Medical Imaging Center, Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands;
Medical Imaging Center, Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
J Nucl Med. 2023 Aug;64(8):1287-1294. doi: 10.2967/jnumed.122.264839. Epub 2023 Jul 6.
We investigated the effects of blood glucose levels on the performance of F-FDG PET/CT for detecting an infection focus in patients with bacteremia. A total of 322 consecutive patients with bacteremia who underwent F-FDG PET/CT between 2010 and 2021 were included. Logistic regression analysis was performed to evaluate the association between finding a true-positive infection focus on F-FDG PET/CT and blood glucose level, type of diabetes, and use of hypoglycemic medication. C-reactive protein, leukocyte count, duration of antibiotic treatment, and type of isolated bacteria were considered as well. Blood glucose level (odds ratio, 0.76 per unit increase; = <0.001) was significantly and independently associated with F-FDG PET/CT outcome. In patients with a blood glucose level between 3.0 and 7.9 mmol/L (54-142 mg/dL), the true-positive detection rate of F-FDG PET/CT varied between 61% and 65%, whereas in patients with a blood glucose level between 8.0 and 10.9 mmol/L (144-196 mg/dL), the true-positive detection rate decreased to 30%-38%. In patients with a blood glucose level greater than 11.0 mmol/L (200 mg/dL), the true-positive detection rate was 17%. In addition to C-reactive protein (odds ratio, 1.004 per point increase; = 0.009), no other variables were independently associated with F-FDG PET/CT outcome. In patients with moderate to severe hyperglycemia, F-FDG PET/CT was much less likely to identify the focus of infection than in normoglycemic patients. Although current guidelines recommend postponing F-FDG PET/CT only in cases of severe hyperglycemia with glucose levels greater than 11 mmol/L (200 mg/dL), a lower blood glucose threshold seems to be more appropriate in patients with bacteremia of unknown origin and other infectious diseases.
我们研究了血糖水平对 F-FDG PET/CT 检测菌血症患者感染病灶的影响。共纳入 2010 年至 2021 年间 322 例连续菌血症患者行 F-FDG PET/CT 检查。采用逻辑回归分析评估 F-FDG PET/CT 上发现真正阳性感染灶与血糖水平、糖尿病类型和使用降血糖药物之间的关系。还考虑了 C 反应蛋白、白细胞计数、抗生素治疗持续时间和分离细菌的类型。血糖水平（每单位增加的优势比，0.76； <0.001）与 F-FDG PET/CT 结果显著相关。血糖水平在 3.0 至 7.9mmol/L（54-142mg/dL）之间的患者，F-FDG PET/CT 的真阳性检出率在 61%至 65%之间，而血糖水平在 8.0 至 10.9mmol/L（144-196mg/dL）之间的患者，真阳性检出率下降至 30%-38%。血糖水平大于 11.0mmol/L（200mg/dL）的患者，真阳性检出率为 17%。除 C 反应蛋白（每点增加的优势比，1.004； = 0.009）外，没有其他变量与 F-FDG PET/CT 结果独立相关。在中度至重度高血糖患者中，F-FDG PET/CT 识别感染灶的可能性远低于血糖正常的患者。尽管目前的指南建议仅在血糖水平大于 11mmol/L（200mg/dL）的严重高血糖情况下推迟 F-FDG PET/CT，但对于原因不明的菌血症和其他传染病患者，似乎需要更低的血糖阈值。
