Vol 24, No 2 (2021)
Research paper
Published online: 2021-07-30

open access

Page views 6690
Article views/downloads 646
Get Citation

Connect on Social Media

Connect on Social Media

Patterns of [18F]FDG myocardial uptake in oncology patients as a predictor of myocardial ischaemia on stress myocardial perfusion imaging

Ahmed Fathala1, Abdulaziz Alsugair1, Moheieldin Abouzied1, Ahmed Almuhaideb1
Pubmed: 34382668
Nucl. Med. Rev 2021;24(2):51-57.


Background: There is variable cardiac uptake observed on oncological 18F-fludeoxyglucose ([18F]FDG) positron emission/computed tomography (PET/CT). The main purpose of this study is to evaluate patterns of overnight fasting myocardial [18F]FDG uptake in oncological PET/CT and analyse the relationship between myocardial [18F]FDG uptake and myocardial ischaemia on stress single-photon emission CT (SPECT) myocardial perfusion imaging (MPI).

Material and methods: A total of 362 subjects underwent both oncological PET/CT and stress SPECT MPI within 3 months of each other. Subjects with focal-mass-like [18F]FDG myocardial uptake raising the suspicion of cardiac metastasis and subjects with coronary artery disease (CAD) were excluded. The myocardial [18F]FDG uptake was classified into four patterns.

Results: Abnormal SPECT MPI was noted in 91 (25%) patients; 220 (61%) patients had completely absent [18F]FDG uptake, 80 (22%) had diffuse [18F]FDG uptake, 39 (11%) had focal on diffuse [18F]FDG uptake, and 23 (6%) had focal or regional myocardial [18F]FDG uptake, the regional [18F]FDG myocardial uptake was the most predictive of myocardial ischaemia on SPECT MPI, and there were positive associations between age, sex, hypertension, tobacco smoking, hypercholesterolemia, and left ventricular ejection, a fair agreement was noted between the focal or regional FDG uptake and presence of ischaemia on SPECT, K = 0.394 (95% CI 0.164 to 0.189).

Conclusions: Based on the presented findings, the physiological myocardial [18F]FDG uptake in fasting oncology patients is variable. The regional myocardial [18F]FDG uptake pattern is the most frequent pattern associated with myocardial ischaemia on stress SPECT MPI, however, the agreement between regional FDG uptake and presence of ischaemia on SPECT is fair.

Article available in PDF format

View PDF Download PDF file


  1. Maurer AH, Burshteyn M, Adler LP, et al. How to differentiate benign versus malignant cardiac and paracardiac 18F FDG uptake at oncologic PET/CT. Radiographics. 2011; 31(5): 1287–1305.
  2. Inglese E, Leva L, Matheoud R, et al. Spatial and temporal heterogeneity of regional myocardial uptake in patients without heart disease under fasting conditions on repeated whole-body 18F-FDG PET/CT. J Nucl Med. 2007; 48(10): 1662–1669.
  3. Thut DP, Ahmed R, Kane M, et al. Variability in myocardial metabolism on serial tumor (18)F-FDG PET/CT scans. Am J Nucl Med Mol Imaging. 2014; 4(4): 346–353.
  4. Heckmann MB, Totakhel B, Finke D, et al. Evidence for a cardiac metabolic switch in patients with Hodgkin's lymphoma. ESC Heart Fail. 2019; 6(4): 824–829.
  5. Camici P, Ferrannini E, Opie LH. Myocardial metabolism in ischemic heart disease: basic principles and application to imaging by positron emission tomography. Prog Cardiovasc Dis. 1989; 32(3): 217–238.
  6. Schwaiger M, Schelbert HR, Ellison D, et al. Sustained regional abnormalities in cardiac metabolism after transient ischemia in the chronic dog model. J Am Coll Cardiol. 1985; 6(2): 336–347.
  7. Lopaschuk GD, Stanley WC. Glucose metabolism in the ischemic heart. Circulation. 1997; 95(2): 313–315.
  8. Araujo LI, Camici P, Spinks TJ, et al. Abnormalities in myocardial metabolism in patients with unstable angina as assessed by positron emission tomography. Cardiovasc Drugs Ther. 1988; 2(1): 41–46.
  9. Garcia JR, Soler M, Fuertes S, et al. [Incidence of focal myocardial (18)F-FDG uptake and correlation with coronary calcifications by PET/CT]. Rev Esp Med Nucl. 2011; 30(1): 8–13.
  10. de Groot M, Meeuwis APW, Kok PJM, et al. Influence of blood glucose level, age and fasting period on non-pathological FDG uptake in heart and gut. Eur J Nucl Med Mol Imaging. 2005; 32(1): 98–101.
  11. Gropler RJ, Siegel BA, Lee KJ, et al. Nonuniformity in myocardial accumulation of fluorine-18-fluorodeoxyglucose in normal fasted humans. J Nucl Med. 1990; 31(11): 1749–1756.
  12. Young LH, Russell RR, Yin R, et al. Regulation of myocardial glucose uptake and transport during ischemia and energetic stress. Am J Cardiol. 1999; 83(12A): 25H–30H.
  13. Dorbala S, Di Carli MF, Delbeke D, et al. SNMMI/ASNC/SCCT guideline for cardiac SPECT/CT and PET/CT 1.0. J Nucl Med. 2013; 54(8): 1485–1507.
  14. Williams G, Kolodny GM. Suppression of myocardial 18F-FDG uptake by preparing patients with a high-fat, low-carbohydrate diet. AJR Am J Roentgenol. 2008; 190(2): W151–W156.
  15. Lee HY, Nam HY, Shin SK. Comparison of myocardial F-18 FDG uptake between overnight and non-overnight fasting in non-diabetic healthy subjects. Jpn J Radiol. 2015; 33(7): 385–391.
  16. Herrero P, Gropler RJ. Imaging of myocardial metabolism. J Nucl Cardiol. 2005; 12(3): 345–358.
  17. Mäki MT, Haaparanta MT, Luotolahti MS, et al. Glucose uptake in the chronically dysfunctional but viable myocardium. Circulation. 1996; 93(9): 1658–1666.
  18. Masuda A, Naya M, Manabe O, et al. Administration of unfractionated heparin with prolonged fasting could reduce physiological 18F-fluorodeoxyglucose uptake in the heart. Acta Radiol. 2016; 57(6): 661–668.
  19. Harisankar CN, Mittal BR, Agrawal KL, et al. Utility of high fat and low carbohydrate diet in suppressing myocardial FDG uptake. J Nucl Cardiol. 2011; 18(5): 926–936.
  20. Chareonthaitawee P, Beanlands RS, Chen W, et al. Joint SNMMI-ASNC Expert Consensus Document on the Role of F-FDG PET/CT in Cardiac Sarcoid Detection and Therapy Monitoring. J Nucl Med. 2017; 58(8): 1341–1353.
  21. Neely JR, Morgan HE. Relationship between carbohydrate and lipid metabolism and the energy balance of heart muscle. Annu Rev Physiol. 1974; 36: 413–459.
  22. Abbott BG, Liu YH, Arrighi JA. [18F]Fluorodeoxyglucose as a memory marker of transient myocardial ischaemia. Nucl Med Commun. 2007; 28(2): 89–94.
  23. McNulty PH, Jagasia D, Cline GW, et al. Persistent changes in myocardial glucose metabolism in vivo during reperfusion of a limited-duration coronary occlusion. Circulation. 2000; 101(8): 917–922.
  24. Kawai Y, Tsukamoto E, Nozaki Y, et al. Significance of reduced uptake of iodinated fatty acid analogue for the evaluation of patients with acute chest pain. J Am Coll Cardiol. 2001; 38(7): 1888–1894.
  25. He ZX, Shi RF, Wu YJ, et al. Direct imaging of exercise-induced myocardial ischemia with fluorine-18-labeled deoxyglucose and Tc-99m-sestamibi in coronary artery disease. Circulation. 2003; 108(10): 1208–1213.
  26. Abramson BL, Ruddy TD, de Kemp RA, et al. Stress perfusion/metabolism imaging: A pilot study for a potential new approach to the diagnosis of coronary disease in women. Journal of Nuclear Cardiology. 2000; 7(3): 205–212.
  27. Dilsizian V, Bateman TM, Bergmann SR, et al. Metabolic imaging with beta-methyl-p-[(123)I]-iodophenyl-pentadecanoic acid identifies ischemic memory after demand ischemia. Circulation. 2005; 112(14): 2169–2174.