Effect of various blood glucose levels on regional FDG uptake in the brain

Document Type : Original Article

Authors

1 Department of Nuclear Medicine, Faculty of Medicine, Mubarak Al-Kabeer Hospital, Kuwait University, Kuwait

2 Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait

3 Department of Nuclear Medicine, Faculty of Medicine, Trakya University, Edirne, Turkey

Abstract

Objective(s): Studies have mainly assessed the effect of hyperglycemia on18F-fluorodeoxyglucose (FDG) uptake in the brain. In this study, we assessed the FDG uptake of the brain not only in normo- and hyperglycemia but also in hypoglycemia to compare the effect of various blood glucose levels on regional FDG uptake in the brain.
Methods: This retrospective study was conducted on whole-body FDG positron emission tomography/computed tomography (PET/CT) images including the brain. The inclusion criteria included adult patients with no known history of diseases or symptoms affecting the brain, lack of abnormal brain findings on both PET and CT images, no image artifacts, and lack of any factors affecting brain FDG uptake. Maximum standardized uptake values (SUVmax) were measured in the lateral and medial frontal, temporal, parietal, and occipital cortices, lateral cerebellar cortex, posterior cingulate cortex, caudate nucleus, putamen, thalamus, brain stem (BS), and scalp in patients with normal (91-100 mg/dl), low (61-70 mg/dl), and high (171-200 mg/dl) blood glucose (BG) levels. Mean SUVmax of the brain regions for each BG range was calculated and statistically analyzed.
Results: In all BG levels, FDG uptake was at the highest level in the lateral frontal cortex and lowest level in the medial temporal cortex (MTC) and BS. The SUVmax in all assessed brain regions was significantly lower in hyperglycemia (P<0.001). However, this value was not significantly different in hypoglycemia (P>0.05) as compared to that in normoglycemia. At the BG range of 171-200 mg/dl, hyperglycemia-induced reduction in regional SUVmax had a range of 55.9-63.7% (60%±2.4%). This reduction was below 60% in the MTC, cerebellum, and BS and above 60% in other regions. Scalp activity was lower in hyperglycemia (P<0.001) and not different in hypoglycemia (P>0.05) as compared to normoglycemia.
Conclusion: The FDG uptake appears to be at the highest level in the lateral frontal cortex and the lowest level in the MTC and BS in normo-, hypo-, and hyperglycemia. Hyperglycemia-induced reduction in FDG uptake was approximately the same as that in various regions of the brain. However, the MTC, cerebellum, and BS may be slightly less affected than the other regions. Hypoglycemia does not seem to have a significant effect on FDG uptake in the brain.

Keywords

References

  1. Mergenthaler P, Lindauer U, Dienel GA, Meisel A. Sugar for the brain: the role of glucose in physiological and pathological brain function. Trends Neurosci. 2013; 36:587- 97.
  2. Simpson IA, Carruthers A, Vannucci SJ. Supply and demand in cerebral energy metabolism: the role of nutrient transporters. J Cereb Blood Flow Metab. 2007; 27:1766-91.
  3. Rouach N, Koulakoff A, Abudara V, Willecke K, Giaume C. Astroglial metabolic  networks sustain hippocampal synaptic transmission. Science. 2008; 322:1551-5.
  4. Sprinz C, Zanon M, Altmayer S, Watte G, Irion K, Marchiori E, et al. Effects of blood glucose level on 18F fluorodeoxyglucose (18F-FDG) uptake for PET/CT in normal organs: an analysis on 5623 patients. Sci Rep. 2018; 8:2126.
  5. Büsing KA, Schönberg SO, Brade J, Wasser K. Impact of blood glucose, diabetes, insulin, and obesity on standardized uptake values in tumors and healthy organs on 18F-FDG PET/CT. Nucl Med Biol. 2013;40:206-13.
  6. Keramida G, Dizdarevic S, Bush J, Peters AM. Quantification of tumor (18) F-FDG uptake: Normalise to blood glucose or scale to liver uptake? Eur Radiol. 2015; 252701-8.
  7. Viglianti BL, Wong KK, Wimer SM, Parameswaran A, Nan B, Ky C, et al. Effect of hyperglycemia on brain and     liver(18)F-FDG standardized uptake value (FDG SUV) measured by quantitative positron emission tomography (PET) imaging. Biomed Pharmacother. 2017; 88: 1038-1045.
  8. Claeys J, Mertens K, Asseler YD. Normoglycemic plasma glucose levels affect F-18FDG uptake in the brain. Ann Nucl Med. 2010; 24: 501-505.
  9. Sarikaya I, Sarikaya A, Sharma P. Assessing effect of various blood glucose levels on 18F-FDG activity in the brain, liver and blood pool. J Nucl Med Technol. 2019. Accepted for publication.
  10. Varrone A, Asenbaum S, Vander Borght T, Booij J, Nobili F, Någren K, et al. European Association of Nuclear Medicine Neuroimaging Committee. EANM procedure guidelines for PET brain imaging using [18F] FDG, version 2. Eur J Nucl Med Mol Imaging. 2009; 36: 2103-10.
  11. Society of Nuclear Medicine Procedure Guideline for FDG PET Brain Imaging Version 1.0, approved February 8, 2009.
  12. Berti V, Mosconi L, Pupi A. Brain: normal variations and benign findings in fluorodeoxyglucose-PET/computed tomography imaging. PET Clin. 2014; 9: 129-40.
  13. Ivançević V, Alavi A, Souder E, Mozley PD, Gur RE, Bénard F, et al. Regional cerebral glucose metabolism in healthy volunteers determined by fluordeoxyglucose positron emission tomography: appearance and variance in the transaxial, coronal, and sagittal planes. Clin Nucl Med. 2000; 25: 596–602.
  14. Pourhassan Shamchi S, Khosravi M, Taghvaei R, Zirakchian Zadeh M, Paydary K, Emamzadehfard S, et al. Normal patterns of regional brain (18) F-FDG uptake in normal aging. Hell J Nucl Med. 2018; 21: 175-180.
  15. Kim IJ, Kim SJ, Kim YK. Age- and sex-associated changes in cerebral glucose metabolism in normal healthy subjects: statistical parametric mapping analysis of F- 18fluorodeoxyglucose brain positron emission tomography. Acta Radiol. 2009; 50: 1169-74.
  16. Kawasaki K, Ishii K, Saito Y, Oda K, Kimura Y, Ishiwata K. Influence of mild hyperglycemia on cerebral FDG distribution patterns calculated by statistical mapping. Ann Nucl Med. 2008; 22: 191-200.                   
  17. Baker LD, Cross DJ, Minoshima S, Belongia D, Watson GS, Craft S. Insulin resistance and Alzheimer-like reductions in regional cerebral glucose metabolism for cognitively normal adults with prediabetes or early type 2 diabetes. Arch Neurol. 2011; 68:51-7.
  18. Burns CM, Chen K, Kaszniak AW, Lee W, Alexander GE, Bandy D, et al. Higher serum glucose levels are associated with cerebral hypometabolism in Alzheimer regions. Neurology. 2013; 80: 1557-64.
  19. Ishibashi K, Kawasaki K, Ishiwata K, Ishii K. Reduced uptake of 18F-FDG and 15 O-H2O  in Alzheimer's disease-related regions after glucose loading. J Cereb Blood Flow Metab. 2015; 35:1380-5.
  20. Ishibashi K, Onishi A, Fujiwara Y, Ishiwata K, Ishii K. Plasma Glucose Levels Affect cerebral 18F-FDG distribution in cognitively normal subjects with diabetes. Clin Nucl Med. 2016; 41: e274-80.
  21. Viglianti BL, Wale DJ, Ma T, Johnson TD, Bohnen NI, Wong KK, et al. Effects of plasma glucose levels on regional cerebral 18F-fluorodeoxyglucose uptake: Implications for dementia evaluation with brain PET imaging. Biomed Pharmacother. 2019; 112:108628.
  22. Hou WK, Xian YX, Zhang L, Lai H, Hou XG, Xu YX, et al. Influence of blood glucose on the expression of glucose trans-porter proteins 1 and 3 in the brain of diabetic rats. Chin Med J (Engl). 2007; 20: 1704-9.
  23. Márián T, Balkay L, Fekete I, Lengyel Z, Veress G, Esik O, et al. Hypoglycemia activates compensatory mechanism of glucose metabolism of brain. Acta Biol Hung. 2001; 52: 35-45.
  24. Choi IY, Lee SP, Kim SG, Gruetter R. In vivo measurements of brain glucose transport using the reversible Michaelis-Menten model and simultaneous measurements of cerebral blood flow changes during hypoglycemia. J Cereb Blood Flow Metab. 2001; 21: 653-63.
  25. Glasser MF, Coalson TS, Robinson EC,  Hacker CD, Harwell J, Yacoub E, et al. A multi-modal parcellation of human cerebral cortex. Nature. 2016; 536:171–178.
  26. Sarikaya I, Sarikaya A, Elgazzar AH. Current Status of (18) F-FDG PET Brain Imaging in Patients with Dementia. J Nucl Med Technol. 2018; 46: 362-367.
  27. Sorokin J, Saboury B, Ahn JA, Moghbel M, Basu S, Alavi A. Adverse functional effects of chemotherapy on whole-brain metabolism: a PET/CT quantitative analysis of FDG metabolic pattern of the "chemo-brain". Clin Nucl Med. 2014; 39:35-9.
  28. Silverman DH, Dy CJ, Castellon SA, Lai J, Pio BS, Abraham L, et al. Altered  frontocortical, cerebellar, and basal ganglia activity in adjuvant-treated breast cancer survivors 5-10 years after chemotherapy. Breast Cancer Res Treat. 2007; 103: 303-11.

Asia Oceania Journal of Nuclear Medicine and Biology
Volume 8, Issue 1
January 2020
Pages 46-53

Files

Share

How to cite

Statistics