Niccoli-Asabella Artor, Iuele Francesca Iuele, Merenda Nunzio, Pisani Antonio Rosario, Notaristefano Antonio, Rubini Giuseppe
Nucl Med Rev Cent East Eur. 2013;16(2):57-61. doi: 10.5603/NMR.2013.0035.
Some patients who undergo 18F-FDG PET/CTfor neoplastic or benign disease are also affected by diabetes or hyperglycaemia. We propose different preparation procedures inpatients (pts) with hyperglycaemia (acute, temporary or chronic)or diabetes (type 1 or 2) at the time of the 18F-FDG injection, in order to improve the diagnostic scheduling of 18F-FDG PET/CT.
We evaluated a sample of 13,063 pts, examined in two different PET/CT centres, one with a stationary scanner (94.4%) and the other with a mobile device (5.6%). High blood sugar was present in 1,698 patients (13%) at the time of the 18F-FDG injection (hyperglycaemia was defined as fasting blood glucose > 11.1 mmol/l). We considered all 18F-FDG PET/CT tests performed over a period of 4 years (2006-2009). In the first 2 years (6,236 tests), scheduling was done directly by the administrative secretary. In the next two years, 6,827 pts underwent a preliminary visit to assess the test indications, medical history, and therapy as well as pre-test preparation. We evaluated different preparation protocols for hyperglycaemic or diabetic pts, especially those recommended in the guidelines of the European Association of Nuclear Medicine (EANM) and Society of Nuclear Medicine (SNM).
In the four-year period, 713/13,063 patients (5.45%)were rescheduled; of these, 78.8% were rescheduled in the two years before the implementation of our preparation protocols and 21.2% in the next two years.Before the implementation of our preparation protocols, 562 patients (9%) presented occasional, acute or chronic hyperglycaemia (56.7%), or diabetes (43.3%), requiring postponement of the test to a later date. The test was not performed in 17 of 6,236 pts (0.27%) because of blood glucose levels above 11.1 mmol/l for several days, while in 16/6236 pts (0.26%) the18F-FDG injection was performed despite high blood glucose levels, in view of the clinical urgency.After the implementation of the preparation protocols, 2.2% of pts were rescheduled because of occasional, acute or chronic hyperglycaemia (79%), or diabetes (21%); 0.1% of pts did not undergo the test because of chronic high blood glucose levels. Although the administration of insulin is recommended in theEANM and SNM guidelines, in our new preparation procedures experience it was not necessary, because we reduced the numbers of hyperglycaemic pts thanks to screening at the preliminary visit and a subsequent good preparation of the patient before scheduling.
The application of our preparation protocols improves the on-time performance and diagnostic accuracy,and increases patients' compliance.
一些因肿瘤性或良性疾病接受18F-FDG PET/CT检查的患者也患有糖尿病或高血糖症。我们针对在注射18F-FDG时出现高血糖（急性、暂时性或慢性）或糖尿病（1型或2型）的患者提出了不同的准备程序，以改善18F-FDG PET/CT的诊断安排。
我们评估了13063例患者的样本，这些患者在两个不同的PET/CT中心接受检查，一个中心使用固定式扫描仪（94.4%），另一个中心使用移动设备（5.6%）。在18F-FDG注射时，1698例患者（13%）存在高血糖（高血糖定义为空腹血糖>11.1 mmol/L）。我们考虑了在4年期间（2006 - 2009年）进行的所有18F-FDG PET/CT检查。在前两年（6236次检查），由行政秘书直接安排检查时间。在接下来的两年中，6827例患者进行了初步问诊，以评估检查指征、病史、治疗情况以及检查前准备。我们评估了针对高血糖或糖尿病患者的不同准备方案，尤其是欧洲核医学协会（EANM）和核医学协会（SNM）指南中推荐的方案。
在这四年期间，13063例患者中有713例（5.45%）重新安排了检查时间；其中，78.8%是在我们的准备方案实施前两年重新安排的，21.2%是在接下来的两年重新安排的。在我们的准备方案实施前，562例患者（9%）出现偶尔、急性或慢性高血糖（56.7%）或糖尿病（43.3%），需要将检查推迟到以后进行。在6236例患者中有17例（0.27%）因血糖水平连续几天高于11.1 mmol/L而未进行检查，而在16/6236例患者（0.26%）中，鉴于临床紧迫性，尽管血糖水平高仍进行了18F-FDG注射。在实施准备方案后，2.2%的患者因偶尔、急性或慢性高血糖（79%）或糖尿病（21%）而重新安排了检查时间；0.1%的患者因慢性高血糖未进行检查。尽管EANM和SNM指南中推荐使用胰岛素，但在我们新的准备程序经验中没有必要，因为通过初步问诊筛查以及在安排检查前对患者进行良好准备，我们减少了高血糖患者的数量。
我们的准备方案的应用提高了按时完成率和诊断准确性，并提高了患者的依从性。
