Effects of blood glucose level on 18F-FDG uptake for PET/CT in normal organs: A systematic review

Abstract

PurposeTo perform a systematic review of the effect of blood glucose levels on 2-Deoxy-2-[18F]fluoro-D-glucose (18F-FDG) uptake in normal organs.MethodsWe searched the MEDLINE, EMBASE and Cochrane databases through 22 April 2017 to identify all relevant studies using the keywords “PET/CT” (positron emission tomography/computed tomography), “standardized uptake value” (SUV), “glycemia,” and “normal.” Analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Maximum and mean SUVs and glycemia were the main parameters analyzed. To objectively measure the magnitude of the association between glycemia and 18F-FDG uptake in different organs, we calculated the effect size (ES) and the coefficient of determination (R2) whenever possible.ResultsThe literature search yielded 225 results, and 14 articles met the inclusion criteria; studies included a total of 2714 (range, 51–557) participants. The brain SUV was related significantly and inversely to glycemia (ES = 1.26; R2 0.16–0.58). Although the liver and mediastinal blood pool were significantly affected by glycemia, the magnitudes of these associations were small (ES = 0.24–0.59, R2 = 0.01–0.08) and negligible (R2 = 0.02), respectively. Lung, bone marrow, tumor, spleen, fat, bowel, and stomach 18F-FDG uptakes were not influenced by glycemia. Individual factors other than glycemia can also affect 18F-FDG uptake in different organs, and body mass index appears to be the most important of these factors.ConclusionThe impact of glycemia on SUVs in most organs is either negligible or too small to be clinically significant. The brain SUV was the only value largely affected by glycemia.

The Relation Between the Blood Glucose Level and the FDG Uptake of Tissues at Normal or Near-Normal PET/CT Imaging

“…Many studies including this study have shown that there was no association between blood glucose level and lung FDG uptake (11,14). Additionally, in accordance with the literature, there was no correlation between glycemia and bone marrow, spleen and pancreas FDG uptake in this study (11,14,16).…”

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

“…Moreover, our analysis of factors potentially influencing FDG concentration within liver and mediastinal blood pool is not complete; e.g. a well-known factor potentially affecting uptake within these regions, the blood glucose concentration [37,38], was not taken into consideration in the current study as results of glucose testing were not recorded in the majority of cases, thus no sufficient data was available for further evaluation. Also, the effects of furosemide and butylscopolamine could not be investigated.…”

A Fast and Sensitive Method Combining Reversed-Phase Chromatography with High Resolution Mass Spectrometry to Quantify 2-Fluoro-2-Deoxyglucose and Its Phosphorylated Metabolite for Determining Glucose Uptake

“…Next we investigated whether other monohalogenated glucose analogues with different m/z, such as 2FDG and 2ClDG, could be used as a tracer and internal standard, respectively. Similar to 2DG, 2FDG (or [ 18 F]FDG) is an established glucose analogue which is often used to in humans and rodents to determine glucose uptake via Positron Emission Tomography (PET) (22)(23)(24)(25). We extracted the ion chromatograms of 2FDG and 2ClDG from blank plasma samples (Figures 5B and 5D) and established that no interference was observed at a similar retention time when the m/z of 2FDG or 2ClDG was extracted.…”