Impact of Intravenous Insulin on <sup>18</sup>F-FDG PET in Diabetic Cancer Patients

Roy, Felix-Nicolas; Beaulieu, Sylvain; Boucher, Luc; Bourdeau, Isabelle; Cohade, Christian

doi:10.2967/jnumed.108.056283

Cited by 59 publications

(32 citation statements)

References 24 publications

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“…DM did not represent an interfering factor in the 18 F-FDG PET/CT assessment of cancer. However, these results, in addition to those in several previously published reports regarding the effect of hyperglycemia on 18 F-FDG uptake in cancer (1,4,7,19), are in disagreement with the results of an experimental study in a rat model. That model suggested that 18 F-FDG uptake in inflammatory lesions was significantly impaired with hyperglycemia, and tumor uptake of 18 F-FDG was not significantly affected (20).…”

Section: Resultscontrasting

confidence: 92%

“…The relationship between the presence of diabetes mellitus (DM) or elevated glucose serum levels and the sensitivity of 18 F-FDG studies is still a controversial issue. Although the biodistribution of 18 F-FDG is adequate in patients (with or without diabetes) with blood glucose levels less than 180 mg/dL at the time of the study (1), guidelines for 18 F-FDG PET/CT in cancer patients recommend that attempts should be made not to inject 18 F-FDG when blood glucose levels exceed 200 mg/dL (2,3). The impact of hyperglycemia or DM has been investigated in cancer patients in a few specific malignancies, with mixed results.…”

mentioning

confidence: 99%

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Do Hyperglycemia and Diabetes Affect the Incidence of False-Negative ¹⁸F-FDG PET/CT Studies in Patients Evaluated for Infection or Inflammation and Cancer? A Comparative Analysis

Rabkin¹,

Israel²,

Keidar³

2010

J Nucl Med

127

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Diabetes mellitus (DM) is a common metabolic disorder. Hyperglycemia occurs in a significant proportion of patients with uncontrolled DM but can also be found in patients without diabetes. Although the relationship between 18 F-FDG uptake in malignant tumors and blood glucose levels has been previously addressed, it has not been investigated in cases of infection and inflammation, despite the high incidence of these entities in diabetic patients. The current study assessed whether hyperglycemia and DM affect the detectability rate of disease in 18 F-FDG PET/CT studies performed for patients with suspected infectious and inflammatory processes, as compared with a group of patients with malignant tumors. Methods: 18 F-FDG PET/CT studies of 123 consecutive patients investigated for suspected infection or inflammation and 320 patients evaluated for malignancy were retrospectively analyzed. The presence of DM and the level of glucose at the time of the study were recorded. Differences between the 2 study populations in false-negative (FN) rates in patients with and without hyperglycemia and DM were compared and analyzed for statistical significance. Results: In the infection or inflammation group, 19 of 123 patients (15%) had serum glucose levels greater than 180 mg/dL and 43 of 123 (35%) had DM. There were no FN studies in patients with hyperglycemia and 4 FN studies in patients with normal glucose levels. There were 2 FN studies each in patients with and without DM. Neither glucose levels nor DM affects the detection rate of infection or inflammation with 18 F-FDG PET/CT. In the oncology group, 84 of 320 patients (26%) had serum glucose levels greater than 180 mg/dL and 183 of 320 (57%) had DM. There were 6 FN studies in cancer patients with hyperglycemia and 7 in patients with normal glucose levels. There were 8 FN studies in cancer patients with DM and 5 FN studies in patients without DM. Higher glucose levels but not DM affected the detection rate of malignancy with 18 F-FDG PET/CT. Conclusion: High glucose levels at the time of the study but not DM may reduce the sensitivity of 18 F-FDG PET/CT in the assessment of malignancy. No significant impact on the FN rate was found in patients with infection and inflammatory processes with either DM or hyperglycemia.

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Section: Resultscontrasting

confidence: 92%

mentioning

confidence: 99%

Do Hyperglycemia and Diabetes Affect the Incidence of False-Negative ¹⁸F-FDG PET/CT Studies in Patients Evaluated for Infection or Inflammation and Cancer? A Comparative Analysis

Rabkin¹,

Israel²,

Keidar³

2010

J Nucl Med

127

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“…We saw an avid 18 F-FDG uptake before treatment in tumor lesions and muscles in our patients. This increased muscle uptake was also seen in euglycemic hyperinsulinemic clamping studies, in which insulin administration resulted in increased muscular uptake [12]. In our patients, everolimus induced lowering in 18 F-FDG tumor uptake.…”

Section: Case Reportsupporting

confidence: 81%

Everolimus Induces Rapid Plasma Glucose Normalization in Insulinoma Patients by Effects on Tumor As Well As Normal Tissues

et al. 2011

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Methods. Three consecutive patients with a metastasized symptomatic insulinoma were started on 100 g of octreotide subcutaneously three times daily. Because of persisting hypoglycemias, treatment with daily 10 mg of oral everolimus was initiated. Serial plasma glucose levels and serum insulin levels were measured. Computer tomography (CT) scans were performed before and after 2 and 5 months of treatment.[18F]fluoro-2-deoxy-d-glucose positron emission tomography (

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“…In 63 (28). Their protocol was safe and effective in decreasing glucose levels but led to an altered biodistribution in 25% of patients (increased muscle uptake and decreased liver uptake).…”

Section: Premedication (As Needed)mentioning

confidence: 99%

18F-FDG PET and PET/CT Patient Preparation: A Review of the Literature

Surasi

Bhambhvani

Baldwin

et al. 2014

Journal of Nuclear Medicine Technology

101

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Impact of Intravenous Insulin on ¹⁸F-FDG PET in Diabetic Cancer Patients

Cited by 59 publications

References 24 publications

Do Hyperglycemia and Diabetes Affect the Incidence of False-Negative ¹⁸F-FDG PET/CT Studies in Patients Evaluated for Infection or Inflammation and Cancer? A Comparative Analysis

Do Hyperglycemia and Diabetes Affect the Incidence of False-Negative ¹⁸F-FDG PET/CT Studies in Patients Evaluated for Infection or Inflammation and Cancer? A Comparative Analysis

Everolimus Induces Rapid Plasma Glucose Normalization in Insulinoma Patients by Effects on Tumor As Well As Normal Tissues

18F-FDG PET and PET/CT Patient Preparation: A Review of the Literature

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Impact of Intravenous Insulin on 18F-FDG PET in Diabetic Cancer Patients

Cited by 59 publications

References 24 publications

Do Hyperglycemia and Diabetes Affect the Incidence of False-Negative 18F-FDG PET/CT Studies in Patients Evaluated for Infection or Inflammation and Cancer? A Comparative Analysis

Do Hyperglycemia and Diabetes Affect the Incidence of False-Negative 18F-FDG PET/CT Studies in Patients Evaluated for Infection or Inflammation and Cancer? A Comparative Analysis

Everolimus Induces Rapid Plasma Glucose Normalization in Insulinoma Patients by Effects on Tumor As Well As Normal Tissues

18F-FDG PET and PET/CT Patient Preparation: A Review of the Literature

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Product

Resources

About

Impact of Intravenous Insulin on ¹⁸F-FDG PET in Diabetic Cancer Patients

Do Hyperglycemia and Diabetes Affect the Incidence of False-Negative ¹⁸F-FDG PET/CT Studies in Patients Evaluated for Infection or Inflammation and Cancer? A Comparative Analysis

Do Hyperglycemia and Diabetes Affect the Incidence of False-Negative ¹⁸F-FDG PET/CT Studies in Patients Evaluated for Infection or Inflammation and Cancer? A Comparative Analysis