Martin W H, Jones R C, Delbeke D, Sandler M P
Section of Nuclear Medicine, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, and Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
Eur J Nucl Med. 1997 Oct;24(10):1291-7. doi: 10.1007/s002590050154.
The myocardial uptake of fluorine-18 fluorodeoxyglucose (FDG) has emerged as the most sensitive and specific technique for the assessment of myocardial viability. With the development of FDG single-photon emission tomography (SPET) and dual head coincidence imaging, a hindrance to the widespread clinical use of FDG cardiac imaging is the complexity of the preinjection glucose loading necessary for obtaining interpretable myocardial FDG scans. In a population of 209 patients undergoing dual-isotope single acquisition (DISA) FDG/sestamibi (MIBI) SPET, we describe the improvements in both image quality and time efficiency using a new short, simple glucose/insulin/potassium (GIK) infusion protocol prior to FDG injection as compared to a conventional oral glucose loading protocol. DISA FDG/MIBI SPET scans were performed in 111 nondiabetic patients after oral loading with 50 g of glucose (group 1). Ninety-eight consecutive nondiabetic patients were subsequently scanned following preparation with a fixed-concentration GIK infusion administered at a standardized rate (group 2). A three-point grading scale was used to assess image quality. The time to FDG injection following glucose administration was significantly shorter for the group 2 patients (39.9+/-15.6 min; range 20-105 min) than for the group 1 patients (99.5+/-30.3 min; range 56-270 min) (P<0.0001), representing a 1-h decrease in patient preparation time. More of the group 1 patients (n=30; 27%) required supplemental intravenous boluses of regular insulin than did the group 2 patients (n=13; 13%) (P<0.02). There were more excellent and good quality graded images using the GIK method (group 2) than the more traditional oral loading protocol (group 1) (P<0.02). Nine of 111 scans (8%) in group 1 were uninterpretable, whereas only one of 98 scans (1%) in group 2 was uninterpretable. Standardized infusion of a fixed concentration of GIK prior to FDG administration and continued during myocardial FDG uptake is an effective yet simple method of obtaining consistently good to excellent quality FDG SPET cardiac scans. It is preferable to conventional oral glucose loading due to decreased patient preparation time and improved image quality. The technique is safe and should improve both the clinical use and the cost-effectiveness of FDG SPET imaging for the identification of injured but viable myocardium.
心肌摄取氟-18氟脱氧葡萄糖（FDG）已成为评估心肌存活最敏感和特异的技术。随着FDG单光子发射断层扫描（SPET）和双头符合成像的发展，获得可解读的心肌FDG扫描所需的注射前葡萄糖负荷的复杂性成为FDG心脏成像广泛临床应用的障碍。在209例接受双同位素单次采集（DISA）FDG/锝-99m甲氧基异丁基异腈（MIBI）SPET检查的患者中，我们描述了与传统口服葡萄糖负荷方案相比，在FDG注射前使用一种新的简短、简单的葡萄糖/胰岛素/钾（GIK）输注方案在图像质量和时间效率方面的改善。111例非糖尿病患者口服50g葡萄糖后进行DISA FDG/MIBI SPET扫描（第1组）。随后，98例连续的非糖尿病患者在以标准化速率给予固定浓度的GIK输注进行准备后进行扫描（第2组）。使用三点分级量表评估图像质量。第2组患者在给予葡萄糖后至FDG注射的时间（39.9±15.6分钟；范围20 - 105分钟）明显短于第1组患者（99.5±30.3分钟；范围56 - 270分钟）（P<0.0001），这意味着患者准备时间减少了1小时。第1组中需要补充静脉注射常规胰岛素的患者（n = 30；27%）比第2组患者（n = 13；13%）更多（P<0.02）。与更传统的口服负荷方案（第1组）相比，使用GIK方法（第2组）获得的优质和良好质量分级的图像更多（P<0.02）。第1组111次扫描中有9次（8%）无法解读，而第2组98次扫描中只有1次（1%）无法解读。在FDG给药前标准化输注固定浓度的GIK并在心肌摄取FDG期间持续输注是获得始终良好至优质的FDG SPET心脏扫描的一种有效且简单的方法。由于减少了患者准备时间并提高了图像质量，它优于传统的口服葡萄糖负荷。该技术是安全的，并且应该会改善FDG SPET成像在识别受损但存活心肌方面的临床应用和成本效益。
