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Application of 18F-FDG brain PET for survival prediction in a rat model of hanging-induced hypoxic brain injury

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Abstract

Background

Accurate prediction of survival outcomes after hanging is a crucial and challenging issue in comatose survivors. In this preclinical study, we evaluated the potential utility of using brain glucose metabolism as measured by fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) for survival prediction in a rat model of hanging-induced hypoxic brain injury (HBI).

Methods

HBI was induced by mechanical hanging using Sprague Dawley rats. 18F-FDG brain PET images were acquired in 26 HBI rats three hours post-injury (3 h post-injury) and 4 controls. During the 1 month follow-up period, HBI rats were further classified as survivors (n = 15) and nonsurvivors (n = 11). Between-group regional (standardized uptake values normalized to the reference whole brain = SUVRWB, cerebellum = SUVRCB, and pons = SUVRpons) and voxel-based analyses were performed. The prognostic value of the SUVR was tested for overall survival (OS). In addition, diffusion-weighted imaging (DWI) was performed in 2 controls and 5 HBI rats (3 survivors, 2 nonsurvivors, 3 h post), and an apparent diffusion coefficient (ADC) map was generated.

Results

The nonsurvivor group showed a significantly lower SUVRWB, SUVRCB, and SUVRpons of the cerebral cortices than the survivor group (all p < 0.001). Voxel-based comparison also demonstrated significant reduction in the nonsurvivor group compared with the survivor group (family-wise error-corrected p < 0.05). However, there was no significant difference between controls and survivors. Of 3 reference regions, the SUVRpons demonstrated the largest difference between the survivor and nonsurvivor groups. With an optimal cutoff value of 1.12 (AUC 0.952, p < 0.001), the SUVRpons predicted survival outcomes with a sensitivity of 81.8% and specificity of 100%. The OS of the low SUVRpons group was significantly shorter than that the high SUVRpons group (p < 0.001). The mean ADC values of each brain region showed no significant difference according to survival outcomes.

Conclusions

These results suggest the potential utility of 18F-FDG brain PET for predicting survival in hanging-induced HBI.

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Acknowledgements

The authors wish to thank the Institute for Bio-Medical Convergence, Incheon St. Mary’s Hospital, The Catholic University of Korea for the excellent assistance.

Funding

This work was supported by the National Research Foundation (NRF) funded by the Ministry of Education of Korea (2020R1A2C1102046, Daehee Kim; 2019R1G1A1100299, Seon Hee Woo; 2021R1A2C1093636, Hai-Jeon Yoon) and a Grant of Translational R&D Project through Institute for Bio-Medical convergence, Incheon St. Mary’s Hospital, The Catholic University of Korea (Seon Hee Woo; IBC2019-14).

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Author notes

  1. Seon Hee Woo and Hai-Jeon Yoon contributed equally to this work.

Authors and Affiliations

  1. Department of Emergency Medicine, Incheon St. Mary’s Hospital, The Catholic University of Korea, Incheon, Korea

    Daehee Kim

  2. Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea

    Daehee Kim, Woon Jeong Lee, Hye Won Lee & Seon Hee Woo

  3. Department of Nuclear Medicine, College of Medicine, Ewha Womans University, Seoul, Korea

    Bom Sahn Kim & Hai-Jeon Yoon

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  1. Daehee Kim
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  2. Woon Jeong Lee
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  3. Hye Won Lee
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Correspondence to Seon Hee Woo or Hai-Jeon Yoon.

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Kim, D., Lee, W.J., Lee, H.W. et al. Application of 18F-FDG brain PET for survival prediction in a rat model of hanging-induced hypoxic brain injury. Ann Nucl Med 36, 570–578 (2022). https://doi.org/10.1007/s12149-022-01738-4

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  • DOI: https://doi.org/10.1007/s12149-022-01738-4

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