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Randomized Controlled Trial
. 2010 Apr;17(2):286-91.
doi: 10.1007/s12350-009-9179-5. Epub 2009 Dec 15.

Impact of carbohydrate restriction with and without fatty acid loading on myocardial 18F-FDG uptake during PET: A randomized controlled trial

Victor Y Cheng  1 , Piotr J Slomka, Marie Ahlen, Louise E J Thomson, Alan D Waxman, Daniel S Berman
Affiliations
Randomized Controlled Trial

Impact of carbohydrate restriction with and without fatty acid loading on myocardial 18F-FDG uptake during PET: A randomized controlled trial

Victor Y Cheng et al. J Nucl Cardiol. 2010 Apr.

Abstract

Background: Low-carbohydrate (LC) and high-fat, low-carbohydrate (HFLC) dietary preparations may enhance (18)F-FDG-PET-based imaging of small, inflamed structures near the heart by suppressing myocardial FDG signal. We compared myocardial (18)F-FDG uptake in patients randomized to LC, HFLC, and unrestricted (UR) preparations prior to (18)F-FDG-PET.

Methods and results: We randomized 63 outpatients referred for oncologic (18)F-FDG-PET to LC, HFLC, or UR dietary preparations (1:1:1 allocation) starting the evening before PET. After eating dinner according to instructions, UR and LC patients fasted until FDG injection (mean time 745 minutes for UR, 899 minutes for LC), and HFLC patients drank a fatty drink 60-70 minutes prior to FDG injection. Attenuation-corrected PET imaging was performed 60 minutes after FDG administration. Maximal myocardial standard uptake values (MyoSUV(max)) were systematically measured in axial view and compared between the three groups. Using UR patients as reference, mean MyoSUV(max) was lower in LC patients (3.3 +/- 2.7 vs 6.2 +/- 5.2, P = .03) but not in HFLC patients (5.5 +/- 4.2, P = .63). Ratios of MyoSUV(max) to liver SUV(max), calculated to control for background uptake, were not significantly different amongst the groups (1.9 +/- 2.1 LC, 2.6 +/- 2.3 HFLC, 3.6 +/- 3.5 UR).

Conclusion: In this small randomized controlled trial using UR diet as reference, LC dietary preparation followed by extended fasting resulted in significant myocardial uptake suppression.

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Figures

Figure 1
Figure 1
Distribution of maximal myocardial 18F-FDG uptake by dietary assignment (LC, Low-carbohydrate; HFLC, high-fat and low-carbohydrate; UR, unrestricted), as measured by standard uptake value (SUVmax). LC patients had significantly lower mean SUVmax than UR patients (P = .03)
Figure 2
Figure 2
Representative images from 7 patients with the highest maximal myocardial standard uptake value (SUVmax) from each diet plan (LC, Low-carbohydrate; HFLC, high-fat and low-carbohydrate; UR, unrestricted). In all cases, the myocardium exhibits greater uptake than the liver and mediastinum. Only LC dietary preparation resulted in patients with SUVmax < 5.0 in this group (the top 3 examples in the leftmost column). The visual impression that not all myocardial uptake appeared to increase in correspondence to increasing SUVmax (e.g., the LC patient with SUVmax of 7.9) is because image contrast has been individually adjusted to show neighboring structures
See this image and copyright information in PMC

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