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18F-FDG Assessment of Glucose Disposal and Production Rates During Fasting and Insulin Stimulation: A Validation Study

Patricia Iozzo1,2, Amalia Gastaldelli2, Mikko J. Järvisalo1, Jan Kiss1, Ronald Borra1, Emma Buzzigoli2, Antti Viljanen1, G. Naum1, Tapio Viljanen1, Vesa Oikonen1, Juhani Knuuti1, Timo Savunen3, Piero A. Salvadori2, Ele Ferrannini2,4 and Pirjo Nuutila1,5

1 Turku PET Centre, University of Turku, Turku, Finland; 2 PET Centre, Institute of Clinical Physiology, CNR National Research Council, Pisa, Italy; 3 Department of Surgery, University of Turku, Turku, Finland; 4 Department of Internal Medicine, University of Pisa School of Medicine, Pisa, Italy; and 5 Department of Medicine, University of Turku, Turku, Finland


Figure 1
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  		FIGURE 1.  Time-dependent kinetics of 18F-FDG ({blacksquare}) and 2H-G ({square}) in 1 study subject per each experimental condition. For comparison, tracer measurements have been normalized to respective peak values.

 

Figure 2
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  		FIGURE 2.  Peak-normalized 18F-FDG (right) and 2H-G (left) in the 3 study groups, showing similarly progressive acceleration in tracer disappearance from top to bottom, in relation to increasing insulin stimulation.

 

Figure 3
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  		FIGURE 3.  Insulin-mediated glucose uptake (M value) and tracer parameters derived using 2H-G and 18F-FDG during fasting conditions (black bars) and during physiologic (white bars) or supraphysiologic (hatched bars) insulin stimulation. No estimated parameters differed significantly between the 2 tracers. Within tracer: *P ≤ 0.0001 vs. other groups; {dagger}P ≤ 0.05 vs. other groups; {ddagger}P = 0.1 vs. fast; #P = 0.001 vs. fast and 0.03 vs. 1-mU clamp; P = 0.0002 vs. 1-mU clamp and <0.0001 vs. fast; {dagger}{dagger}P = 0.058 vs. 1-mU clamp and 0.004 vs. 5-mU clamp; **P = 0.006 vs. 1-mU clamp and 0.0006 vs. 5-mU clamp.

 

Figure 4
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  		FIGURE 4.  Bland–Altman plot: x-axis shows mean EGP results of the 2 methods, and y-axis shows absolute EGP difference between the 2 methods. SD appears to be similar with increasing mean values, and mean difference between results of the 2 methods is virtually zero; most values (80%) fall within 1 SD, with only 1 value being just outside, but close to, 95% agreement interval.

 

Figure 5
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  		FIGURE 5.  Regression analyses showing associations between M values (left) and RdFDG ({blacksquare}) (r = 0.92; P = 0.001) or Rd2H-G ({square}) (r = 0.74; P = 0.036) and between mean transit time (right) and RdFDG ({blacksquare}) (r = 0.91; P < 0.0001) or Rd2H-G ({square}) (r = 0.67; P = 0.009).

 




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