Poster Presentation ESA-SRB-ANZBMS 2024 in conjunction with ENSA

Role of intravenous insulin in reducing hyperglycaemia in patients undergoing F18-FDG PET/CT imaging and its effects on image quality (#571)

Christine M Yang 1 , Jeremy Hoang 1 2
  1. Nuclear Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
  2. Faculty of Medicine, University of Sydney, Sydney, NSW, Australia

Hyperglycaemia can negatively affect image quality of F18-FDG PET/CT scans (1). IV insulin has been shown to be safe and effective in reducing BSL levels (2). This study aims to assess the utility of IV insulin in reducing hyperglycaemia and its effects on image quality. 

This is a single centre retrospective cohort study. Patients who underwent a standard whole body F18-FDG PET/CT scan over a period of 6 months at a tertiary hospital nuclear medicine department were analysed. From medical records, data was collected on these patients’ diabetic status, blood sugar level (BSL) at time of arrival, IV insulin administration and BSL prior to administration of F18-FDG. Qualitative analysis was performed to evaluate image quality with a numeric scale from 1-3. A score of 1 represents a normal diagnostic scan, a score of 2 represents a suboptimal but diagnostic scan, and a score of 3 represents a non-diagnostic scan. 

A total of 900 whole body F18-FDG PET/CT studies were performed over 6 months. 155 out of the 900 patients (17.2%) were documented as diabetic. 33 out of the 900 patients (3.7%) had a BSL >10 on arrival. 6 of these patients (0.7%) were administered IV insulin, these 6 patients had a BSL range of 14.0-17.4 mmol/L on arrival, were given a total dose between 2-8 units of IV NovoRapid, and their BSL prior to injection ranged from 5.9 to 10.9 mmol/L. 5 out of the 6 scans were given a score of 1, 1 out of the 6 scans was given a score of 2.

Diabetic patients who are hyperglycaemic at the time of presentation for their F18-FDG PET/CT represent a small but important population that requires extra care to ensure appropriate management for adequate image quality. The study showed that IV insulin administration produced scans with adequate image quality.

  1. Surasi, D.S., Bhambhvani, P., Baldwin, J.A., Almodovar, S.E. and O’Malley, J.P. (2014). 18F-FDG PET and PET/CT Patient Preparation: A Review of the Literature. Journal of Nuclear Medicine Technology, 42(1), pp.5–13. doi:https://doi.org/10.2967/jnmt.113.132621.
  2. Roy, F.-N. ., Beaulieu, S., Boucher, L., Bourdeau, I. and Cohade, C. (2009). Impact of Intravenous Insulin on 18F-FDG PET in Diabetic Cancer Patients. Journal of Nuclear Medicine, 50(2), pp.178–183. doi:https://doi.org/10.2967/jnumed.108.056283.