title: Impact of carbohydrate restriction with and without fatty acid loading on myocardial 18F-FDG uptake during PET: A randomized controlled trial.
abstract: BACKGROUND
  Low-carbohydrate (LC) and high-fat, low-carbohydrate (HFLC) dietary preparations may enhance (18)F-FDG-PET-based imaging of small, inflamed structures near the heart by suppressing myocardial FDG signal. We compared myocardial (18)F-FDG uptake in patients randomized to LC, HFLC, and unrestricted (UR) preparations prior to (18)F-FDG-PET.
  
  
  RESULTS
  We randomized 63 outpatients referred for oncologic (18)F-FDG-PET to LC, HFLC, or UR dietary preparations (1:1:1 allocation) starting the evening before PET. After eating dinner according to instructions, UR and LC patients fasted until FDG injection (mean time 745 minutes for UR, 899 minutes for LC), and HFLC patients drank a fatty drink 60-70 minutes prior to FDG injection. Attenuation-corrected PET imaging was performed 60 minutes after FDG administration. Maximal myocardial standard uptake values (MyoSUV(max)) were systematically measured in axial view and compared between the three groups. Using UR patients as reference, mean MyoSUV(max) was lower in LC patients (3.3 +/- 2.7 vs 6.2 +/- 5.2, P = .03) but not in HFLC patients (5.5 +/- 4.2, P = .63). Ratios of MyoSUV(max) to liver SUV(max), calculated to control for background uptake, were not significantly different amongst the groups (1.9 +/- 2.1 LC, 2.6 +/- 2.3 HFLC, 3.6 +/- 3.5 UR).
  
  
  CONCLUSIONS
  In this small randomized controlled trial using UR diet as reference, LC dietary preparation followed by extended fasting resulted in significant myocardial uptake suppression.
authors.affiliation: Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA. victor.cheng@cshs.org
authors.forename: Victor Y
authors.initials: VY
authors.lastname: Cheng
authors.forename: Piotr J
authors.initials: PJ
authors.lastname: Slomka
authors.forename: Marie
authors.initials: M
authors.lastname: Ahlen
authors.forename: Louise E J
authors.initials: LE
authors.lastname: Thomson
authors.forename: Alan D
authors.initials: AD
authors.lastname: Waxman
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
mesh_terms: D000368:Aged; D004032:Diet; D004040:Dietary Carbohydrates / Q000378:metabolism*; D005215:Fasting; D005227:Fatty Acids / Q000737:chemistry*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D007249:Inflammation; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals
chemical_list: D004040:Dietary Carbohydrates; D005227:Fatty Acids; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18