18F-fluorodeoxyglucose use after cardiac transplant: A comparative study of suppression of physiological myocardial uptake
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18F-fluorodeoxyglucose (FDG) has been useful in the evaluation of myocardial inflammatory processes. However, it is challenging to identify them due to physiological 18F-FDG uptake. There are no publications demonstrating the application of FDG in post-transplant rejection in humans yet. The aim of this study is to determine the feasibility of suppression of myocardial FDG uptake in post-transplant patients, comparing three different protocols of preparation.
Ten patients after heart transplantation were imaged by FDG associated with three endomyocardial biopsies (EMB), scheduled in the first year after the procedure. Before each imaging, patients were randomized to one of three preparations: (1) hyperlipidic-hypoglycemic diet; (2) fasting longer than 12 hours; and (3) fasting associated with intravenous heparin. All patients would undergo the three methods. FDG images were analyzed using visual analysis scores and relative radiotracer cardiac uptake (RRCU).
The suppression rate of radiotracer activity ranged from 55% to 62%. Visual analysis showed that preparation 3 presented less efficacy in the suppression compared to the others. However, RRCU did not show difference between the preparations.
Suppression of physiological myocardial FDG uptake after cardiac transplantation is feasible. The usefulness of heparin in the suppression is unclear.
KeywordsHeart transplant PET 18F-FDG myocardial uptake
Positron emission tomography/computed tomography
Single-photon emission computerized tomography/computed tomography
Region of interest
Computed tomography attenuation correction
Acknowledgement of Grant support: National Institute of Cardiology, Brazil.
The authors have indicated that they have no financial conflict of interest.
- 18.Wykrzykowska J, Lehman S, Williams G, Parker JA, Palmer MR, Varkey S, et al. 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;50:563–8.CrossRefPubMedGoogle Scholar
- 19.Manabe O, Yoshinaga K, Ohira H, Masuda A, et al. The effects of 18-h fasting with low-carbohydrate diet preparation on suppressed physiological myocardial 18F-fluorodeoxyglucose (FDG) uptake and possible minimal effects of unfractionated heparin use in patients with suspected cardiac involvement sarcoidosis. J Nucl Cardiol. 2016;23:244–52.CrossRefPubMedGoogle Scholar
- 21.Cheng J, Chen Y, Chen S, et al. Measurement of standard uptake value in dual-head coincidence system. Bio-Med Mater Eng. 2007;17:219–27.Google Scholar
- 23.Van Berkel A, Rao JU, Lenders JWM, et al. Semiquantitative 123I-metaiodobenzylguanidine scintigraphy to distinguish pheochromocytoma and paraganglioma from physiologic adrenal uptake and its correlation with genotype-dependent expression of catecholamine transporters. J Nucl Med. 2015;56:839–46.CrossRefPubMedGoogle Scholar
- 24.Fujita S, Nagamachi S, Umemura Y, et al. Usability of the heparin appositional whole body FDG PET—new methods to reduce cardiac physiological accumulation. Eur J Nucl Med Mol Imaging. 2011;38:S359.Google Scholar
- 26.Gormsen LC, Christensen NL, Bendstrup E, Tolbod LP, Nielsen SS. Complete somatostatin-induced insulin suppression combined with heparin loading does not significantly suppress myocardial 18F-FDG uptake in patients with suspected cardiac sarcoidosis. J Nucl Cardiol. 2013;20:1108–15.CrossRefPubMedGoogle Scholar
- 27.Badano LP, Miglioranza MH, Edvardsen T, et al. European Association of Cardiovascular Imaging/Cardiovascular Imaging Department of the Brazilian Society of Cardiology recommendations for the use of cardiac imaging to assess and follow patients after heart transplantation. Eur Heart J Cardiovasc Imaging. 2015;9:919–48.CrossRefGoogle Scholar