Intravenous regular insulin is an efficient and safe procedure for obtaining high-quality cardiac 18F-FDG PET images: an open-label, single-center, randomized controlled prospective trial.

BACKGROUND: An open-label, single-center, randomized controlled prospective trial was performed to assess the efficiency and safety of an insulin loading procedure to obtain high-quality cardiac 18F-FDG PET/CT images for patients with coronary artery disease (CAD). METHODS: Between November 22, 2018 and August 15, 2019, 60 patients with CAD scheduled for cardiac 18F-FDG PET/CT imaging in our department were randomly allocated in a 1:1 ratio to receive an insulin or standardized glucose loading procedure for cardiac 18F-FDG imaging. The primary outcome was the ratio of interpretable images (high-quality images defined as myocardium-to-liver ratios ≥ 1). The secondary outcome was the patient preparation time (time interval between administration of insulin/glucose and 18F-FDG injection). Hypoglycemia events were recorded. RESULTS: The ratio of interpretable cardiac PET images in the insulin loading group surpassed the glucose loading group (30/30 vs. 25/30, P = 0.026). Preparation time was 71±2 min shorter for the insulin loading group than for the glucose loading group (P < 0.01). Two and six hypoglycemia cases occurred in the insulin and glucose loading groups, respectively. CONCLUSION: The insulin loading protocol was a quicker, more efficient, and safer preparation for gaining high-quality cardiac 18F-FDG images.

Intravenous insulin injection supplemented with subsequent milk consumption is a safer formulation for cardiac viability 18F-FDG imaging.

BACKGROUND: The safety and efficacy of intravenous insulin injection coupled with subsequent milk consumption was evaluated for high-quality cardiac viability F-18-fluorodeoxyglucose (18F-FDG) images. METHODS AND RESULTS: A total of 328 patients with known/suspected coronary artery disease received intravenous insulin injection with or without subsequent milk consumption for cardiac 18F-FDG imaging. When blood glucose levels had decreased by ≥ 20%, 18F-FDG was injected. Patients were scored for hypoglycemic symptoms using a 10-point scale (discomfort: 0, none; 1 to 3, mild; 4 to 6, moderate; 7 to 9, severe). An insulin-related hypoglycemic event was defined as an increased symptomatic score following insulin injection. The number of hypoglycemic events was significantly lower in the milk consumption group than in the group that did not (24/164 vs. 51/164, P < .01). Maximal and averaged standardized uptake value of the left ventricular myocardium (MyoSUVmax and MyoSUVmean) were also measured. The milk and control groups had similar mean hypoglycemic symptom scores (4.2 ± 4.0 vs. 3.3 ± 3.1, respectively), MyoSUVmax, and MyoSUVmean (11.1 ± 4.8, 7.3 ± 3.2 vs. 11.4 ± 4.5, 7.4 ± 3.2, respectively). CONCLUSION: Intravenous insulin injection supplemented with subsequent milk consumption is a safer formulation for cardiac viability 18F-FDG imaging without impairing image quality.