title: Additional Heparin Preadministration Improves Cardiac Glucose Metabolism Suppression over Low-Carbohydrate Diet Alone in ¹⁸F-FDG PET Imaging.
abstract: Adequate suppression of cardiac glucose metabolism increases the interpretability and diagnostic reliability of (18)F-FDG PET studies performed to detect cardiac inflammation and infection. There are no standardized guidelines, though prolonged fasting (>6 h), carbohydrate-restricted diets, fatty meals, and heparin loading all have been proposed. The aim of this study was to compare the 3 preparatory protocols used in our institution.
  
  
  METHODS
  (18)F-FDG PET scans were selected and grouped according to 3 preparatory protocols (50 consecutive scans per group): 6-h fast (group 1), low-carbohydrate diet plus 12-h fast (group 2), and low-carbohydrate diet plus 12-h fast plus intravenous heparin preadministration (50 IU/kg) (group 3). Consecutive scans were retrospectively included from time frames during which the particular protocol was used. Group 1 included oncologic indications, and groups 2 and 3 infection or inflammation detection. Cardiac segments for which inflammation or infection foci had been confirmed on other imaging modalities were excluded from the analysis. (18)F-FDG uptake in normal myocardium was scored according to a scale ranging from 0 (uptake less than that in left ventricle blood pool) to 4 (diffuse uptake greater than that in liver). Adequate suppression was defined as uptake less than that in liver and without any focus (scores 0-2).
  
  
  RESULTS
  Adequate suppression differed significantly between groups: 28% in group 1, 54% in group 2, and 88% in group 3 (P< 0.0001 for all comparisons).
  
  
  CONCLUSIONS
  Single-dose heparin administration before (18)F-FDG PET in addition to a low-carbohydrate diet significantly outperforms a low-carbohydrate diet alone in adequately suppressing cardiac glucose metabolism.
authors.affiliation: Department of Radiology and Nuclear Medicine, Meander Medical Center, Amersfoort, The Netherlands a.scholtens@meandermc.nl.
authors.forename: Asbjørn M
authors.initials: AM
authors.lastname: Scholtens
authors.affiliation: Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Hein J
authors.initials: HJ
authors.lastname: Verberne
authors.affiliation: Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands; and.
authors.forename: Ricardo P J
authors.initials: RP
authors.lastname: Budde
authors.affiliation: Department of Imaging, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Marnix G E H
authors.initials: MG
authors.lastname: Lam
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000494:pharmacology*; D004032:Diet; D050528:Diet, Carbohydrate-Restricted; D004696:Endocarditis / Q000000981:diagnostic imaging; D005260:Female; D019788:Fluorodeoxyglucose F18; D005947:Glucose / Q000378:metabolism*; D006321:Heart / Q000187:drug effects; D006493:Heparin / Q000494:pharmacology*; D006801:Humans; D007249:Inflammation / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism*; D009369:Neoplasms / Q000000981:diagnostic imaging; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012507:Sarcoidosis / Q000000981:diagnostic imaging; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D006493:Heparin; D005947:Glucose
keywords: FDG-PET; cardiac glucose metabolism; endocarditis; heparin; low carbohydrate diet; sarcoidosis