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18F-exendin-4 is an investigational positron emission tomography (PET) radiotracer designed for the non-invasive imaging of pancreatic beta cells and the localization of insulinomas. The radiopharmaceutical consists of exendin-4, a 39-amino-acid peptide and glucagon-like peptide-1 receptor (GLP-1R) agonist, labeled with the positron-emitting radioisotope fluorine-18. The most clinically advanced variant is `[18F]FB(ePEG12)12-exendin-4`, a PEGylated, 18F-fluorobenzoyl-labeled analog developed to optimize biodistribution and reduce renal radiation burden. By targeting GLP-1R, which is highly expressed on pancreatic beta cells and insulinomas, `18F-exendin-4` enables high-resolution PET imaging to quantify beta cell mass in type 1 diabetes and precisely localize occult insulinomas that are often missed by conventional imaging modalities.
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