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Personalised insulin calculator enables safe and effective correction of hyperglycaemia prior to FDG PET/CT.

ABSTRACT: BACKGROUND:Hyperglycaemia can influence 18F-fluorodeoxyglucose (FDG) uptake due to competition for glucose transport and phosphorylation by hexokinase. Major international nuclear medicine societies recommend blood glucose level (BGL) < 11.1 mmol/L (200 mg/dL) prior to performing FDG positron emission tomography/computed tomography (PET/CT). However, there is no consensus approach and complications of previously proposed insulin guidelines included significant hypoglycaemia, inconvenience and skeletal muscle uptake. This study aims to establish the safety and efficacy of a personalised insulin calculator protocol to estimate the dose of intravenous insulin injection for correction of hyperglycaemia prior to FDG PET/CT. RESULTS:This is a retrospective audit of all patients treated with insulin for hyperglycaemia (BGL > 10 mmol/L) prior to FDG PET/CT at the Peter MacCallum Cancer Centre over a 2-year period. Cohort 1 comprised a 12-month period (April 1, 2014-March 31, 2015) using the department's established empiric-dose insulin protocol, and Cohort 2 the 12 months (April 1, 2015-March 31, 2016) following introduction of a personalised insulin calculator protocol. Variables including body mass index, insulin-dose calculated and/or administered, BGL at baseline and nadir, and time to FDG injection were analysed. There were 115 and 136 patients treated with insulin in Cohorts 1 and 2 respectively, with similar baseline variables including mean BGL (14.5 vs 14.4 mmol/L) and range (10.5-22.7 vs 10.4-24.3 mmol/L). Use of the new personalised insulin calculator resulted in significantly fewer hypoglycaemic events (0.7% vs 5.2%; P < 0.03), shorter median time from insulin to FDG injections (108 min vs 136 min; P < 0.001) and greater individualised range in insulin prescription (3-32 IU vs 4-20 IU). The majority of patients (88.3%) receiving the personalised insulin calculator prescribed dose achieved BGL < 10.0 mmol/L. All scans obtained were of diagnostic quality. CONCLUSIONS:The use of our personalised insulin calculator protocol effectively lowered BGL to the target range, resulted in significantly fewer hypoglycaemic events and reduced median time between insulin and FDG injection compared to a pre-existing empiric protocol whilst achieving diagnostic scans.

SUBMITTER: Pattison DA

PROVIDER: S-EPMC6368634 | biostudies-other | 2019 Feb

REPOSITORIES: biostudies-other

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Personalised insulin calculator enables safe and effective correction of hyperglycaemia prior to FDG PET/CT.

Pattison David A DA MacFarlane Lisa L LL Callahan Jason J Kane Emma L EL Akhurst Timothy T Hicks Rodney J RJ

EJNMMI research 20190208 1

<h4>Background</h4>Hyperglycaemia can influence <sup>18</sup>F-fluorodeoxyglucose (FDG) uptake due to competition for glucose transport and phosphorylation by hexokinase. Major international nuclear medicine societies recommend blood glucose level (BGL) < 11.1 mmol/L (200 mg/dL) prior to performing FDG positron emission tomography/computed tomography (PET/CT). However, there is no consensus approach and complications of previously proposed insulin guidelines included significant hypoglycaemia, i ...[more]

PMID: 30737563

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Project description:To dynamically detect and characterize 18F-fluorodeoxyglucose (FDG) dose infiltrations and evaluate their effects on positron emission tomography (PET) standardized uptake values (SUV) at the injection site and in control tissue.Investigational gamma scintillation sensors were topically applied to patients with locally advanced breast cancer scheduled to undergo limited whole-body FDG-PET as part of an ongoing clinical study. Relative to the affected breast, sensors were placed on the contralateral injection arm and ipsilateral control arm during the resting uptake phase prior to each patient's PET scan. Time-activity curves (TACs) from the sensors were integrated at varying intervals (0-10, 0-20, 0-30, 0-40, and 30-40 min) post-FDG and the resulting areas under the curve (AUCs) were compared to SUVs obtained from PET.In cases of infiltration, observed in three sensor recordings (30 %), the injection arm TAC shape varied depending on the extent and severity of infiltration. In two of these cases, TAC characteristics suggested the infiltration was partially resolving prior to image acquisition, although it was still apparent on subsequent PET. Areas under the TAC 0-10 and 0-20 min post-FDG were significantly different in infiltrated versus non-infiltrated cases (Mann-Whitney, p?<?0.05). When normalized to control, all TAC integration intervals from the injection arm were significantly correlated with SUVpeak and SUVmax measured over the infiltration site (Spearman ????0.77, p?<?0.05). Receiver operating characteristic (ROC) analyses, testing the ability of the first 10 min of post-FDG sensor data to predict infiltration visibility on the ensuing PET, yielded an area under the ROC curve of 0.92.Topical sensors applied near the injection site provide dynamic information from the time of FDG administration through the uptake period and may be useful in detecting infiltrations regardless of PET image field of view. This dynamic information may also complement the static PET image to better characterize the true extent of infiltrations.

Project description:PURPOSE:The aim of this study was to evaluate and quantify the effect of improved attenuation correction (AC) including bone segmentation and truncation correction on 18F-Fluordesoxyglucose cardiac positron emission tomography/magnetic resonance (PET/MR) imaging. METHODS:PET data of 32 cardiac PET/MR datasets were reconstructed with three different AC-maps (1. Dixon-VIBE only, 2. HUGE truncation correction and bone segmentation, 3. MLAA). The Dixon-VIBE AC-maps served as reference of reconstructed PET data. 17-segment short-axis polar plots of the left ventricle were analyzed regarding the impact of each of the three AC methods on PET quantification in cardiac PET/MR imaging. Non-AC PET images were segmented to specify the amount of truncation in the Dixon-VIBE AC-map serving as a reference. All AC-maps were evaluated for artifacts. RESULTS:Using HUGE + bone AC results in a homogeneous gain of ca. 6% and for MLAA 8% of PET signal distribution across the myocardium of the left ventricle over all patients compared to Dixon-VIBE AC only. Maximal relative differences up to 18% were observed in segment 17 (apex). The body volume truncation of -12.7 ± 7.1% compared to the segmented non-AC PET images using the Dixon-VIBE AC method was reduced to -1.9 ± 3.9% using HUGE and 7.8 ± 8.3% using MLAA. In each patient, a systematic overestimation in AC-map volume was observed when applying MLAA. Quantitative impact of artifacts showed regional differences up to 6% within single segments of the myocardium. CONCLUSIONS:Improved AC including bone segmentation and truncation correction in cardiac PET/MR imaging is important to ensure best possible diagnostic quality and PET quantification. The results exhibited an overestimation of AC-map volume using MLAA, while HUGE resulted in a more realistic body contouring. Incorporation of bone segmentation into the Dixon-VIBE AC-map resulted in homogeneous gain in PET signal distribution across the myocardium. The majority of observed AC-map artifacts did not significantly affect the quantitative assessment of the myocardium.

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Personalised insulin calculator enables safe and effective correction of hyperglycaemia prior to FDG PET/CT.

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Personalised insulin calculator enables safe and effective correction of hyperglycaemia prior to FDG PET/CT.

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