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. 2014 Feb;41(2):369-83.
doi: 10.1007/s00259-013-2569-6. Epub 2013 Nov 23.

Optimizing 18F-FDG PET/CT imaging of vessel wall inflammation: the impact of 18F-FDG circulation time, injected dose, uptake parameters, and fasting blood glucose levels

Jan Bucerius  1 , Venkatesh Mani, Colin Moncrieff, Josef Machac, Valentin Fuster, Michael E Farkouh, Ahmed Tawakol, James H F Rudd, Zahi A Fayad
Affiliations

Optimizing 18F-FDG PET/CT imaging of vessel wall inflammation: the impact of 18F-FDG circulation time, injected dose, uptake parameters, and fasting blood glucose levels

Jan Bucerius et al. Eur J Nucl Med Mol Imaging. 2014 Feb.

Abstract

Purpose: (18)F-FDG PET is increasingly used for imaging of vessel wall inflammation. However, limited data are available on the impact of methodological variables, i.e. prescan fasting glucose, FDG circulation time and injected FDG dose, and of different FDG uptake parameters, in vascular FDG PET imaging.

Methods: Included in the study were 195 patients who underwent vascular FDG PET/CT of the aorta and the carotids. Arterial standardized uptake values (meanSUVmax), target-to-background ratios (meanTBRmax) and FDG blood-pool activity in the superior vena cava (SVC) and the jugular veins (JV) were quantified. Vascular FDG uptake values classified according to the tertiles of prescan fasting glucose levels, the FDG circulation time, and the injected FDG dose were compared using ANOVA. Multivariate regression analyses were performed to identify the potential impact of all variables described on the arterial and blood-pool FDG uptake.

Results: Tertile analyses revealed FDG circulation times of about 2.5 h and prescan glucose levels of less than 7.0 mmol/l, showing a favorable relationship between arterial and blood-pool FDG uptake. FDG circulation times showed negative associations with aortic meanSUVmax values as well as SVC and JV FDG blood-pool activity, but positive correlations with aortic and carotid meanTBRmax values. Prescan glucose levels were negatively associated with aortic and carotid meanTBRmax and carotid meanSUVmax values, but were positively correlated with SVC blood-pool uptake. The injected FDG dose failed to show any significant association with vascular FDG uptake.

Conclusion: FDG circulation times and prescan blood glucose levels significantly affect FDG uptake in the aortic and carotid walls and may bias the results of image interpretation in patients undergoing vascular FDG PET/CT. The injected FDG dose was less critical. Therefore, circulation times of about 2.5 h and prescan glucose levels less than 7.0 mmol/l should be preferred in this setting.

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Conflict of interest statement

Conflict of interest statement:

The authors declare that they have no conflict of interest.

Figures

Figure 1a
Figure 1a
Relation Between the Classified Pre-scan Glucose Values and the Arterial FDG Uptake in the Aorta and the Carotids. The FDG uptake is given as mean standardized uptake value (meanSUVmax). All values are given as mean. A one-way ANOVA was performed to test for between group differences. [Table: see text] Mean values ± standard deviation are given in the figures
Figure 2a
Figure 2a
Relation Between Tertiles of the Injected FDG Dose and the Arterial FDG Uptake in the Aorta and the Carotids. The FDG uptake is given as mean standardized uptake value (meanSUVmax). All values are given as mean. A one-way ANOVA was performed to test for between group differences. [Table: see text] Mean values ± standard deviation are given in the figures
Figure 3a
Figure 3a
Relation Between Tertiles of the FDG Circulation Time for the Chest and Neck Scan and the FDG Uptake in the Aorta and the Carotids. The FDG uptake is given as mean standardized uptake value (meanSUVmax). All values are given as mean. A one-way ANOVA was performed to test for between group differences. [Table: see text] Mean values ± standard deviation are given in the figures
Figure 1
Figure 1. Relation Between the Classified Pre-scan Glucose Values and the Arterial FDG Uptake in the Aorta and the Carotids (upper) and the FDG Blood Pool Activity in the SVC and JV (lower)
The FDG uptake is given as mean Target-to-Background Ratio (meanTBRmax). FDG blood pool activity is given as meanSUVmean. All values are given as mean. A one-way ANOVA was performed to test for between group differences. [Table: see text] Mean values ± standard deviation are given in the figures
Figure 1
Figure 1. Relation Between the Classified Pre-scan Glucose Values and the Arterial FDG Uptake in the Aorta and the Carotids (upper) and the FDG Blood Pool Activity in the SVC and JV (lower)
The FDG uptake is given as mean Target-to-Background Ratio (meanTBRmax). FDG blood pool activity is given as meanSUVmean. All values are given as mean. A one-way ANOVA was performed to test for between group differences. [Table: see text] Mean values ± standard deviation are given in the figures
Figure 2
Figure 2. Relation Between Tertiles of the Injected FDG Dose and the Arterial FDG Uptake in the Aorta and the Carotids (upper), and the FDG Blood Pool Activity in the SVC and JV (lower)
The FDG uptake is given as mean Target-to-Background Ratio (meanTBRmax). FDG blood pool activity is given as meanSUVmean. All values are given as mean. A one-way ANOVA was performed to test for between group differences. [Table: see text] Mean values ± standard deviation are given in the figures
Figure 3
Figure 3. Relation Between Tertiles of the FDG Circulation Time for the Chest and Neck Scan and the FDG Uptake in the Aorta and the Carotids (upper) and the FDG Blood Pool Activity in the SVC and JV (lower)
The FDG uptake is given as mean Target-to-Background Ratio (meanTBRmax). FDG blood pool activity is given as meanSUVmean. All values are given as mean. A one-way ANOVA was performed to test for between group differences. [Table: see text] Mean values ± standard deviation are given in the figures
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