Background. An open-label, single-center, randomized controlled prospective trial was performed to assess the efficiency and safety of an insulin loading procedure to obtain highquality cardiac 18 F-FDG PET/CT images for patients with coronary artery disease (CAD).Methods. Between November 22, 2018 and August 15, 2019, 60 patients with CAD scheduled for cardiac 18 F-FDG PET/CT imaging in our department were randomly allocated in a 1:1 ratio to receive an insulin or standardized glucose loading procedure for cardiac 18 F-FDG imaging. The primary outcome was the ratio of interpretable images (high-quality images defined as myocardium-to-liver ratios ‡ 1). The secondary outcome was the patient preparation time (time interval between administration of insulin/glucose and 18 F-FDG injection). Hypoglycemia events were recorded.Results. The ratio of interpretable cardiac PET images in the insulin loading group surpassed the glucose loading group (30/30 vs. 25/30, P = 0.026). Preparation time was 71±2 min shorter for the insulin loading group than for the glucose loading group (P < 0.01). Two and six hypoglycemia cases occurred in the insulin and glucose loading groups, respectively.Conclusion. The insulin loading protocol was a quicker, more efficient, and safer preparation for gaining high-quality cardiac 18 F-FDG images. (J Nucl Cardiol 2020
Purpose
This study aimed to identify and validate the optimal 18F-FDG activity and acquisition time for cardiac viability imaging with intravenous insulin administration based on a fixed 18F-FDG activity.
Methods
Cardiac positron emission tomography (PET) images from 30 patients with coronary artery disease (CAD) were retrospectively reconstructed into 900, 360, 180, 90, and 45 s durations. An optimal product of the maximum standardized uptake value (SUV) of the myocardium and segmental uptake (SU) and acquisition time (MSAT) was determined through a receiver operating characteristic curve. The optimal acquisition time (OAT) was equal to MSAT divided by mean SUV of the myocardium (MyoSUV) and validated in another 26 patients with CAD.
Results
The MyoSUV, mean SUV of the blood, SU, and their biases on reconstructed image durations of 90, 180, and 360 s were equivalent to those on an image duration of 900 s. The optimal MSAT was 848.2. In the validation group, the OAT was 129 ± 76 s (95% confidence interval, 99–160), approximately one-third of the usual acquisition time. The MyoSUV and SU were equivalent for the difference (0.15 ± 0.21, P < 0.001; −0.01 ± 0.03, P < 0.001) between PET image duration of OAT and 600 s (7.71 ± 3.01 vs. 7.56 ± 2.94, 67.1 ± 15.4% vs. 67.7 ± 15.6%).
Conclusion
Intravenous insulin administration preparation has the potential to reduce radiation exposure and acquisition time of cardiac 18F-FDG viability imaging without losing the accurate measurement of MyoSUV and SU when reaching an OAT.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.