Excess Muscle FDG Uptake in an Euglycaemic Patient That Is Corrected by Fasting

A 61-year-old non-diabetic woman underwent a non-diagnostic FDG PET study due to ingestion of milk and sugar 150 minutes prior to injection of FDG despite being euglycaemic. A repeat study 2 days later showed 4 pathological foci of FDG uptake, of which only two could be seen retrospectively on the original study. The loss of lesion perspicuity and suppression of FDG uptake in the pathological lesions was corrected by fasting for more than 6 hours. The calculated SUV suppression due to eating could be corrected by normalizing according to the average of the patient's liver SUV. Proper patient preparation is essential in any medical procedure but even more so in FDG PET imaging, as small pathological lesions may be missed if the patient is improperly prepared.