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Annals of Nuclear Medicine

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01-11-2016 | Original Article

Metformin discontinuation less than 72 h is suboptimal for F-18 FDG PET/CT interpretation of the bowel

Authors: Suk Hyun Lee, Soyoung Jin, Hyo Sang Lee, Jin-Sook Ryu, Jong Jin Lee

Published in: Annals of Nuclear Medicine | Issue 9/2016

Abstract

Objective

Metformin-induced [F-18] fluorodeoxyglucose (FDG) bowel uptake can hinder positron emission tomography/computed tomography (PET/CT) evaluation of the bowel. This study aimed to investigate the segmental bowel uptake of FDG according to metformin discontinuation times up to 72 h.

Methods

We retrospectively divided 240 diabetic patients into four groups: metformin discontinuation <24 h (group A; n = 86), 24–48 h (group B; n = 40), 48–72 h (group C; n = 12), and no metformin (control group; n = 102). Segmental FDG bowel uptakes were measured visually (four-point scale) and semi-quantitatively (maximum standardized uptake value).

Results

Compared with the control group, FDG uptake increased significantly from the ileum to the rectosigmoid colon in group A, from the transverse to the rectosigmoid colon in group B, and from the descending colon to the rectosigmoid colon in group C in both visual and semi-quantitative analyses.

Conclusions

Metformin discontinuation for <72 h is likely suboptimal for PET/CT image interpretation, especially with respect to the distal segments of the colon.

Bybel B, Greenberg ID, Paterson J, Ducharme J, Leslie WD. Increased F-18 FDG intestinal uptake in diabetic patients on metformin: a matched case–control analysis. Clin Nucl Med. 2011;36:452–6.CrossRefPubMed

Gontier E, Fourme E, Wartski M, Blondet C, Bonardel G, Le Stanc E, et al. High and typical ¹⁸F-FDG bowel uptake in patients treated with metformin. Eur J Nucl Med Mol Imaging. 2008;35:95–9.CrossRefPubMed

Ozulker T, Ozulker F, Mert M, Ozpacaci T. Clearance of the high intestinal ¹⁸F-FDG uptake associated with metformin after stopping the drug. Eur J Nucl Med Mol Imaging. 2010;37:1011–7.CrossRefPubMed

Surasi DS, Bhambhvani P, Baldwin JA, Almodovar SE, O’Malley JP. ¹⁸F-FDG PET and PET/CT patient preparation: a review of the literature. J Nucl Med Technol. 2014;42:5–13.CrossRefPubMed

Oh JR, Song HC, Chong A, Ha JM, Jeong SY, Min JJ, et al. Impact of medication discontinuation on increased intestinal FDG accumulation in diabetic patients treated with metformin. AJR Am J Roentgenol. 2010;195:1404–10.CrossRefPubMed

Abele JT, Fung CI. Effect of hepatic steatosis on liver FDG uptake measured in mean standard uptake values. Radiology. 2010;254:917–24.CrossRefPubMed

Abikhzer G, Alabed YZ, Azoulay L, Assayag J, Rush C. Altered hepatic metabolic activity in patients with hepatic steatosis on FDG PET/CT. AJR Am J Roentgenol. 2011;196:176–80.CrossRefPubMed

Dostbil Z, Varoglu E, Serdengecti M, Kaya B, Onder H, Sari O. Evaluation of hepatic metabolic activity in non-alcoholic fatty livers on ¹⁸FDG PET/CT. Rev Esp Med Nucl Imagen Mol. 2013;32:156–61.PubMed

Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner M-J. SEER survival monograph: cancer survival among adults: US SEER Program, 1988–2001, patient and tumor characteristics. In: National Cancer Institute, SEER Program, NIH Pub. No. 07-6215 2007. http://seer.cancer.gov/archive/publications/survival/seer_survival_mono_lowres.pdf. Accessed 2 June 2016.

10.

Treglia G, Taralli S, Salsano M, Muoio B, Sadeghi R, Giovanella L. Prevalence and malignancy risk of focal colorectal incidental uptake detected by ¹⁸F-FDG-PET or PET/CT: a meta-analysis. Radiol Oncol. 2014;48:99–104.CrossRefPubMedPubMedCentral

11.

Ikeda T, Iwata K, Murakami H. Inhibitory effect of metformin on intestinal glucose absorption in the perfused rat intestine. Biochem Pharmacol. 2000;59:887–90.CrossRefPubMed

12.

Lorch E. Inhibition of intestinal absorption and improvement of oral glucose tolerance by biguanides in the normal and in the streptozotocin-diabetic rat. Diabetologia. 1971;7:195–203.CrossRefPubMed

13.

Wilcock C, Bailey CJ. Accumulation of metformin by tissues of the normal and diabetic mouse. Xenobiotica. 1994;24:49–57.CrossRefPubMed

14.

Bailey CJ, Turner RC. Metformin. N Engl J Med. 1996;334:574–9.CrossRefPubMed

15.

Bailey CJ, Mynett KJ, Page T. Importance of the intestine as a site of metformin-stimulated glucose utilization. Br J Pharmacol. 1994;112:671–5.CrossRefPubMedPubMedCentral

16.

Penicaud L, Hitier Y, Ferre P, Girard J. Hypoglycaemic effect of metformin in genetically obese (fa/fa) rats results from an increased utilization of blood glucose by intestine. Biochem J. 1989;262:881–5.CrossRefPubMedPubMedCentral

17.

Drozdowski LA, Thomson AB. Intestinal sugar transport. World J Gastroenterol. 2006;12:1657–70.CrossRefPubMedPubMedCentral

18.

Wright EM, Martin MG, Turk E. Intestinal absorption in health and disease—sugars. Best Pract Res Clin Gastroenterol. 2003;17:943–56.CrossRefPubMed

19.

Massollo M, Marini C, Brignone M, Emionite L, Salani B, Riondato M, et al. Metformin temporal and localized effects on gut glucose metabolism assessed using ¹⁸F-FDG PET in mice. J Nucl Med. 2013;54:259–66.CrossRefPubMed

20.

Wilcock C, Bailey CJ. Sites of metformin-stimulated glucose metabolism. Biochem Pharmacol. 1990;39:1831–4.CrossRefPubMed

21.

Chai TF, Hong SY, He H, Zheng L, Hagen T, Luo Y, et al. A potential mechanism of metformin-mediated regulation of glucose homeostasis: inhibition of Thioredoxin-interacting protein (Txnip) gene expression. Cell Signal. 2012;24:1700–5.CrossRefPubMed

22.

Oka S, Liu W, Masutani H, Hirata H, Shinkai Y, Yamada S, et al. Impaired fatty acid utilization in thioredoxin binding protein-2 (TBP-2)-deficient mice: a unique animal model of Reye syndrome. Faseb J. 2006;20:121–3.PubMed

23.

Shaked M, Ketzinel-Gilad M, Cerasi E, Kaiser N, Leibowitz G. AMP-activated protein kinase (AMPK) mediates nutrient regulation of thioredoxin-interacting protein (TXNIP) in pancreatic beta-cells. PLoS One. 2011;6:e28804.CrossRefPubMedPubMedCentral

24.

Roy FN, Beaulieu S, Boucher L, Bourdeau I, Cohade C. Impact of intravenous insulin on ¹⁸F-FDG PET in diabetic cancer patients. J Nucl Med. 2009;50:178–83.CrossRefPubMed

Title: Metformin discontinuation less than 72 h is suboptimal for F-18 FDG PET/CT interpretation of the bowel
Authors: Suk Hyun Lee
Soyoung Jin
Hyo Sang Lee
Jin-Sook Ryu
Jong Jin Lee
Publication date: 01-11-2016
Publisher: Springer Japan
Published in: Annals of Nuclear Medicine / Issue 9/2016
Print ISSN: 0914-7187
Electronic ISSN: 1864-6433
DOI: https://doi.org/10.1007/s12149-016-1106-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Metformin discontinuation less than 72 h is suboptimal for F-18 FDG PET/CT interpretation of the bowel

Abstract

Objective

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

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