Could Different Hydration Protocols Affect the Quality of 18F-FDG PET/CT Images?

Abstract

In a group of oncologic patients undergoing 18 F-FDG PET/CT, we compared 4 different protocols of hydration to investigate their impact on image quality and to choose the best practice. Methods: One hundred twenty subjects undergoing 18 F-FDG PET/CT were randomized into 4 groups: group A, receiving free oral hydration; group B, receiving an intravenous injection of 10 mg of furosemide and infusion of 500 mL of saline solution starting 5 min after tracer injection; group C, receiving oral hydration with 500 mL of water; and group D, receiving intravenous injection of 10 mg of furosemide and infusion of 250 mL of the saline solution starting 30 min after the 18 F-FDG injection. The maximum standardized uptake value of muscular and adipose tissues, blood pool (aortic and left ventricular cavity), bladder, and renal parenchyma was calculated for each subject. Results: These 4 groups were comparable in age, body mass index, blood glucose level, and serum creatinine level. Group A showed the worst results. The controlled hydration protocols (groups B, C, and D) provided lower background activity in the soft tissues and lower urinary activity in the bladder and kidney without significant differences in blood activity. The administration of furosemide produces lower activity in the urinary tract without significant changes in 18 F-FDG distribution in the muscle, fat, or blood pool. The best results were in group D. Conclusion: Controlled hydration, particularly with standardized parenteral protocols, reduces the background activity in the soft tissues with the potential benefit of increasing the tumor-to-background contrast. Furosemide does not change tracer distribution in normal tissues but improves the quality of PET/CT images, reducing activity in the excretory system, particularly if the furosemide is administered late after 18 F-FDG injection.

Association between habitual physical activity and brown adipose tissue activity in individuals undergoing PET‐CT scan

“…They provided medical history, completed the International Physical Activity Questionnaire (IPAQ) and underwent measurements for anthropometry, blood pressure and plasma glucose using standard methods . Subsequently, we administered intravenously 5 mg of diazepam (stedon) to avoid excessive muscle activity during the examination and 40 mg of furosemide (lasix) to reduce excretory system activity in participants with systolic blood pressure >110 mmHg . Thereafter, we administered 358 ± 21·9 mega Becquerel of 18 F‐FDG intravenously according to each participant's body weight following standard methodology .…”

“…12 Subsequently, we administered intravenously 5 mg of diazepam (stedon) to avoid excessive muscle activity during the examination 13 and 40 mg of furosemide (lasix) to reduce excretory system activity in participants with systolic blood pressure >110 mmHg. 14 Thereafter, we administered 358 AE 21Á9 mega Becquerel of 18 F-FDG intravenously according to each participant's body weight following standard methodology. 15 Finally, we performed the PET/CT examination 1 h thereafter.…”

What and how should we measure in paediatric oncology FDG-PET/CT? Comparison of commonly used SUV metrics for differentiation between paediatric tumours

“…Also, the effects of furosemide and butylscopolamine could not be investigated. However, research on adults has demonstrated that furosemide effectively eliminates 18 F-FDG activity from the lower urinary tract and thus improves the diagnostic accuracy in abdominopelvic malignancies [39]; interestingly, furosemide was shown to not substantially affect tracer distribution within the mediastinal blood pool and soft tissues, respectively [40]. Butylscopolamine, on the other hand, reduces artefacts coming from bowel peristalsis, thus also improving the accuracy of abdominal 18 F-FDG PET reporting [41].…”

Repetition of FDG PET study in the same day after appropriate patient preparation revealed two new cancer localizations: a case report

“…This points to the necessity of implementing several protocols for patient preparation, which can signifi cantly improve the detection rate of primary bladder malignancy [5][6][7].…”