Preparation methods prior to PET/CT scanning that decrease uptake of 18F-FDG by myocardium,brown adipose tissue,and skeletal muscle

Abstract

Background

The hypermetabolic environment of the myocardium, brown adipose tissue (BAT), and muscle will have an effect on the diagnostic accuracy of 18F-fluorodeoxyglucose (18F-FDG) positron-emission tomography (PET)/computed tomography (CT). A low carbohydrate, high fat, and protein-permitted diet before PET/CT scanning can reduce the degree of 18F-FDG uptake by the myocardium, brown adipose tissue, and skeletal muscle.

Purpose

To determine the effect of a low carbohydrate, high fat and protein-permitted diet on 18F-FDG uptake by myocardium, BAT, and muscle during PET/CT.

Material and Methods

A total of 126 patients who adhered to two meals before PET/CT scanning (that were prepared using a low carbohydrate, high fat, and protein-permitted diet), i.e. the diet group, were compared with 126 patients who fasted for at least 12 h prior to scanning (i.e. the fasting group). The degree of 18F-FDG uptake within the myocardium, BAT, and muscle were stratified into four grades (range, 0–3) with 0 for negligible uptake, and 3 for intense uptake. Correlations between the diet and fasting groups with respect to degree of 18F-FDG uptake within the myocardium, BAT, and muscle were analyzed.

Results

The degree of 18F-FDG uptake within the myocardium, BAT, and muscle in the diet group was significantly lower compared with the 18F-FDG uptake within myocardium, BAT, and muscle in the fasting group (P < 0.001, P = 0.001, P < 0.001).

Conclusion

A low carbohydrate/high fat diet before 18F-FDG injection can suppress uptake of 18F-FDG within the myocardium, BAT, and skeletal muscle.

Keywords

18F-fluorodeoxyglucose (18F-FDG)positron emission tomography (PET)myocardium adipose tissue brown muscles diet carbohydrate-restricted

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References

Kodde

van der Stok

Smolenski

. Metabolic and genetic regulation of cardiac energy substrate preference. Comp Biochem Physiol A Mol Integr Physiol 2007; 146: 26–39.

Williams

Kolodny

. Suppression of myocardial 18F-FDG uptake by preparing patients with a high-fat, low-carbohydrate diet. Am J Roentgenol 2008; 190: W151–156.

Cohade

Osman

Pannu

. Uptake in supraclavicular area fat (“USA-Fat”): description on 18F-FDG PET/CT. J Nucl Med 2003; 44: 170–176.

Shreve

Anzai

Wahl

. Pitfalls in oncologic diagnosis with 18F-FDG PET imaging: physiologic and benign variants. Radiographics 1999; 19: 61–77. quiz 150–151.

Williams

Kolodny

. Method for decreasing uptake of 18F-FDG by hypermetabolic brown adipose tissue on PET. Am J of Roentgenol 2008; 190: 1406–1409.

Randle

Garland

Hales

. The glucose fatty-acid cycle. Its role in insulin sensitivity and the metabolic disturbances of diabetes mellitus. Lancet 1963; 1: 785–789.

Frayn

. The glucose-fatty acid cycle: a physiological perspective. Biochem Soc Trans 2003; 31: 1115–1119.

Wykrzykowska

Lehman

Williams

. Imaging of inflamed and vulnerable plaque in coronary arteries with 18F-FDG PET/CT in patients with suppression of myocardial uptake using a low-carbohydrate, high-fat preparation. J Nucl Med 2009; 50: 563–568.

Coulden

Chung

Sonnex

. Suppression of myocardial 18F-FDG uptake with a preparatory “Atkins-style” low-carbohydrate diet. Eur Radiol 2012; 22: 2221–2228.

10.

Enerback

. The origins of brown adipose tissue. N Engl J Med 2009; 360: 2021–2023.

11.

Jezek

Spacek

Garlid

. Undecanesulfonate does not allosterically activate H+ uniport mediated by uncoupling protein-1 in brown adipose tissue mitochondria. Int J Biochem Cell Biol 2006; 38: 1965–1974.

12.

Boden

Shulman

. Free fatty acids in obesity and type 2 diabetes: defining their role in the development of insulin resistance and beta-cell dysfunction. Eur J Clin Invest 2002; 32: 14–23.

13.

Rudd

Warburton

Fryer

. Imaging atherosclerotic plaque inflammation with [18F]-fluorodeoxyglucose positron emission tomography. Circulation 2002; 105: 2708–2711.

14.

Tatsumi

Cohade

Nakamoto

. Fluorodeoxyglucose uptake in the aortic wall at PET/CT: possible finding for active atherosclerosis. Radiology 2003; 229: 831–837.

15.

Andrews

Al-Nahhas

Pennell

. Non-invasive imaging in the diagnosis and management of Takayasu's arteritis. Ann Rheum Dis 2004; 63: 995–1000.

16.

Ben-Haim

Kupzov

Tamir

. Evaluation of 18F-FDG uptake and arterial wall calcifications using 18F-FDG PET/CT. J Nucl Med 2004; 45: 1816–1821.

17.

Yeung

Grewal

Gonen

. Patterns of (18)F-FDG uptake in adipose tissue and muscle: a potential source of false-positives for PET. J Nucl Med 2003; 44: 1789–1796.

18.

Parysow

Mollerach

Jager

. Low-dose oral propranolol could reduce brown adipose tissue F-18 FDG uptake in patients undergoing PET scans. Clin Nucl Med 2007; 32: 351–357.

19.

Rabelo

Camirand

Silva

. 3′, 5′-cyclic adenosine monophosphate-response sequences of the uncoupling protein gene are sequentially recruited during darglitazone-induced brown adipocyte differentiation. Endocrinology 1997; 138: 5325–5332.

20.

Valverde

Benito

Lorenzo

. The brown adipose cell: a model for understanding the molecular mechanisms of insulin resistance. Acta Physiol Scand 2005; 183: 59–73.

21.

Kemppainen

Fujimoto

Kalliokoski

. Myocardial and skeletal muscle glucose uptake during exercise in humans. J Physiol 2002; 542: 403–412.

22.

Gradinscak

Fulham

Mohamed

. Skeletal muscle uptake detected on 18F-FDG PET 48 hours after exertion. Clin Nucl Med 2003; 28: 840–841.

23.

Jackson

Schlarman

Hubble

. Prevalence and patterns of physiologic muscle uptake detected with whole-body 18F-FDG PET. J Nucl Med Technol 2006; 34: 29–33.

24.

Maianu

Melbert

. Facilitative glucose transporter gene expression in human lymphocytes, monocytes, and macrophages: a role for GLUT isoforms 1, 3, and 5 in the immune response and foam cell formation. Blood Cells Mol Dis 2004; 32: 182–190.