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The distribution of FDG at PET examinations constitutes a relative mechanism: significant effects at activity quantification in patients with a high muscular uptake

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

At 18F-2-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) examinations a high tracer uptake of the skeletal muscles is sometimes encountered which can lead to reduced uptake in pathological lesions. This was evaluated in retrospect in patients being recalled for a repeat examination after reducing the muscular uptake.

Methods

Ten patients with increased muscular tracer uptake were examined with FDG PET/CT on two occasions with a mean of 6 days. All patients showed at least one pathological lesion with increased tracer uptake. The muscular uptake was reduced at the second examination by informing the patient to refrain from physical activity together with pretreatment with diazepam. The maximum standardized uptake value (SUVmax) of the pathological lesion and SUVmean of certain skeletal muscles, liver, spleen, lungs, blood and certain bone marrow portions were calculated.

Results

In all patients, the muscular uptake was reduced to a normal level at visual evaluation as well as at comparison of SUVs with 25 consecutive clinical patients exhibiting a normal FDG distribution (p < 0.001). The mean lesion SUVmax increased from 2.4 to 3.7 (54 %) between the examinations (p < 0.05). All reference tissues/organs showed a significant increase of SUV at the second examination. Relating lesion SUVmax to the activity of any of the reference tissues/organs there was no significant difference between the studies.

Conclusion

The distribution of FDG constitutes a relative mechanism. This must be especially considered at longitudinal examinations in the same patient at therapy evaluations. In examinations with a somehow distorted general distribution of the activity, it may be more relevant to relate the lesion activity to a reference tissue/organ than relying on SUV assessments.

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Acknowledgments

The authors wish to thank Elisabeth Berg, B.Sc., Karolinska Institutet, for the statistical analysis.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Radiology, Karolinska University Hospital Solna, 171 76, Stockholm, Sweden

    Henry Lindholm, Ove Johansson & Hans Jacobsson

  2. Department of Hospital Physics, Karolinska University Hospital Solna, Stockholm, Sweden

    Cathrine Jonsson

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  1. Henry Lindholm
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  2. Ove Johansson
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  3. Cathrine Jonsson
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  4. Hans Jacobsson
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Correspondence to Henry Lindholm.

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Lindholm, H., Johansson, O., Jonsson, C. et al. The distribution of FDG at PET examinations constitutes a relative mechanism: significant effects at activity quantification in patients with a high muscular uptake. Eur J Nucl Med Mol Imaging 39, 1685–1690 (2012). https://doi.org/10.1007/s00259-012-2202-0

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  • DOI: https://doi.org/10.1007/s00259-012-2202-0

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