title: Evaluation of a low-carbohydrate diet-based preparation protocol without fasting for cardiac PET/MR imaging.
abstract: Assessment of increased glucose uptake in inflammatory or malignant myocardial disease using PET/MRI relies on uptake suppression in normal myocardium. We evaluated the efficacy of a ≥24 hours high-fat, low-carbohydrate, and protein-permitted diet (HFLCPP) in combination with unfractionated heparin for suppression of "physiologic" myocardial glucose uptake.
  
  
  
  PET/MRI was successfully performed in 89 patients. HFLCPP was started ≥24 hours prior to PET/MRI. All patients received i.v. injection of unfractionated heparin (50 IU·kg-1) 15 minutes prior to FDG administration. Left ventricular FDG uptake was visually evaluated by two readers. Diffuse myocardial uptake exceeding liver uptake, isolated uptake in the lateral wall, or diffuse uptake in the entire circumference of the heart base were defined as failed suppression. Homogeneous myocardial uptake below liver uptake with/without focal uptake was defined as successful suppression.
  
  
  
  Success rate was 84%. Suppression was unsuccessful in 14 patients. No significant influence of gender (P = .40) or age (P = .21) was found. However, insufficient suppression was more common in patients younger than 45 years (20% vs 7%). PET/MR imaging completion rate was >97%.
  
  
  
  A HFLCPP diet in combination with unfractionated heparin was successfully implemented for cardiac PET/MRI and resulted in a sufficient suppression of myocardial FDG uptake in 84% of patients.
authors.affiliation: Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany. felix.nensa@gmail.com.
authors.forename: Felix
authors.initials: F
authors.lastname: Nensa
authors.affiliation: Clinic for Cardiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Tezgah
authors.affiliation: Department of Diet and Nutrition, University of Duisburg-Essen, Essen, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Schweins
authors.affiliation: Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Goebel
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Dusseldorf, University of Dusseldorf, Dūsseldorf, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Heusch
authors.affiliation: Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Nassenstein
authors.affiliation: Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Schlosser
authors.affiliation: Clinic for Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
authors.forename: T D
authors.initials: TD
authors.lastname: Poeppel
mesh_terms: D000328:Adult; D057791:Cardiac Imaging Techniques / Q000379:methods*; D050528:Diet, Carbohydrate-Restricted / Q000379:methods*; D004044:Dietary Proteins / Q000008:administration & dosage*; D005215:Fasting; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics*; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D009206:Myocardium / Q000378:metabolism*; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D004044:Dietary Proteins; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: PET/MRI; fatty acid loading; fluorodeoxyglucose (FDG); high-fat; low-carbohydrate; protein-permitted diet; unfractionated heparin