Intravenous insulin administration preparation for myocardial 18F-fluorodeoxyglucose viability imaging has the potential to reduce radiation exposure dose

Abstract Purpose This study aimed to identify and validate the optimal 18F-FDG activity and acquisition time for cardiac viability imaging with intravenous insulin administration based on a fixed 18F-FDG activity. Methods Cardiac positron emission tomography (PET) images from 30 patients with coronary artery disease (CAD) were retrospectively reconstructed into 900, 360, 180, 90, and 45 s durations. An optimal product of the maximum standardized uptake value (SUV) of the myocardium and segmental uptake (SU) and acquisition time (MSAT) was determined through a receiver operating characteristic curve. The optimal acquisition time (OAT) was equal to MSAT divided by mean SUV of the myocardium (MyoSUV) and validated in another 26 patients with CAD. Results The MyoSUV, mean SUV of the blood, SU, and their biases on reconstructed image durations of 90, 180, and 360 s were equivalent to those on an image duration of 900 s. The optimal MSAT was 848.2. In the validation group, the OAT was 129 ± 76 s (95% confidence interval, 99–160), approximately one-third of the usual acquisition time. The MyoSUV and SU were equivalent for the difference (0.15 ± 0.21, P < 0.001; −0.01 ± 0.03, P < 0.001) between PET image duration of OAT and 600 s (7.71 ± 3.01 vs. 7.56 ± 2.94, 67.1 ± 15.4% vs. 67.7 ± 15.6%). Conclusion Intravenous insulin administration preparation has the potential to reduce radiation exposure and acquisition time of cardiac 18F-FDG viability imaging without losing the accurate measurement of MyoSUV and SU when reaching an OAT.