From the Faculty of Medicine (R.H.) and Department of Radiology (D.W., F.B.), University of British Columbia, Vancouver, BC, Canada; BC Cancer, BC Cancer Research Centre, 675 W 10th Ave, Vancouver, BC, Canada V5Z 1L3 (A.E., D.W., T.A., F.B.); Department of Diagnostic Radiology, Surrey Memorial Hospital, Surrey, BC, Canada (A.E.); and Department of Nuclear Medicine, QEII Health Sciences Centre, Halifax, NS, Canada (A.W.).
Radiology. 2018 Nov;289(2):418-425. doi: 10.1148/radiol.2018180078. Epub 2018 Aug 14.
Purpose To investigate the relationship of 24- and 48-hour metformin discontinuation to bowel uptake of fluorine 18 fluorodeoxyglucose (FDG) on PET/CT scans. Materials and Methods Patients with diabetes who were treated with metformin and referred for FDG PET/CT were randomized to three equal groups based on duration of metformin discontinuation: 24 hours, 48 hours, and no discontinuation (control group). Two interpreters blinded to the study groups assessed FDG uptake in multiple segments of small and large bowel qualitatively and semiquantitatively by using maximum standardized uptake values (SUVs). Differences in age, sex, weight, dose of metformin, duration of metformin treatment, blood glucose levels, and FDG dose injected were assessed. Data were analyzed with analysis of variance when passing normality, and by nonparametric testing when not. Results Ninety study participants (62 male, 28 female; median age, 70 years) were enrolled from July 2010 through March 2012. There were no differences between study groups in weight, blood glucose levels 3 days prior to scanning, or normal organ uptake. Large bowel SUV was lower after 24 hours (4.10 ± 2.00 vs 5.42 ± 2.36; P = .020) and 48 hours (2.63 ± 0.88 vs 5.42 ± 2.36; P ˂ .001) of metformin discontinuation than for no discontinuation (control), and for 48 hours versus 24 hours of discontinuation (P = .0015). Small bowel SUV was lower after 24 hours (2.86 ± 0.67 vs 3.73 ± 1.08 [control]; P ˂ .001) and 48 hours (2.78 ± 0.73 vs 3.73 ± 1.08 [control]; P ˂ .001) of metformin discontinuation versus no metformin discontinuation, but not for 48 hours versus 24 hours of discontinuation (P = .57). Examination-day blood glucose levels increased after 48-hour withdrawal of metformin (8.41 mmol/L ± 2.86 vs 6.83 mmol/L ± 2.13 [control]; P = .002). Conclusion Metformin discontinuation for 48 hours prior to PET/CT was associated with lower accumulation of fluorodeoxyglucose in the bowel, compared to when there was no discontinuation (control group) or 24-hour discontinuation of metformin. © RSNA, 2018.
目的 研究二甲双胍停用 24 小时和 48 小时与氟 18 氟脱氧葡萄糖（FDG）在 PET/CT 扫描中肠道摄取的关系。
材料与方法 对接受二甲双胍治疗并接受 FDG PET/CT 检查的糖尿病患者进行随机分组，根据二甲双胍停药时间分为三组：24 小时、48 小时和不停药（对照组）。两位对研究组不知情的解读者通过最大标准化摄取值（SUV）对小肠和大肠的多个节段进行 FDG 摄取的定性和半定量评估。评估年龄、性别、体重、二甲双胍剂量、二甲双胍治疗时间、血糖水平和注射的 FDG 剂量的差异。当通过正态性检验时，采用方差分析进行分析，当不通过正态性检验时，采用非参数检验进行分析。
结果 2010 年 7 月至 2012 年 3 月，共有 90 名研究参与者（62 名男性，28 名女性；中位年龄 70 岁）入选。研究组之间在体重、扫描前 3 天的血糖水平或正常器官摄取方面无差异。停用二甲双胍 24 小时（4.10 ± 2.00 比 5.42 ± 2.36；P =.020）和 48 小时（2.63 ± 0.88 比 5.42 ± 2.36；P ＜.001）后，大肠 SUV 低于不停药（对照组），48 小时低于 24 小时（P =.0015）。停用二甲双胍 24 小时（2.86 ± 0.67 比 3.73 ± 1.08[对照组]；P ＜.001）和 48 小时（2.78 ± 0.73 比 3.73 ± 1.08[对照组]；P ＜.001）后，小肠 SUV 低于不停药（对照组），但 48 小时与 24 小时之间无差异（P =.57）。停用二甲双胍 48 小时后，检查日血糖水平升高（8.41 mmol/L ± 2.86 比 6.83 mmol/L ± 2.13[对照组]；P =.002）。
结论 与不停药（对照组）或停用二甲双胍 24 小时相比，PET/CT 检查前停用二甲双胍 48 小时与肠道中氟脱氧葡萄糖的积累减少相关。
© RSNA，2018。
