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

Abstract

Background

With appropriate protocols, F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) can visualize myocardial inflammation. Optimal protocols and normative myocardial FDG uptake values are not well-established.

Methods

We evaluated 111 patients referred for inflammation cardiac FDG PET/CT. Patients followed a low-carbohydrate, high-fat diet for 36 hours before imaging and received unfractionated heparin. Glucose and fatty acid metabolism biomarkers were obtained. Mean blood pool and maximum myocardial uptake (SUVmean, SUVmax) were measured, avoiding areas of abnormal FDG uptake or spillover.

Results

Adequate suppression of myocardial FDG uptake occurred in 95% of patients (n = 106). Myocardial SUVmax was significantly below background blood pool SUVmean: septal myocardial to blood pool ratio 0.75 (95% CI 0.73-0.77; P < 0.001); lateral myocardial to blood pool ratio 0.70 (95% CI 0.68-0.72; P < 0.001). Glucose, insulin, and C-peptide correlated to blood pool SUVmean (Spearman rs = 0.39, P < 0.01; rs = 0.40, P < 0.01; rs = 0.35, P < 0.01) and myocardial SUVmax (Spearman rs = 0.31, P < 0.01; rs = 0.31, P < 0.01; rs = 0.26, P < 0.01). Fatty acid metabolism biomarkers did not correlate to myocardial SUVmax.

Conclusions

Patients following intensive metabolic preparation have myocardial FDG SUVmax below background SUVmean. Biomarkers of glucose metabolism modestly correlate to FDG uptake.

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Abbreviations

FDG:

F-18 fluorodeoxyglucose

PET/CT:

Positron emission tomography/computed tomography

SUVmax :

Maximal standard uptake value

SUVmean :

Mean standardized uptake value

ROI:

Region of interest

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Disclosure

S. R. Larson, J.A. Pieper, E. A. Hulten, and R. L. Weinberg have no disclosures or conflicts of interest related to this publication. E. P. Ficaro and J. R. Corbett have financial interest in INVIA Medical Imaging Solutions, which licenses the commercial software used for imaging processing. INVIA Medical Imaging Solutions did not provide direct support to this study. V. L. Murthy has received consulting fees and stock options from Ionetix, Inc., owns stock in General Electric and Cardinal Health, has a research grant from Siemens Medical Imaging, and has provided expert witness testimony on behalf of Jubilant Draximage. V. L. Murthy is supported by 1R01HL136685 from the National, Heart, Lung, Blood Institute and 1R01AG059729 from the National Institute on Aging. The views expressed are those of the author and do not reflect official policy of Fort Belvoir Community Hospital, the Defense Health Agency, the Department of Defense, or the United States Government.

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Correspondence to Richard L. Weinberg MD, PhD.

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Larson, S.R., Pieper, J.A., Hulten, E.A. et al. Characterization of a highly effective preparation for suppression of myocardial glucose utilization. J. Nucl. Cardiol. 27, 849–861 (2020). https://doi.org/10.1007/s12350-019-01786-w

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Keywords

  • PET/CT
  • FDG
  • myocardial inflammation
  • metabolic preparation