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Significance of chronic marked hyperglycemia on FDG-PET: is it really problematic for clinical oncologic imaging?

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Abstract

Objectives

The purpose of this study was to evaluate the adverse effects of chronic marked hyperglycemia on clinical diagnostic performance of positron emission tomography (PET) using 18F-fuorodeoxyglucose (FDG).

Methods

Fifty-seven scans of 54 patients, who received FDG-PET for the diagnosis of various cancer(s), and who showed high plasma glucose level of more than 200 mg/dl at the time of administration of FDG in spite of at least 4-h fasting, were retrospectively analyzed. In the clinical follow-up, this high plasma glucose was confirmed as chronic hyperglycemia derived from uncontrolled diabetes (n = 32) and untreated diabetes (n = 25). Based on the final diagnosis of malignancy obtained by histopathology or clinical follow-up for at least 6 months, the diagnostic performance of visual PET analysis was evaluated.

Results

Excluding nine scans of nine patients without sufficient follow-up, final diagnosis was obtained in 48 scans of 45 patients. In 36 scans of 36 patients, at least one malignant lesion was finally confirmed, and true-positive and false-negative results were obtained in 30 and six cases, respectively. Six cases showed false-negative results due to low FDG-avid pathological characteristics (hepatocellular carcinoma, etc.), chemotherapeutic effect or small tumor size. Overall, the patient-based sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 83, 83, 94, 63 and 83%, respectively. In lesion-based diagnosis, 56 of 75 lesions (74%) were depicted by PET, while 19 lesions were negative on PET, also due to low FDG-avid characteristics or small size (less than 15 mm).

Conclusions

At the time of chronic hyperglycemia (not acute hyperglycemia), the adverse effect caused by high plasma glucose level was minimum. The FDG uptake of the tumor maintained a sufficiently high level for visual clinical diagnosis in most cases, except in the cases of low FDG-avid tumors or small lesions (15 mm in size).

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References

  1. Bomanji JB, Costa DC, Ell PJ. Clinical role of positron emission tomography in oncology. Lancet Oncol. 2001;3:157–64.

    Article  Google Scholar 

  2. Wahl RL, Henry CA, Ethier SP. Serum glucose: effects on tumor and normal tissue accumulation of 2-[F-18]-fluoro-2-deoxy-d-glucose in rodents with mammary carcinoma. Radiology. 1992;183:643–7.

    PubMed  CAS  Google Scholar 

  3. Torizuka T, Clavo AC, Wahl RL. Effect of hyperglycemia on in vitro tumor uptake of tritiated FDG, thymidine, l-methionine and l-leucine. J Nucl Med. 1997;38:382–6.

    PubMed  CAS  Google Scholar 

  4. Zhao S, Kuge Y, Tsukamoto E, Mochizuki T, Kato T, Hikosaka K, et al. Effects of insulin and glucose loading on FDG uptake in experimental malignant tumours and inflammatory lesions. Eur J Nucl Med. 2001;28:730–5.

    Article  PubMed  CAS  Google Scholar 

  5. Lindholm P, Minn H, Leskinen-Kallio S, Bergman J, Ruotsalainen U, Joensuu H. Influence of the blood glucose concentration on FDG uptake in cancer—a PET study. J Nucl Med. 1993;34:1–6.

    PubMed  CAS  Google Scholar 

  6. Diederichs CG, Staib L, Glatting G, Beger HG, Reske SN. FDG-PET: elevated plasma glucose reduces both uptake and detection rate of pancreatic malignancies. J Nucl Med. 1998;39:1030–3.

    PubMed  CAS  Google Scholar 

  7. Zimny M, Bares R, Fass J, Adam G, Cremerius U, Dohmen B, et al. Fluorine-18 fluorodeoxyglucose positron emission tomography in the differential diagnosis of pancreatic carcinoma: a report of 106 cases. Eur J Nucl Med. 1997;24:678–82.

    PubMed  CAS  Google Scholar 

  8. Delbeke D, Coleman RE, Guiberteau MJ, Brown ML, Royal HD, Siegel BA, et al. Procedure guideline for tumor imaging with 18F-FDG PET/CT 1.0. J Nucl Med. 2006;47:885–95.

    PubMed  Google Scholar 

  9. Kitano H, Magata Y, Tanaka A, Mukai T, Kuge Y, Nagatsu K, et al. Performance assessment of O-18 water purifier. Ann Nucl Med. 2001;15:75–8.

    Article  PubMed  CAS  Google Scholar 

  10. Gorenberg M, Hallett WA, O’Doherty MJ. Does diabetes affect [(18)F]FDG standardised uptake values in lung cancer? Eur J Nucl Med Mol Imaging. 2002;29:1324–7.

    Article  PubMed  CAS  Google Scholar 

  11. Chang YC, Yen TC, Ng KK, See LC, Lai CH, Chang TC, et al. Does diabetes mellitus influence the efficacy of FDG-PET in the diagnosis of cervical cancer? Eur J Nucl Med Mol Imaging. 2005;32:647–52.

    Article  PubMed  Google Scholar 

  12. Hatano E, Ikai I, Higashi T, Teramukai S, Torizuka T, Saga T, et al. Preoperative positron emission tomography with fluorine-18-fluorodeoxyglucose is predictive of prognosis in patients with hepatocellular carcinoma after resection. World J Surgery. 2006;30:1736–41.

    Article  Google Scholar 

  13. Higashi T, Saga T, Nakamoto Y, Ishimori T, Fujimoto K, Doi R, et al. Diagnosis of pancreatic cancer using fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET)—usefulness and limitation in “clinical reality”. Ann Nucl Med. 2003;17:261–79.

    Article  PubMed  Google Scholar 

  14. Seo S, Hatano E, Higashi T, Hara T, Tada M, Tamaki N, et al. Fluorine-18 fluorodeoxyglucose positron emission tomography predicts tumor differentiation, P-glycoprotein expression, and outcome after resection in hepatocellular carcinoma. Clin Cancer Res. 2007;13:427–33.

    Article  PubMed  CAS  Google Scholar 

  15. Cook GJ, Houston S, Rubens R, Maisey MN, Fogelman I. Detection of bone metastases in breast cancer by 18FDG PET: differing metabolic activity in osteoblastic and osteolytic lesions. J Clin Oncol. 1998;16:3375–9.

    PubMed  CAS  Google Scholar 

  16. Mamede M, Higashi T, Kitaichi M, Ishizu K, Ishimori T, Nakamoto Y, et al. [18F]FDG uptake and PCNA, Glut-1, and Hexokinase-II expressions in cancers and inflammatory lesions of the lung. Neoplasia. 2005;7:369–79.

    Article  PubMed  CAS  Google Scholar 

  17. Seo S, Hatano E, Higashi T, Nakajima A, Nakamoto Y, Tada M, et al. Fluorine-18 fluorodeoxyglucose positron emission tomography predicts lymph node metastasis, P-glycoprotein expression, and recurrence after resection in mass-forming intrahepatic cholangiocarcinoma. Surgery. 2008;143:769–77.

    Article  PubMed  Google Scholar 

  18. Namageyo-Funa A, Nanavati P. The challenges of addressing primary prevention of diabetes: a response to recommendations from the chronic disease directors’ project. J Public Health Manag Pract. 2008;14:26–8.

    PubMed  Google Scholar 

  19. Schiel R, Beltschikow W, Steiner T, Stein G. Diabetes, insulin, and risk of cancer. Methods Find Exp Clin Pharmacol. 2006;28:169–75.

    Article  PubMed  CAS  Google Scholar 

  20. Nishikawa T, Edelstein D, Du XL. Normalizing mitochondrial superoxide production blocks three pathways of hyperglycemic damage. Nature. 2000;404:787–90.

    Article  PubMed  CAS  Google Scholar 

  21. Guyot LL, Diaz FG, O’Regan MH, Song D, Phillis JW. The effect of topical insulin on the release of excitotoxic and other amino acids from the rat cerebral cortex during streptozotocin-induced hyperglycemic ischemia. Brain Res. 2000;872:29–36.

    Article  PubMed  CAS  Google Scholar 

  22. Duelli R, Maurer MH, Staudt R, Heiland S, Duembgen L, Kuschinsky W. Increased cerebral glucose utilization and decreased glucose transporter Glut-1 during chronic hyperglycemia in rat brain. Brain Res. 2000;858:338–47.

    Article  PubMed  CAS  Google Scholar 

  23. Alpert E, Gruzman A, Totary H, Kaiser N, Reich R, Sasson S. A natural protective mechanism against hyperglycemia in vascular endothelial and smooth-muscle cells: role of glucose and 12-hydroxyeicosatetraenoic acid. Biochem J. 2002;362:413–22.

    Article  PubMed  CAS  Google Scholar 

  24. Nagamatsu S, Sawa H, Wakizaka A, Hoshino T. Expression of facilitative glucose transporter isoforms in human brain tumors. J Neurochem. 1993;61:2048–53.

    Article  PubMed  CAS  Google Scholar 

  25. Peiró C, Lafuente N, Matesanz N, Cercas E, Llergo JL, Vallejo S, et al. High glucose induces cell death of cultured human aortic smooth muscle cells through the formation of hydrogen peroxide. Br J Pharmacol. 2001;133:967–74.

    Article  PubMed  Google Scholar 

  26. Ishiki M, Klip A. Minireview: recent developments in the regulation of glucose transporter-4 traffic: new signals, locations, and partners. Endocrinology. 2005;146:5071–8.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan

    Tadashi Hara, Tatsuya Higashi, Yuji Nakamoto, Tsuyoshi Suga, Takayoshi Ishimori, Koichi Ishizu, Hidekazu Kawashima, Shigeto Kawase & Kaori Togashi

  2. Shiga Medical Center Research Institute, 5-4-30 Moriyama, Moriyama, Shiga, 524-8524, Japan

    Tatsuya Higashi

  3. Department of Diagnostic Imaging Molecular Imaging Center, National Institute of Radiological Sciences, Chiba, Japan

    Tsuneo Saga

  4. Department of Radiology, Kurashiki Central Hospital, Okayama, Japan

    Takayoshi Ishimori

  5. Kyoto College of Medical Science, Kyoto, Japan

    Keiichi Matsumoto

Authors
  1. Tadashi Hara
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  2. Tatsuya Higashi
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  3. Yuji Nakamoto
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  4. Tsuyoshi Suga
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  8. Hidekazu Kawashima
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  9. Shigeto Kawase
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  11. Kaori Togashi
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Correspondence to Tatsuya Higashi.

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Hara, T., Higashi, T., Nakamoto, Y. et al. Significance of chronic marked hyperglycemia on FDG-PET: is it really problematic for clinical oncologic imaging?. Ann Nucl Med 23, 657–669 (2009). https://doi.org/10.1007/s12149-009-0288-7

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  • DOI: https://doi.org/10.1007/s12149-009-0288-7

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