Effect of blood glucose level on standardized uptake value (SUV) in 18F- FDG PET-scan: a systematic review and meta-analysis of 20,807 individual SUV measurements

Abstract

Objectives To evaluate the effect of pre-scan blood glucose levels (BGL) on standardized uptake value (SUV) in 18 F-FDG-PET scan. Methods A literature review was performed in the MEDLINE, Embase, and Cochrane library databases. Multivariate regression analysis was performed on individual datum to investigate the correlation of BGL with SUV max and SUV mean adjusting for sex, age, body mass index (BMI), diabetes mellitus diagnosis, 18 F-FDG injected dose, and time interval. The ANOVA test was done to evaluate differences in SUV max or SUV mean among five different BGL groups (< 110, 110-125, 125-150, 150-200, and > 200 mg/dl). Results Individual data for a total of 20,807 SUV max and SUV mean measurements from 29 studies with 8380 patients was included in the analysis. Increased BGL is significantly correlated with decreased SUV max and SUV mean in brain (p < 0.001, p < 0.001,) and muscle (p < 0.001, p < 0.001) and increased SUV max and SUV mean in liver (p = 0.001, p = 0004) and blood pool (p = 0.008, p < 0.001). No significant correlation was found between BGL and SUV max or SUV mean in tumors. In the ANOVA test, all hyperglycemic groups had significantly lower SUVs compared with the euglycemic group in brain and muscle, and significantly higher SUVs in liver and blood pool. However, in tumors only the hyperglycemic group with BGL of > 200 mg/dl had significantly lower SUV max. Conclusion If BGL is lower than 200 mg/dl no interventions are needed for lowering BGL, unless the liver is the organ of interest. Future studies are needed to evaluate sensitivity and specificity of FDG-PET scan in diagnosis of malignant lesions in hyperglycemia.

Usefulness of Hybrid PET/MRI in Clinical Evaluation of Head and Neck Cancer Patients

“…A recent meta-analysis investigating the effect of blood glucose levels on SUV values assessed with FDG-PET scans revealed positive correlations between glucose levels and SUVmax and SUVmean values in normal tissue such as brain, muscle, liver, but no significant correlations were found between blood glucose levels and SUVmax or SUVmean values in primary malignant tumors [37]. No evidence of a linear relationship between glycaemia and SUV has been reported by other authors [38].…”

18F‐fluorodeoxyglucose positron emission tomography/computed tomography in the evaluation of clinically node‐negative non‐small cell lung cancer

“…In contrast, there is no consensus on the appropriate cutoff value of primary tumor SUVmax to differentiate tumors without ONM as well as recurrence in clinical stage I NSCLC, because no prospective study has demonstrated a specific cut-off value so far. Furthermore, further investigations are required to clarify the most appropriate parameter of FDG accumulation for risk stratification in clinical stage IA NSCLC, because SUVmax can be affected by many factors, including tumor histology, 62,63 race, 64 blood sugar, [65][66][67][68] and inflammation. 69,70 Ongoing randomized trials investigating the survival outcome of sublobar resection showed comparable prognosis with lobectomy in clinical stage IA NSCLC.…”

Management of hyperglycemia in oncological patients scheduled for an FDG-PET/CT examination

“…Original article 500 The influence of glycemia on the FDG uptake in normal organs Niccoli-Asabella et al [14] 2013 Review 13,063 The screening at the preliminary visit and a subsequent good preparation of the patient before scheduling can reduce hyperglycemic status Khandani et al [15] 2016 Original article 117 The frequency of glycemia > 150 mg/dL in patients without diabetes Sprintz et al [16] 2017 Review 2714 The influence of glycemia on the FDG uptake in normal organs Sprintz et al [17] 2018 Original article 5623 The influence of glycemia on the FDG uptake in normal organs Eskian et al [4] 2019 Review 20,807 To evaluate the effect of glycemia on SUV (standardized uptake value) b. In case of FDG-PET/CT performed late in the morning or at mid-day, the patient should have a normal breakfast early in the morning (around 7.00 a.m.) and receive the usual dose of insulin.…”

“…Cutoff values varied from 150 to 250 mg/dL (8.3-13.9 mmol/L) and 7% of the sites used no cutoff. Based on the recent systematic review and meta-analysis by Eskian et al [4], patients who are still hyperglycemic after at least 4 h of fasting would have significantly lower FDG uptake in the brain and muscles and significantly higher FDG uptake in the liver and mediastinal blood pool in comparison with euglycemic patients. However, pooled findings reported that glycemia levels do not have any apparent significant effect on FDG uptake by tumors.…”

“…However, pooled findings reported that glycemia levels do not have any apparent significant effect on FDG uptake by tumors. Considering the lack of significant correlation between glycemia and FDG uptake in tumors, Eskian et al recommend no interventions for hyperglycemic patients who are scheduled to undergo PET scan, except under two conditions: glycemia > 200 mg/dL, or when the liver is the area of interest [4]. In this latter condition, FDG uptake significantly increases in liver during hyperglycemia, therefore patients should be kept euglycemic (glycemia ≤ 110 mg/dL), when liver assessment is required, to prevent decreased tumor-tobackground uptake ratios.…”