Department of Radiology, Tokushima University Hospital, 2-50-1 Kuramoto-cho, Tokushima, 770-8503, Japan.
Ann Nucl Med. 2019 Sep;33(9):689-696. doi: 10.1007/s12149-019-01377-2. Epub 2019 Jun 14.
F-FDG PET/CT is a hybrid imaging method widely used as a useful, noninvasive imaging modality for evaluating various neoplastic diseases. When assessing the tumor uptake, the liver and the mediastinal blood pool are often used as a reference region. In daily clinical practice, the F-FDG uptake in the liver sometimes appears to decrease on PET images of patients with malnutrition. The purpose of this study was to investigate whether or not the liver F-FDG uptake is decreased in patients with malnutrition.
We retrospectively analyzed 246 patients who underwent F-FDG PET/CT from January 2018 to June 2018 and whose blood serum albumin was measured within 1 month of PET/CT. We compared the liver uptake and mediastinal blood uptake of patients with low serum albumin level (< 4.0 g/dl) and hypoalbuminemia (< 3.5 g/dl) with those with a normal serum albumin level (≥ 4.0 g/dl). Correlations between the liver and mediastinal blood uptake and the serum albumin level were also calculated.
The maximum standardized uptake value (SUV) and mean standardized uptake value (SUV) of the liver in 117 patients with low serum albumin were 3.1 ± 0.5 and 2.3 ± 0.3, respectively, while they were 2.9 ± 0.4, 2.0 ± 0.3 in 29 patients with hypoalbuminemia; these values were all significantly lower than the respective ones (3.4 ± 0.5, 2.5 ± 0.4) in 129 patients with normal serum albumin (all p < 0.001). The SUV of the mediastinal blood uptake in patients with hypoalbuminemia and normal serum albumin were 1.6 ± 0.2 and 1.7 ± 0.3, respectively (p = 0.053). The serum albumin level demonstrated a significantly positive, moderate correlation with the liver SUV, showing a regression line of y = 0.31x + 1.1 (r = 0.41, p < 0.001).
The liver F-FDG uptake tended to decrease in patients with hypoalbuminemia. In the patients with malnutrition, the mediastinal blood pool may be a more stable reference than the liver for evaluating the tumor activity because hypoalbuminemia is considered to less strongly influence the mediastinal blood pool than that in the liver.
FDG-PET/CT 是一种混合成像方法，广泛用作评估各种肿瘤疾病的有用、无创成像方式。在评估肿瘤摄取时，肝脏和纵隔血池常被用作参考区域。在日常临床实践中，营养不良患者的 PET 图像上有时会出现肝脏 FDG 摄取减少。本研究旨在探讨营养不良患者的肝脏 FDG 摄取是否减少。
我们回顾性分析了 2018 年 1 月至 2018 年 6 月期间进行 F-FDG PET/CT 的 246 例患者，这些患者在 PET/CT 检查后 1 个月内测量了血清白蛋白。我们比较了血清白蛋白水平低（<4.0g/dl）和低白蛋白血症（<3.5g/dl）患者与血清白蛋白水平正常（≥4.0g/dl）患者的肝脏摄取和纵隔血摄取。还计算了肝脏和纵隔血摄取与血清白蛋白水平之间的相关性。
117 例血清白蛋白水平低的患者的最大标准化摄取值（SUV）和平均标准化摄取值（SUV）分别为 3.1±0.5 和 2.3±0.3，而 29 例低白蛋白血症患者分别为 2.9±0.4 和 2.0±0.3；这些值均明显低于 129 例血清白蛋白正常患者的相应值（均 p<0.001）。低白蛋白血症和血清白蛋白正常患者的纵隔血摄取 SUV 分别为 1.6±0.2 和 1.7±0.3（p=0.053）。血清白蛋白水平与肝脏 SUV 呈显著正相关，呈回归线 y=0.31x+1.1（r=0.41，p<0.001）。
低白蛋白血症患者的肝脏 FDG 摄取倾向于减少。在营养不良患者中，由于低白蛋白血症对纵隔血池的影响可能不如肝脏，因此纵隔血池可能是评估肿瘤活性比肝脏更稳定的参考。
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