title: Do hyperglycemia and diabetes affect the incidence of false-negative 18F-FDG PET/CT studies in patients evaluated for infection or inflammation and cancer? A Comparative analysis.
abstract: Diabetes mellitus (DM) is a common metabolic disorder. Hyperglycemia occurs in a significant proportion of patients with uncontrolled DM but can also be found in patients without diabetes. Although the relationship between (18)F-FDG uptake in malignant tumors and blood glucose levels has been previously addressed, it has not been investigated in cases of infection and inflammation, despite the high incidence of these entities in diabetic patients. The current study assessed whether hyperglycemia and DM affect the detectability rate of disease in (18)F-FDG PET/CT studies performed for patients with suspected infectious and inflammatory processes, as compared with a group of patients with malignant tumors.
  
  
  METHODS
  (18)F-FDG PET/CT studies of 123 consecutive patients investigated for suspected infection or inflammation and 320 patients evaluated for malignancy were retrospectively analyzed. The presence of DM and the level of glucose at the time of the study were recorded. Differences between the 2 study populations in false-negative (FN) rates in patients with and without hyperglycemia and DM were compared and analyzed for statistical significance.
  
  
  RESULTS
  In the infection or inflammation group, 19 of 123 patients (15%) had serum glucose levels greater than 180 mg/dL and 43 of 123 (35%) had DM. There were no FN studies in patients with hyperglycemia and 4 FN studies in patients with normal glucose levels. There were 2 FN studies each in patients with and without DM. Neither glucose levels nor DM affects the detection rate of infection or inflammation with (18)F-FDG PET/CT. In the oncology group, 84 of 320 patients (26%) had serum glucose levels greater than 180 mg/dL and 183 of 320 (57%) had DM. There were 6 FN studies in cancer patients with hyperglycemia and 7 in patients with normal glucose levels. There were 8 FN studies in cancer patients with DM and 5 FN studies in patients without DM. Higher glucose levels but not DM affected the detection rate of malignancy with (18)F-FDG PET/CT.
  
  
  CONCLUSIONS
  High glucose levels at the time of the study but not DM may reduce the sensitivity of (18)F-FDG PET/CT in the assessment of malignancy. No significant impact on the FN rate was found in patients with infection and inflammatory processes with either DM or hyperglycemia.
authors.affiliation: B and R Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Zoya
authors.initials: Z
authors.lastname: Rabkin
authors.forename: Ora
authors.initials: O
authors.lastname: Israel
authors.forename: Zohar
authors.initials: Z
authors.lastname: Keidar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D003920:Diabetes Mellitus / Q000000981:diagnostic imaging*; D005188:False Negative Reactions; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D006943:Hyperglycemia / Q000000981:diagnostic imaging*; D007091:Image Processing, Computer-Assisted; D007239:Infections / Q000150:complications / Q000000981:diagnostic imaging*; D007249:Inflammation / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D014055:Tomography, Emission-Computed; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18