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Characterization of a highly effective preparation for suppression of myocardial glucose utilization

Sophia R Larson1, Justin A Pieper1, Edward A Hulten2

  • 1Department of Medicine, University of Michigan, Ann Arbor, MI, USA.

Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology
|June 26, 2019
PubMed

Insights

Intensive metabolic preparation, including a low-carbohydrate diet, effectively suppresses myocardial F-18 fluorodeoxyglucose (FDG) uptake for cardiac PET/CT imaging. This protocol establishes a reliable baseline for visualizing myocardial inflammation.

Area of Science:

  • Nuclear Medicine
  • Cardiovascular Imaging
  • Metabolic Research

Background:

  • F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is a valuable tool for visualizing myocardial inflammation.
  • Optimal protocols and established normative values for myocardial FDG uptake are not well-defined, hindering accurate interpretation.

Purpose of the Study:

  • To evaluate the effectiveness of a specific metabolic preparation protocol for cardiac FDG PET/CT.
  • To establish normative myocardial FDG uptake values in patients undergoing inflammation imaging.

Main Methods:

  • 111 patients referred for cardiac FDG PET/CT underwent imaging after a 36-hour low-carbohydrate, high-fat diet and unfractionated heparin administration.
  • Blood pool and myocardial uptake (SUVmax) were measured, with attention to avoiding abnormal uptake areas.
  • Biomarkers of glucose and fatty acid metabolism were collected concurrently.

Main Results:

  • 95% of patients achieved adequate suppression of myocardial FDG uptake.
  • Myocardial SUVmax was significantly lower than background blood pool SUVmean (septal ratio 0.75, lateral ratio 0.70).
  • Glucose metabolism biomarkers (glucose, insulin, C-peptide) showed modest correlations with blood pool and myocardial FDG uptake.

Conclusions:

  • Intensive metabolic preparation, including dietary changes, effectively suppresses myocardial FDG uptake below background levels.
  • Established normative values for myocardial FDG uptake can be achieved with this protocol.
  • Glucose metabolism biomarkers correlate with FDG uptake, suggesting a link between metabolic state and imaging results.
Abstract

Keywords:
FDGPET/CTmetabolic preparationmyocardial inflammation

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