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

Evangelista, Laura; Gori, Stefania; Rubini, Giuseppe; Gallo, Marco

doi:10.1007/s40336-019-00347-y

Cited by 4 publications

(2 citation statements)

References 16 publications

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“…This includes fasting for 4-6 h and also making sure that no external glucose is intravenously administered. Rapid-acting insulin should be administered only up to 4 h before 18 F-FDG PET/CT, short-acting insulin should be administered within 6 h, and intermediate-or long-acting insulin should not be used on the day 18 F-FDG PET/CT is scheduled (26). Interestingly, the use of hypoglycemic medication such as metformin or insulin was not statistically associated with 18 F-FDG PET/CT outcome, implying that a satisfactory effect of these medications on glucose level and not the use of these medications alone is important for 18 F-FDG PET/CT outcome.…”

Section: Discussionmentioning

confidence: 99%

Importance of Blood Glucose Management Before¹⁸F-FDG PET/CT in 322 Patients with Bacteremia of Unknown Origin

et al. 2023

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We investigated the effects of blood glucose levels on the performance of 18 F-FDG PET/CT for detecting an infection focus in patients with bacteremia. Methods: A total of 322 consecutive patients with bacteremia who underwent 18 F-FDG PET/CT between 2010 and 2021 were included. Logistic regression analysis was performed to evaluate the association between finding a true-positive infection focus on 18 F-FDG PET/CT and blood glucose level, type of diabetes, and use of hypoglycemic medication. C-reactive protein, leukocyte count, duration of antibiotic treatment, and type of isolated bacteria were considered as well. Results: Blood glucose level (odds ratio, 0.76 per unit increase; P 5 ,0.001) was significantly and independently associated with 18 F-FDG PET/CT outcome. In patients with a blood glucose level between 3.0 and 7.9 mmol/L (54-142 mg/dL), the true-positive detection rate of 18 F-FDG PET/CT varied between 61% and 65%, whereas in patients with a blood glucose level between 8.0 and 10.9 mmol/L (144-196 mg/dL), the true-positive detection rate decreased to 30%-38%. In patients with a blood glucose level greater than 11.0 mmol/L (200 mg/dL), the true-positive detection rate was 17%. In addition to C-reactive protein (odds ratio, 1.004 per point increase; P 5 0.009), no other variables were independently associated with 18 F-FDG PET/CT outcome. Conclusion: In patients with moderate to severe hyperglycemia, 18 F-FDG PET/CT was much less likely to identify the focus of infection than in normoglycemic patients. Although current guidelines recommend postponing 18 F-FDG PET/CT only in cases of severe hyperglycemia with glucose levels greater than 11 mmol/L (200 mg/dL), a lower blood glucose threshold seems to be more appropriate in patients with bacteremia of unknown origin and other infectious diseases.

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Section: Discussionmentioning

confidence: 99%

Importance of Blood Glucose Management Before¹⁸F-FDG PET/CT in 322 Patients with Bacteremia of Unknown Origin

et al. 2023

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“…28 Atualmente, não existe evidência sobre a influência de outros fármacos anti-diabéticos na sensibilidade da PET-18FDG, à excepção da pioglitazona, que parece aumentar a captação de FDG pelas lesões malignas. 29…”

Section: Esquema De Profilaxiaunclassified

Proposta de Protocolo para Redução dos Riscos e Otimização da Sensibilidade nos Exames de Imagem em Pessoas com Diabetes

Donato¹,

Simões

Donato

2021

Acta Med Port

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Diabetes is a very common chronic disease in the Portuguese population, with an estimated prevalence of 13.6% in the adults. Doubts often arise regarding the best preparation and the risks associated with doing imaging tests in these patients. In this article we intend to review the main precautions in imaging tests in people with diabetes and to suggest a guideline to reduce the risks and optimize the sensitivity of these tests in this population. The main topics addressed in this article are the need to suspend metformin after the administration of endovascular iodinated contrast due to the risk of lactic acidosis, the precautions in insulin-treated patients or those taking medicines with a higher risk of hypoglycemia when performing imaging tests that require fasting, and the influence of hyperglycemia and of anti-diabetic therapy on the sensitivity of PET-FDG. With this review and the presentation of a guideline, we intend to demystify and simplify the management of individuals with diabetes who are undergoing imaging tests.

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FDG imaging with long-axial field-of-view PET/CT in patients with high blood glucose—a matched pair analysis

Mingels,

Weissenrieder,

Zeimpekis

et al. 2024

Eur J Nucl Med Mol Imaging

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Purpose High blood glucose (hBG) in patients undergoing [18F]FDG PET/CT scans often results in rescheduling the examination, which may lead to clinical delay for the patient and decrease productivity for the department. The aim of this study was to evaluate whether long-axial field-of-view (LAFOV) PET/CT can minimize the effect of altered bio-distribution in hBG patients and is able to provide diagnostic image quality in hBG situations. Materials and methods Oncologic patients with elevated blood glucose (≥ 8.0 mmol/l) and normal blood glucose (< 8.0 mmol/l, nBG) levels were matched for tumor entity, gender, age, and BMI. hBG patients were further subdivided into two groups (BG 8–11 mmol/l and BG > 11 mmol/l). Tracer uptake in the liver, muscle, and tumor was evaluated. Furthermore, image quality was compared between long acquisitions (ultra-high sensitivity mode, 360 s) on a LAFOV PET/CT and routine acquisitions equivalent to a short-axial field-of-view scanner (simulated (sSAFOV), obtained with high sensitivity mode, 120 s). Tumor-to-background ratio (TBR) and contrast-to-noise ratio (CNR) were used as the main image quality criteria. Results Thirty-one hBG patients met the inclusion criteria and were matched with 31 nBG patients. Overall, liver uptake was significantly higher in hBG patients (SUVmean, 3.07 ± 0.41 vs. 2.37 ± 0.33; p = 0.03), and brain uptake was significantly lower (SUVmax, 7.58 ± 0.74 vs. 13.38 ± 3.94; p < 0.001), whereas muscle (shoulder/gluteal) uptake showed no statistically significant difference. Tumor uptake was lower in hBG patients, resulting in a significantly lower TBR in the hBG cohort (3.48 ± 0.74 vs. 5.29 ± 1.48, p < 0.001). CNR was higher in nBG compared to hBG patients (12.17 ± 4.86 vs. 23.31 ± 12.22, p < 0.001). However, subgroup analysis of nBG 8–11 mmol/l on sSAFOV PET/CT compared to hBG (> 11 mmol/l) patients examined with LAFOV PET/CT showed no statistical significant difference in CNR (19.84 ± 8.40 vs. 17.79 ± 9.3, p = 0.08). Conclusion While elevated blood glucose (> 11 mmol) negatively affected TBR and CNR in our cohort, the images from a LAFOV PET-scanner had comparable CNR to PET-images acquired from nBG patients using sSAFOV PET/CT. Therefore, we argue that oncologic patients with increased blood sugar levels might be imaged safely with LAFOV PET/CT when rescheduling is not feasible.

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

Cited by 4 publications

References 16 publications

Importance of Blood Glucose Management Before¹⁸F-FDG PET/CT in 322 Patients with Bacteremia of Unknown Origin

Importance of Blood Glucose Management Before¹⁸F-FDG PET/CT in 322 Patients with Bacteremia of Unknown Origin

Proposta de Protocolo para Redução dos Riscos e Otimização da Sensibilidade nos Exames de Imagem em Pessoas com Diabetes

FDG imaging with long-axial field-of-view PET/CT in patients with high blood glucose—a matched pair analysis

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

Cited by 4 publications

References 16 publications

Importance of Blood Glucose Management Before18F-FDG PET/CT in 322 Patients with Bacteremia of Unknown Origin

Importance of Blood Glucose Management Before18F-FDG PET/CT in 322 Patients with Bacteremia of Unknown Origin

Proposta de Protocolo para Redução dos Riscos e Otimização da Sensibilidade nos Exames de Imagem em Pessoas com Diabetes

FDG imaging with long-axial field-of-view PET/CT in patients with high blood glucose—a matched pair analysis

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Importance of Blood Glucose Management Before¹⁸F-FDG PET/CT in 322 Patients with Bacteremia of Unknown Origin

Importance of Blood Glucose Management Before¹⁸F-FDG PET/CT in 322 Patients with Bacteremia of Unknown Origin