DOI: 10.1007/s00259-018-4194-xPages: 1-14

Effect of blood glucose level on standardized uptake value (SUV) in 18F- FDG PET-scan: a systematic review and meta-analysis of 20,807 individual SUV measurements

1. Tehran University of Medical Sciences, Research Center for Immunodeficiencies, Children’s Medical Center

2. Universal Scientific Education and Research Network (USERN), Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA)

3. University of Pennsylvania

4. Hospital of the University of Pennsylvania, Division of Nuclear Medicine

5. Department of Nuclear Medicine and Molecular Imaging University of Michigan

6. Nuclear Medicine Service, Department of Veterans Affairs Healthcare System

7. Karolinska Institutet, Department of Molecular Medicine and Surgery

8. Imperial College Healthcare NHS Trust, Department of Imaging

9. Imperial College, Department of Surgery and Cancer

10. Tehran University of Medical Sciences, Department of Community and Preventive Medicine, Faculty of Medicine, School of Medicine

11. University of Arizona, Department of Radiation Oncology

12. Department of Radiology Nagoya University Graduate School of Medicine

13. Department of Radiology University of Manitoba

14. University Hospital Basel, Department of Nuclear Medicine, Clinic of Radiology and Nuclear Medicine

15. Arcispedale Santa Maria Nuova, Department of Thoracic Surgery

16. Hospital del Mar - IMIM. CIBERES, ISCiii

17. Helsinki University Central Hospital, Department of Nuclear Medicine, HUS Medical Imaging Center

18. Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Nuclear Medicine

19. University Hospital Würzburg, Department of Nuclear Medicine

20. Royal Brompton and Harefield Hospital, Department of Nuclear Medicine

21. NHS Trust, Brighton and Sussex University Hospitals

22. St. John of God Hospital, Lake Imaging

23. Cairo University, National Cancer Institute

24. Thomas’ Hospital, Superintendent Radiographer & RPS PET Centre

25. University of Notre Dame

26. Medical University of Warsaw, Department of Cardiology

27. Tehran University of Medical Sciences, Department of Immunology, School of Medicine

Correspondence to:
Abass Alavi
Tel: (215) 662-3069
Email: Abass.Alavi@uphs.upenn.edu

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Abstract

Objectives

To evaluate the effect of pre-scan blood glucose levels (BGL) on standardized uptake value (SUV) in 18F-FDG-PET scan.

Methods

A literature review was performed in the MEDLINE, Embase, and Cochrane library databases. Multivariate regression analysis was performed on individual datum to investigate the correlation of BGL with SUVmax and SUVmean adjusting for sex, age, body mass index (BMI), diabetes mellitus diagnosis, 18F-FDG injected dose, and time interval. The ANOVA test was done to evaluate differences in SUVmax or SUVmean among five different BGL groups (< 110, 110–125, 125–150, 150–200, and > 200 mg/dl).

Results

Individual data for a total of 20,807 SUVmax and SUVmean measurements from 29 studies with 8380 patients was included in the analysis. Increased BGL is significantly correlated with decreased SUVmax and SUVmean in brain (p < 0.001, p < 0.001,) and muscle (p < 0.001, p < 0.001) and increased SUVmax and SUVmean in liver (p = 0.001, p = 0004) and blood pool (p = 0.008, p < 0.001). No significant correlation was found between BGL and SUVmax or SUVmean in tumors. In the ANOVA test, all hyperglycemic groups had significantly lower SUVs compared with the euglycemic group in brain and muscle, and significantly higher SUVs in liver and blood pool. However, in tumors only the hyperglycemic group with BGL of > 200 mg/dl had significantly lower SUVmax.

Conclusion

If BGL is lower than 200 mg/dl no interventions are needed for lowering BGL, unless the liver is the organ of interest. Future studies are needed to evaluate sensitivity and specificity of FDG-PET scan in diagnosis of malignant lesions in hyperglycemia.

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  • Accepted: Oct 10, 2018
  • Online: Oct 22, 2018

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