title: Ultrashort-acting insulin may improve on 18F-FDG PET/CT image quality in patients with uncontrolled diabetic mellitus.
abstract: OBJECTIVE
  It is known that the poor image quality of (18)F-fluorodeoxyglucose ((18)F-FDG) PET scans leads to interpretation difficulty in patients with uncontrolled diabetes mellitus (DM). We usually delay (18)F-FDG PET examination when patients show high glucose levels. This study was performed to evaluate the usefulness and effects of ultrashort-acting insulin on (18)F-FDG PET/computed tomography (CT) imaging in DM patients.
  
  
  METHODS
  A total of 105 DM patients (68 men and 37 women) were included. Ultrashort-acting insulin was intravenously injected when patients showed high glucose levels (>190 mg/dl). (18)F-FDG was injected 60 min after ultrashort-acting insulin injection, and PET/CT images were acquired. Image quality was graded by consensus using the following scale: 1, good; 2, moderate; and 3, poor. The mean standardized uptake value (SUV(mean)) of the liver, gluteal muscle, and brain was assessed to evaluate the effects of ultrashort-acting insulin.
  
  
  RESULTS
  The group administered ultrashort-acting insulin (n=52, blood glucose level: 243.7 ± 46.2 mg/dl) showed a significantly higher glucose level compared with the group not administered ultrashort-acting insulin (n=53, 177.1 ± 5.2 mg/dl). Nevertheless, the image quality of the group with ultrashort-acting insulin was not significantly different from that of the group without ultrashort-acting insulin (χ(2) -test, P=0.47). No significant differences were seen in SUV(mean) in the liver (P=0.13), gluteal muscle (P=0.71), and brain (P=0.16) between groups.
  
  
  CONCLUSIONS
  Ultrashort-acting insulin can be used to improve the image quality of F-FDG PET/CT in uncontrolled DM patients without significant differences in SUV.
authors.affiliation: Department of Nuclear Medicine and Molecular Imaging, School of Medicine, Ajou University, Suwon, Korea.
authors.forename: Hee-Sung
authors.initials: HS
authors.lastname: Song
authors.forename: Joon-Kee
authors.initials: JK
authors.lastname: Yoon
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Lee
authors.forename: Seok-Ho
authors.initials: SH
authors.lastname: Yoon
authors.forename: Kyung-Sook
authors.initials: KS
authors.lastname: Jo
authors.forename: Young-Sil
authors.initials: YS
authors.lastname: An
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003920:Diabetes Mellitus / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000628:therapy; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics; D006801:Humans; D007328:Insulin / Q000008:administration & dosage / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D049268:Positron-Emission Tomography; D013997:Time Factors; D014018:Tissue Distribution / Q000187:drug effects; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure
chemical_list: D007328:Insulin; D019788:Fluorodeoxyglucose F18