Rosica Dillenia, Cheng Su-Chun, Hudson Margo, Sakellis Christopher, Van den Abbeele Annick D, Kim Chun K, Jacene Heather A
Departments of Imaging.
Biostatistics and Computational Biology, Dana-Farber Cancer Institute.
Nucl Med Commun. 2018 May;39(5):417-422. doi: 10.1097/MNM.0000000000000829.
Suggested cutoff points of blood glucose levels (BGL) before F-FDG PET/CT scanning vary between 120 and 200 mg/dl in current guidelines. This study's purpose was to compare the frequency of abnormal fluorine-18-fluorodeoxyglucose (F-FDG) biodistribution on PET/CT scans of patients with various ranges of abnormal BGL and to determine the effect of BGL greater than 200 mg/dl on F-FDG uptake in various organs.
F-FDG PET/CT scans were retrospectively reviewed for 325 patients with BGL greater than 120 mg/dl at the time of scan and 112 with BGL less than or equal to 120 mg/dl. F-FDG biodistribution was categorized as normal, mildly abnormal, or abnormal by visual analysis of brain, background soft tissue, and muscle. Mean standardized uptake values (SUVmean) in brain, liver, fat (flank), gluteal muscle, and blood pool (aorta) were recorded. F-FDG biodistribution frequencies were assessed using a nonparametric χ-test for trend. Normal organ SUVs were compared using Kruskal-Wallis tests using the following BGL groupings: ≤120, 121-150, 151-200, and ≥201 mg/dl.
Although higher BGL were significantly associated with an increased proportion of abnormal biodistribution (P<0.001), most patients with BGL less than or equal to 200 mg/dl had normal or mildly abnormal biodistribution. Average brain SUVmean significantly decreased with higher BGL groupings (P<0.001). Average aorta, gluteal muscle, and liver SUVmean did not significantly differ among groups with BGL greater than 120 mg/dl (P=0.66, 0.84, and 0.39, respectively), but were significantly lower in those with BGL less than or equal to 120 mg/dl (P≤0.001). Flank fat SUVmean was not significantly different among BGL groups (P=0.67).
Abnormal F-FDG biodistribution is associated with higher BGL at the time of scan, but the effects are negligible or mild in most patients with BGL less than 200 mg/dl. Although mildly increased soft tissue uptake is seen with BGL greater than 120 mg/dl, decline in brain metabolic activity correlated the most with various BGL.
目前的指南建议，在进行F-FDG PET/CT扫描前，血糖水平（BGL）的截断点在120至200mg/dl之间。本研究的目的是比较不同BGL异常范围患者PET/CT扫描中氟-18-氟脱氧葡萄糖（F-FDG）生物分布异常的频率，并确定BGL大于200mg/dl对各器官F-FDG摄取的影响。
回顾性分析325例扫描时BGL大于120mg/dl以及112例BGL小于或等于120mg/dl患者的F-FDG PET/CT扫描结果。通过对脑、背景软组织和肌肉的视觉分析，将F-FDG生物分布分为正常、轻度异常或异常。记录脑、肝、脂肪（侧腹）、臀肌和血池（主动脉）的平均标准化摄取值（SUVmean）。使用非参数χ检验趋势评估F-FDG生物分布频率。使用Kruskal-Wallis检验比较以下BGL分组的正常器官SUV：≤120、121 - 150、151 - 200和≥201mg/dl。
虽然较高的BGL与生物分布异常比例增加显著相关（P<0.001），但大多数BGL小于或等于200mg/dl的患者生物分布正常或轻度异常。随着BGL分组升高，平均脑SUVmean显著降低（P<0.001）。BGL大于120mg/dl的各组间，主动脉、臀肌和肝脏的平均SUVmean无显著差异（分别为P = 0.66、0.84和0.39），但BGL小于或等于120mg/dl的患者中这些值显著更低（P≤0.001）。侧腹脂肪SUVmean在各BGL组间无显著差异（P = 0.67）。
扫描时F-FDG生物分布异常与较高的BGL相关，但在大多数BGL小于200mg/dl的患者中，这种影响可忽略不计或较轻微。虽然BGL大于120mg/dl时可见软组织摄取轻度增加，但脑代谢活性下降与不同BGL的相关性最强。
