Morris Michael, Saboury Babak, Chen Wengen, Siegel Eliot L, Dasgeb Bahar
aDepartment of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine bDepartment of Internal Medicine, Mercy Medical Center cDepartment of Radiology, Baltimore Veteran's Affairs Hospital, Baltimore, Maryland dDepartment of Dermatology and Cutaneous Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Nucl Med Commun. 2017 Oct;38(10):875-880. doi: 10.1097/MNM.0000000000000728.
The effect of oral hypoglycemic agents on fluorine-18-flurodeoxyglucose (F-FDG) uptake is less understood than the effect of exogenous insulin. In this study, the effect of withholding metformin on F-FDG distribution in subsequent PET imaging was evaluated.
A retrospective observational study was carried out. A total of 15 patients taking metformin were grouped according to the time interval from the last dose of metformin to F-FDG-PET. Those who received PET after stopping metformin for less than 24 h were compared with those stopping metformin 24-48 h before PET. The F-FDG uptake and PET image fidelity for these groups were compared qualitatively and the associated blood glucose was recorded. The average standardized uptake value of the liver, tongue, and subcutaneous tissues among the groups were also compared.
The F-FDG-PET distribution and image quality were found to be the best at time points greater than 24 h following metformin dose. There was significantly increased F-FDG uptake in the liver and tongue and tongue-to-liver ratio in patients who had metformin within 24 h of F-FDG-PET compared with those who last had metformin greater than 24 h before F-FDG-PET; however, the F-FDG uptake in the subcutaneous tissues was unchanged.
Less than 24 h between metformin dose and F-FDG-PET resulted in increased muscle and fat uptake in addition to increased bowel uptake. Abnormal F-FDG uptake can limit the diagnostic quality of an exam and affect F-FDG uptake in cancer. The emerging role of biguanides in the treatment of cancer calls for more personalized standardization for F-FDG-PET in the presence of oral hypoglycemic agents.
与外源性胰岛素的作用相比，口服降糖药对氟-18-氟脱氧葡萄糖（F-FDG）摄取的影响了解较少。在本研究中，评估了停用二甲双胍对后续PET成像中F-FDG分布的影响。
进行了一项回顾性观察研究。根据从最后一剂二甲双胍到F-FDG-PET的时间间隔，将15名服用二甲双胍的患者分组。将在停用二甲双胍后不到24小时接受PET检查的患者与在PET检查前24-48小时停用二甲双胍的患者进行比较。对这些组的F-FDG摄取和PET图像保真度进行定性比较，并记录相关血糖。还比较了各组肝脏、舌头和皮下组织的平均标准化摄取值。
发现二甲双胍给药后大于24小时的时间点，F-FDG-PET分布和图像质量最佳。与在F-FDG-PET前最后一次服用二甲双胍超过24小时的患者相比，在F-FDG-PET前24小时内服用二甲双胍的患者肝脏和舌头的F-FDG摄取以及舌肝比显著增加；然而，皮下组织的F-FDG摄取没有变化。
二甲双胍给药与F-FDG-PET之间间隔少于24小时，除了肠道摄取增加外，还导致肌肉和脂肪摄取增加。F-FDG摄取异常会限制检查的诊断质量，并影响癌症中的F-FDG摄取。双胍类药物在癌症治疗中日益凸显的作用，要求在存在口服降糖药的情况下，对F-FDG-PET进行更个性化的标准化。
