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Evaluation of a low-carbohydrate diet-based preparation protocol without fasting for cardiac PET/MR imaging

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Objective

Assessment of increased glucose uptake in inflammatory or malignant myocardial disease using PET/MRI relies on uptake suppression in normal myocardium. We evaluated the efficacy of a ≥24 hours high-fat, low-carbohydrate, and protein-permitted diet (HFLCPP) in combination with unfractionated heparin for suppression of “physiologic” myocardial glucose uptake.

Methods

PET/MRI was successfully performed in 89 patients. HFLCPP was started ≥24 hours prior to PET/MRI. All patients received i.v. injection of unfractionated heparin (50 IU·kg−1) 15 minutes prior to FDG administration. Left ventricular FDG uptake was visually evaluated by two readers. Diffuse myocardial uptake exceeding liver uptake, isolated uptake in the lateral wall, or diffuse uptake in the entire circumference of the heart base were defined as failed suppression. Homogeneous myocardial uptake below liver uptake with/without focal uptake was defined as successful suppression.

Results

Success rate was 84%. Suppression was unsuccessful in 14 patients. No significant influence of gender (P = .40) or age (P = .21) was found. However, insufficient suppression was more common in patients younger than 45 years (20% vs 7%). PET/MR imaging completion rate was >97%.

Conclusion

A HFLCPP diet in combination with unfractionated heparin was successfully implemented for cardiac PET/MRI and resulted in a sufficient suppression of myocardial FDG uptake in 84% of patients.

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Abbreviations

FDG:

18F-fluorodeoxyglucose

FFA:

Free fatty acids

HFLCPP:

High-fat, low-carbohydrate, protein-permitted

JSNC:

Japanese Society of Nuclear Cardiology

MRI:

Magnetic resonance imaging

PET:

Positron emission tomography

ROI:

Region of interest

SUV:

Standardized uptake value

UFH:

Unfractionated heparin

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany

    Felix Nensa MD, J. Goebel MD, K. Nassenstein MD & T. Schlosser MD

  2. Clinic for Cardiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany

    E. Tezgah MD

  3. Department of Diet and Nutrition, University of Duisburg-Essen, Essen, Germany

    K. Schweins

  4. Department of Diagnostic and Interventional Radiology, University Hospital Dusseldorf, University of Dusseldorf, Dūsseldorf, Germany

    P. Heusch MD, Msc

  5. Clinic for Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany

    T. D. Poeppel MD

Authors
  1. Felix Nensa MD
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  2. E. Tezgah MD
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  3. K. Schweins
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  4. J. Goebel MD
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  5. P. Heusch MD, Msc
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  6. K. Nassenstein MD
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  7. T. Schlosser MD
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  8. T. D. Poeppel MD
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Corresponding author

Correspondence to Felix Nensa MD.

Additional information

See related editorial, doi:10.1007/s12350-016-0477-4.

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Nensa, F., Tezgah, E., Schweins, K. et al. Evaluation of a low-carbohydrate diet-based preparation protocol without fasting for cardiac PET/MR imaging. J. Nucl. Cardiol. 24, 980–988 (2017). https://doi.org/10.1007/s12350-016-0443-1

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  • DOI: https://doi.org/10.1007/s12350-016-0443-1

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