Combining DMI and [¹⁸F]FDG-PET can complement the assessment of metabolic dysfunction-associated fatty liver disease

The unique capability of deuterium metabolic imaging (DMI) to detect downstream metabolic products and trace substrates' transport within tissues using conventional magnetic resonance (MR) scanners can, in theory, be employed with routine positron emission tomography (PET)/MR equipment. Our technical proof-of-concept study proposes a protocol for the simultaneous acquisition of DMI and [¹⁸F]FDG-PET data to enable dual assessment of hepatic glucose metabolism. A protocol that integrates high-dose glucose administration, required for DMI, with [¹⁸F]FDG-PET imaging was applied in a spectroscopy-validated rodent model of metabolic dysfunction-associated fatty liver disease (MAFLD). We acquired and quantified high-quality DMI and PET data of the liver that could provide a distinction between healthy and MAFLD cohorts in the future. RELEVANCE STATEMENT: This proof-of-concept study demonstrates the simultaneous DMI-[¹⁸F]FDG-PET acquisition for assessing hepatic glucose metabolism. With its proven viability in healthy and MAFLD livers, hybrid DMI-PET imaging shows promise as a prospective non-invasive tool to improve metabolic disease characterization and support future research applications. KEY POINTS: Simultaneous DMI and [¹⁸F]FDG-PET acquisition is technically feasible on a standard PET/MR system. Hybrid DMI-PET imaging enables dual assessment of hepatic glucose transport and metabolism, offering the advantage of reduced assessment duration. High-dose glucose administration for DMI is compatible with PET imaging, thereby reducing the subject's burden and enhancing liver metabolic evaluation.