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

Objectives To evaluate the effect of pre-scan blood glucose levels (BGL) on standardized uptake value (SUV) in F-18-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, F-18-FDG injected dose, and time interval. The ANOVA test was done to evaluate differences in SUVmax or SUVmean among five different BGL groups (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, p200 mg/dl had significantly lower SUVmax. Conclusion If BGL is lower than 200mg/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.Peer reviewe

Normal range of osteoblastic activity in total hip arthroplasties on single-photon emission computed tomography bone scintigraphy

AIM: Knowledge of the normal range of periprosthetic osteoblastic activity around total hip arthroplasties is required for rational diagnosis of complications. The aim of this study was to establish such a normal range for single-photon emission computed tomography (SPECT). Clinical utility of such a range is confident differentiation of normal from abnormal arthroplasties. METHODS: A total of 122 asymptomatic acetabular cups (age: 0-22 years) and 71 femoral stems (age: 0-20 years) were scanned with SPECT/CT. Two acetabular and three femoral activity ratios to normal reference bone were defined [acetabular axial (AA/RA), acetabular coronal (AC/RA), RA=reference acetabulum; femoral calcar (FC/RF), femoral mid-stem (FM/RF), femoral stem tip (FS/RF), RF=reference femur]. Upper cut-off of normal was defined as mean +3 SD (rounded). Two time breakpoints were analysed (12 and 24 months). RESULTS: The upper cut-off for the normal range was 1.0 for AA/RA, 1.5 for AC/RA and 2.2 for all thee of FC/RF, FM/RF and FS/RF. AA/RA, FM/RF and FS/RF showed no statistically significant temporal trends. AC/RA showed stabilization of activity after 12 months and FC/RF after 24 months. CONCLUSION: Measured activity ratios that fall within our normal range are likely to represent normal periprosthetic osteoblastic activity. Measured activity ratios that fall above the upper cut-offs of our normal range are likely to be abnormal. The cut-offs are robust in clinical practice and have utility in discriminating normal from abnormal stabilized arthroplasties where visual interpretation is ambiguous. Elevated AC/RA under 12 months and FC/RF under 24 months may represent normal periprosthetic activity and should be interpreted with caution