; 2 University of Copenhagen, Copenhagen, Denmark
Prupose: The uptake of [11C]methionine ([11 C]MET) in the pancreas has been discussed in the context of exocrine and endocrine pancreatic function. Cholecystokinin (CCK) is a strong stimulator of pancreatic enzyme release. It was the aim of this study to examine possible relationships of CCK release with the uptake of [11 C]MET in the gland and with the velocity of gastric emptying.
Methods: Nineteen tumor-free survivors after PD (age mean ±SD: 61±8.7 yr; ten male, nine female) were given a mixed test meal. One gram paracetamol was ingested with the meal to evaluate the speed of gastric emptying. Paracetamol and CCK were measured before as well as 10, 20 and 30 minutes after ingestion. Simultaneously 800 MBq of [11C]MET were administered and the activity (maximum tissue standardized uptake values [SUVmax]) over the pancreas was measured using PET-CT at 15, 30 and 60 minutes after injection. Areas under the curve (AUC) were calculated for SUVmax over 60 minutes (total integrated SUVmax[AUC60]), as well as for paracetamol and CCK over the first 30 minutes after test meal consumption (AUC30).
Results: Gastric emptying velocity (paracetamol AUC30, median and range: 217.7 [60.5 - 587] mg/l x min ) showed no correlation with postprandial CCK concentrations (AUC30, median and range: 201 [77.5 - 552] pmol/l x min). CCK AUC30 correlated with total integrated SUVmax (AUC60; R2=0.26, p=0.0307, Figure 1).
Conclusion: Since CCK is a well-known stimulant of the exocrine pancreas the association between postprandial CCK concentrations and pancreatic [11 C]MET uptake might suggest a causal relationship. To some extent [11 C]MET uptake could be used to assess the activity of the exocrine pancreas. Further research in that direction could provide a barely invasive method to assess the activity of the exocrine pancreas.
Figure 1: Relationship between total integrated SUVmax (AUC60) and cholecystokinin AUC30 in patients after PD
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