Metformin May Be Associated with False-Negative Cancer Detection in the Gastrointestinal Tract on Pet/Ct

Steenkamp, Devin; McDonnell, Marie E.; Meibom, Sara K.

doi:10.4158/ep14127.ra

Cited by 18 publications

(8 citation statements)

References 26 publications

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“…Focal FDG uptake in bowel can be related to abscesses, appendicitis, diverticulitis, infectious and inflammatory colitis, as well as immunotherapy-related colitis [31][32][33][34][35][36][37]. Moreover, it is well known that metformin can lead to intense FDG uptake in the colon [38]. Figure 4 demonstrates examples of physiologic uptake, immunotherapy-induced colitis, diverticulitis, and colon cancer.…”

Section: Abdomen and Pelvismentioning

confidence: 99%

Acute Findings on FDG PET/CT: Key Imaging Features and How to Differentiate Them from Malignancy

Behr

2020

Curr Radiol Rep

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Purpose of review To review acute findings commonly encountered during routine clinical FDG PET/CT studies and present key imaging features to differentiate them from malignant counterparts. Recent findings FDG PET/CT is extensively used in routine clinical practice for oncology patients. Incidental acute findings in patients undergoing FDG PET/CT are increasingly common, and awareness of these findings and their mimics are important in delivering a clinically relevant and accurate radiological report for directing further management. Summary This article will review examples of common acute findings encountered during routine FDG PET/CT scans, compare them against examples of FDG-avid malignancy that can mimic these findings and emphasize key imaging findings to differentiate acute findings from their malignant mimics.

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Section: Abdomen and Pelvismentioning

confidence: 99%

Acute Findings on FDG PET/CT: Key Imaging Features and How to Differentiate Them from Malignancy

Behr

2020

Curr Radiol Rep

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“…The current results also suggest a possible explanation for a clinical observation, previously described in the literature, showing diffuse colonic 18F-FDG PET uptake in diabetic patients that are treated with metformin [ 22 , 23 ]. This uptake can be reduced if the medication is stopped 48 hours prior to PET imaging [ 24 – 26 ]. Metformin, an oral hypoglycemic medication, is known to activate the AMP-activated protein kinase (AMPK) pathway, a key regulator of cell metabolism, promoting glycolysis and generation of ATP while inhibiting anabolic pathways, thus increasing 18F-FDG avidity [ 27 – 29 ].…”

Section: Discussionmentioning

confidence: 99%

Functional imaging of the interaction between gut microbiota and the human host: A proof-of-concept clinical study evaluating novel use for 18F-FDG PET-CT

et al. 2018

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Recent data comparing germ-free to conventionally-raised mice demonstrated that energy homeostasis of colonocytes is dependent on gut microbiota through regulation of short chain fatty acids (SCFA) production and glucose utilization. We sought to evaluate 18F-FDG PET-CT as a novel technique for functional imaging of alterations in glucose metabolism as a result of the interaction between the gut microbiota and the human host. We conducted a prospective study in healthy humans that underwent 18F-FDG PET-CT and sampling of the gut microbiota before and after orally administered broad-spectrum antibiotics. The primary outcomes were total and regional physiologic colonic 18F-FDG uptake (measured as the mean and max standardized uptake values [SUVmean and SUVmax]). The study demonstrated significant increases in physiologic colonic 18F-FDG uptake in all study participants following antibiotic treatment and a 4-5log reduction of gut bacterial load. The mean increase in SUVmax was 0.63±0.37 SD (p = 0.004) and the median increase was 0.42 with an IQR of 0.40–0.81. The mean increase in SUVmean was 0.31±0.24 SD (p = 0.01) and the median increase was 0.41 with an IQR of 0.06–0.55. A likely explanation for this phenomenon is a shift in colonocyte metabolism to glycolysis due to a shortage of SCFA.

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“…This is due to the fact that metformin leads to an intense increase of diffuse images of 18 F-FDG in the colon and, to a lesser extent, in the small intestine. This limits the capacity of PET-CT diagnosis and possibly masks the detection of a neoplasm (9). Incidental uptake was defined as the focal accumulation of 18 F-FDG in patients that underwent a pathological study that was not related to the colon or in areas incompatible with the previously known pathology.…”

Section: Methodsmentioning

confidence: 99%

Clinical-endoscopic relevance of incidental colorectal lesions detected by PET-CT

et al. 2018

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Metformin May Be Associated with False-Negative Cancer Detection in the Gastrointestinal Tract on Pet/Ct

Cited by 18 publications

References 26 publications

Acute Findings on FDG PET/CT: Key Imaging Features and How to Differentiate Them from Malignancy

Acute Findings on FDG PET/CT: Key Imaging Features and How to Differentiate Them from Malignancy

Functional imaging of the interaction between gut microbiota and the human host: A proof-of-concept clinical study evaluating novel use for 18F-FDG PET-CT

Clinical-endoscopic relevance of incidental colorectal lesions detected by PET-CT

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