A precise oral glucose loading 18F-FDG PET myocardial metabolic imaging protocol in coronary artery disease patients complicated by diabetes mellitus: an exploratory prospective cohort study.
We evaluated the feasibility of using a precise oral glucose loading combined with subcutaneous insulin administration protocol for 18F-FDG PET myocardial metabolic imaging in patients with coronary artery disease (CAD) complicated by diabetes mellitus (DM).
179 consecutive CAD patients complicated by DM were enrolled. Oral glucose was given at variable doses based on baseline blood glucose, and subcutaneous insulin was injected at adjusted doses according to post-load glucose levels before FDG injection. SPECT myocardial perfusion imaging and PET myocardial metabolic imaging were performed using a one-day protocol. The image quality and adverse reaction data were analyzed.
Among 179 patients, FDG image quality was scored as excellent in 57.5%, very good in 31.8%, good in 7.8%, fair in 1.7% and non-diagnostic in 1.1%. When patients were stratified by blood glucose level at time of FDG injection >7.77 mmol/L, 5.55-7.77 mmol/L and <5.55 mmol/L, the image quality were excellent in 43.1, 60.4 and 74.1%, very good in 43.1, 30.7 and 14.8%, good in 9.8, 5.9 and 11.1%, fair in 3.9, 1.0% and 0, and non-diagnostic in 0, 2.0% and 0, respectively. Patients were divided into insulin therapy group and oral medication group, the image quality were excellent in 50.7 and 62.5%, very good in 33.3 and 30.8%, good in 10.7 and 5.8%, fair in 2.7 and 1.0%, and non-diagnostic in 2.7% and 0, respectively. Patients with blood glucose at time of FDG injection >7.77 mmol/L had significantly lower odds of excellent image quality (p = 0.021) than those with 5.55-7.77 mmol/L or <5.55 mmol/L, while no significant difference was observed between the latter two groups (p = 0.262). 47 patients (26.3%) exhibited completely viable myocardium, 89 patients (49.7%) had partially viable myocardium, and 43 patients (24.0%) showed nonviable myocardium. None of the patients had severe adverse reactions.
The precise oral glucose loading protocol prior to 18F-FDG injection is feasible for clinical application.
179 consecutive CAD patients complicated by DM were enrolled. Oral glucose was given at variable doses based on baseline blood glucose, and subcutaneous insulin was injected at adjusted doses according to post-load glucose levels before FDG injection. SPECT myocardial perfusion imaging and PET myocardial metabolic imaging were performed using a one-day protocol. The image quality and adverse reaction data were analyzed.
Among 179 patients, FDG image quality was scored as excellent in 57.5%, very good in 31.8%, good in 7.8%, fair in 1.7% and non-diagnostic in 1.1%. When patients were stratified by blood glucose level at time of FDG injection >7.77 mmol/L, 5.55-7.77 mmol/L and <5.55 mmol/L, the image quality were excellent in 43.1, 60.4 and 74.1%, very good in 43.1, 30.7 and 14.8%, good in 9.8, 5.9 and 11.1%, fair in 3.9, 1.0% and 0, and non-diagnostic in 0, 2.0% and 0, respectively. Patients were divided into insulin therapy group and oral medication group, the image quality were excellent in 50.7 and 62.5%, very good in 33.3 and 30.8%, good in 10.7 and 5.8%, fair in 2.7 and 1.0%, and non-diagnostic in 2.7% and 0, respectively. Patients with blood glucose at time of FDG injection >7.77 mmol/L had significantly lower odds of excellent image quality (p = 0.021) than those with 5.55-7.77 mmol/L or <5.55 mmol/L, while no significant difference was observed between the latter two groups (p = 0.262). 47 patients (26.3%) exhibited completely viable myocardium, 89 patients (49.7%) had partially viable myocardium, and 43 patients (24.0%) showed nonviable myocardium. None of the patients had severe adverse reactions.
The precise oral glucose loading protocol prior to 18F-FDG injection is feasible for clinical application.