Top

Published in:

01-06-2019 | Original Article

Volume-based glucose metabolic analysis of FDG PET/CT: The optimum threshold and conditions to suppress physiological myocardial uptake

Authors: Osamu Manabe, MD, PhD, Markus Kroenke, MD, Tadao Aikawa, MD, Atsuto Murayama, MSc, Masanao Naya, MD, PhD, Atsuro Masuda, MD, PhD, Noriko Oyama-Manabe, MD, PhD, Kenji Hirata, MD, PhD, Shiro Watanabe, MD, PhD, Tohru Shiga, MD, PhD, Chietsugu Katoh, MD, PhD, Nagara Tamaki, MD, PhD

Published in: Journal of Nuclear Cardiology | Issue 3/2019

Abstract

Objective

FDG PET/CT plays a significant role in the diagnosis of inflammatory heart diseases and cardiac tumors. We attempted to determine the optimal FDG uptake threshold for volume-based analyses and to evaluate the relationship between the myocardial physiological uptake volume in FDG PET and several clinical factors.

Methods

A total of 190 patients were retrospectively analyzed. The cardiac metabolic volume (CMV) was defined as a volume within the boundary determined by a threshold (SUVmean of blood pool × 1.5).

Results

The SUVmean of the blood pool measured in the descending aorta (DA) (r = 0.86, intraclass correlation coefficient [ICC] = 0.93, P < 0.0001) and that in the left ventricle (LV) cavity (r = 0.87, ICC = 0.90, P < 0.0001) showed high inter-operator reproducibility. However, the SUVmean in the LV cavity showed a significant correlation with the CMV (P = 0.0002, r = 0.26). The CMV in the patients who fasted < 18 hours were significantly higher (49.7 ± 73.2 vs. 18.0 ± 53.8 mL, P = 0.0013) compared to the patients with > 18-hour fasting. The multivariate analysis demonstrated that only the fasting period > 18 hours was independently associated with CMV = 0.

Conclusion

Our findings revealed that the DA is suitable to decide the threshold for the volume-based analysis. The fasting time was significantly associated with the cardiac FDG uptake.

Available only for authorised users

Manabe O, Yoshinaga K, Ohira H, et al. The effects of 18-h fasting with low-carbohydrate diet preparation on suppressed physiological myocardial (18)F-fluorodeoxyglucose (FDG) uptake and possible minimal effects of unfractionated heparin use in patients with suspected cardiac involvement sarcoidosis. J Nucl Cardiol. 2016;23:244–52.CrossRefPubMed

Hyun SH, Choi JY, Shim YM, et al. Prognostic value of metabolic tumor volume measured by ¹⁸F-fluorodeoxyglucose positron emission tomography in patients with esophageal carcinoma. Ann Surg Oncol. 2010;17:115–22.CrossRefPubMed

Burger IA, Casanova R, Steiger S, et al. ¹⁸F-FDG PET/CT of non-small cell lung carcinoma under neoadjuvant chemotherapy: background-based adaptive-volume metrics outperform TLG and MTV in predicting histopathologic response. J Nucl Med. 2016;57:849–54.CrossRefPubMed

Ohira H, Mc Ardle B, de Kemp RA, et al. Inter- and intra- observer agreement of FDG-PET/CT image interpretation in patients referred for assessment of Cardiac Sarcoidosis. J Nucl Med. 2017;58:1324–9.CrossRefPubMed

Manabe O, Ohira H, Yoshinaga K, Naya M, Oyama-Manabe N, Tamaki N. Qualitative and quantitative assessments of cardiac sarcoidosis using ¹⁸F-FDG PET. Ann Nucl Cardiol. 2017;3:125–30.CrossRef

Ahmadian A, Brogan A, Berman J, et al. Quantitative interpretation of FDG PET/CT with myocardial perfusion imaging increases diagnostic information in the evaluation of cardiac sarcoidosis. J Nucl Cardiol. 2014;21:925–39.CrossRefPubMed

Masuda A, Naya M, Manabe O, et al. Administration of unfractionated heparin with prolonged fasting could reduce physiological ¹⁸F-fluorodeoxyglucose uptake in the heart. Acta Radiol. 2016;57:661–8.CrossRefPubMed

Blomberg BA, Bashyam A, Ramachandran A, et al. Quantifying [(1)(8)F]fluorodeoxyglucose uptake in the arterial wall: the effects of dual time-point imaging and partial volume effect correction. Eur J Nucl Med Mol Imaging. 2015;42:1414–22.CrossRefPubMed

Choi Y, Hawkins RA, Huang SC, et al. Evaluation of the effect of glucose ingestion and kinetic model configurations of FDG in the normal liver. J Nucl Med. 1994;35:818–23.PubMed

10.

Ishida Y, Yoshinaga K, Miyagawa M, et al. Recommendations for (18)F-fluorodeoxyglucose positron emission tomography imaging for cardiac sarcoidosis: Japanese Society of Nuclear Cardiology recommendations. Ann Nucl Med. 2014;28:393–403.CrossRefPubMed

11.

Hirata K, Kobayashi K, Wong KP, et al. A semi-automated technique determining the liver standardized uptake value reference for tumor delineation in FDG PET-CT. PloS ONE. 2014;9:e105682.CrossRefPubMedPubMedCentral

12.

Wahl RL, Jacene H, Kasamon Y, Lodge MA. From RECIST to PERCIST: Evolving considerations for PET response criteria in solid tumors. J Nucl Med. 2009;50:122S–50S.CrossRefPubMed

13.

Kaneta T, Hakamatsuka T, Takanami K, et al. Evaluation of the relationship between physiological FDG uptake in the heart and age, blood glucose level, fasting period, and hospitalization. Ann Nucl Med. 2006;20:203–8.CrossRefPubMed

14.

Morooka M, Moroi M, Uno K, et al. Long fasting is effective in inhibiting physiological myocardial ¹⁸F-FDG uptake and for evaluating active lesions of cardiac sarcoidosis. EJNMMI Res. 2014;4:1.CrossRefPubMedPubMedCentral

15.

Youssef G, Leung E, Mylonas I, et al. The use of ¹⁸F-FDG PET in the diagnosis of cardiac sarcoidosis: a systematic review and metaanalysis including the Ontario experience. J Nucl Med. 2012;53:241–8.CrossRefPubMed

16.

Israel O, Weiler-Sagie M, Rispler S, et al. PET/CT quantitation of the effect of patient-related factors on cardiac ¹⁸F-FDG uptake. J Nucl Med. 2007;48:234–9.PubMed

17.

Manabe O, Yoshinaga K, Ohira H, et al. The effects of 18-h fasting with low-carbohydrate diet preparation on suppressed physiological myocardial F-fluorodeoxyglucose (FDG) uptake and possible minimal effects of unfractionated heparin use in patients with suspected cardiac involvement sarcoidosis. J Nucl Cardiol. 2015;23:244–52.CrossRefPubMedPubMedCentral

18.

Keramida G, Potts J, Bush J, Dizdarevic S, Peters AM. Hepatic steatosis is associated with increased hepatic FDG uptake. Eur J Radiol. 2014;83:751–5.CrossRefPubMed

19.

Osborne MT, Hulten EA, Singh A, et al. Reduction in (1)(8)F-fluorodeoxyglucose uptake on serial cardiac positron emission tomography is associated with improved left ventricular ejection fraction in patients with cardiac sarcoidosis. J Nucl Cardiol. 2014;21:166–74.CrossRefPubMed

20.

Ito K, Okazaki O, Morooka M, Kubota K, Minamimoto R, Hiroe M. Visual findings of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with cardiac sarcoidosis. Intern Med. 2014;53:2041–9.CrossRefPubMed

21.

de Groot M, Meeuwis AP, Kok PJ, Corstens FH, Oyen WJ. Influence of blood glucose level, age and fasting period on non-pathological FDG uptake in heart and gut. Eur J Nucl Med Mol Imaging. 2005;32:98–101.CrossRefPubMed

22.

Miyagawa M, Tashiro R, Watanabe E, et al. Optimal patient preparation for detection and assessment of cardiac sarcoidosis by FDG-PET. Ann Nucl Cardiol. 2017;3:113–6.CrossRef

23.

Ohira H, Tsujino I, Yoshinaga K. (1)(8)F-Fluoro-2-deoxyglucose positron emission tomography in cardiac sarcoidosis. Eur J Nucl Med Mol Imaging. 2011;38:1773–83.CrossRefPubMed

Title: Volume-based glucose metabolic analysis of FDG PET/CT: The optimum threshold and conditions to suppress physiological myocardial uptake
Authors: Osamu Manabe, MD, PhD
Markus Kroenke, MD
Tadao Aikawa, MD
Atsuto Murayama, MSc
Masanao Naya, MD, PhD
Atsuro Masuda, MD, PhD
Noriko Oyama-Manabe, MD, PhD
Kenji Hirata, MD, PhD
Shiro Watanabe, MD, PhD
Tohru Shiga, MD, PhD
Chietsugu Katoh, MD, PhD
Nagara Tamaki, MD, PhD
Publication date: 01-06-2019
Publisher: Springer International Publishing
Published in: Journal of Nuclear Cardiology / Issue 3/2019
Print ISSN: 1071-3581
Electronic ISSN: 1532-6551
DOI: https://doi.org/10.1007/s12350-017-1122-6

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The STEP trials

Springer Medicine

Volume-based glucose metabolic analysis of FDG PET/CT: The optimum threshold and conditions to suppress physiological myocardial uptake

Abstract

Objective

Methods

Results

Conclusion

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2019

Social media update: The launch of @JNCjournal

Myocardial perfusion imaging prior to coronary revascularization: From risk stratification to procedure guidance

An unmet clinical need: The history of thrombus imaging

Letter regarding “Meta-analysis of 18F-FDG PET/CT in the diagnosis of infective endocarditis”

On-site CT-FFR of an anomalous right coronary artery to influence revascularization strategy

Prediction of 14-year cardiovascular outcomes by dobutamine stress 99mTc-tetrofosmin myocardial perfusion SPECT; methodological issues in prediction studies

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page