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Cited by 109Medical Imaging Techniques and ApplicationsLung Cancer Diagnosis and TreatmentRadiopharmaceutical Chemistry and Applications

Effect of blood glucose level on standardized uptake value (SUV) in 18F-FDG PET-scan: a systematic review and meta-analysis of 20,807 individual SUV measurements

Open access
Eskian, Mahsa, Alavi, Abass, Khorasanizadeh, MirHojjat, Viglianti, Benjamin L., Jacobsson, Hans, Barwick, Tara D., Meysamie, Alipasha, Yi, Sun K. +16 more·2019·European Journal of Nuclear Medicine and Molecular Imaging
DOI 10.1007/s00259-018-4194-x
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Abstract

Systematic review and meta-analysis of blood glucose effects on SUV measurements.

AI snapshot

Written from the paper’s full text.

TL;DR

This individual-data systematic review and meta-analysis examined whether pre-scan blood glucose influences FDG-PET standardized uptake values across normal organs and tumors. It found glucose inversely associated with brain and muscle uptake and positively associated with liver and blood-pool uptake, while tumor uptake showed no clear adjusted relationship except a possible reduction when glucose exceeded 200 mg/dl.

Key findings

  • The analysis pooled 20,807 SUV measurements (14,879 SUVmax and 5,928 SUVmean) from 8,380 patients across 29 studies; 14.3% of patients were hyperglycemic.
  • In adjusted models, higher blood glucose was significantly associated with lower brain SUVmax and SUVmean (both p < 0.001) and lower muscle SUVmax and SUVmean (both p < 0.001), but with higher liver SUVmax (p = 0.001) and SUVmean (p = 0.004) and higher blood-pool SUVmax (p = 0.008) and SUVmean (p < 0.001).
  • Tumor uptake showed no significant adjusted association with glucose for SUVmax (p = 0.948) or SUVmean (p = 0.507), nor for lung-tumor SUVmax (p = 0.505); in ANOVA, only the tumor group with glucose above 200 mg/dl had significantly lower SUVmax than the euglycemic group (mean difference 3.49, p < 0.001).
  • ANOVA showed all hyperglycemic groups had lower brain and muscle SUVs and higher liver and blood-pool SUVs than the euglycemic group, with some exceptions such as muscle SUVmean in only two hyperglycemic groups and blood-pool SUVmean in the 110–125 mg/dl group (mean difference 0.06, p = 0.756).

Methods

  • Systematic review and meta-analysis conducted according to Cochrane and PRISMA guidance; MEDLINE, Embase, and Cochrane Library were searched through January 2018, with author contact to obtain individual patient data.
  • Eligible studies reported FDG-PET or PET/CT SUVs for tumors or normal organs, measured pre-scan blood glucose immediately before FDG after at least 4 hours of fasting, and confirmed malignant lesions histologically; 29 studies (13 prospective, 16 retrospective) were included.
  • Individual-level linear and multiple linear regression adjusted for sex, age, BMI, diabetes diagnosis, injected FDG dose, and uptake time; ANOVA compared five glucose groups (≤109, 110–125, 126–150, 151–200, and >200 mg/dl) separately by organ and SUV type.

Limitations

  • The paper states that many included studies were retrospective, raising possible selection bias, and that several potential confounders could not be included, such as scanner resolution, reconstruction methods, ROI definition, exact fasting duration, and insulin levels.
  • The paper also states that it could not assess how glucose affects PET sensitivity or specificity for malignant lesions, nor analyze most tumor types separately by origin or histopathology except lung tumors.
  • Evident from the text: reliance on author-provided individual data and heterogeneous study protocols, tumor types, and organ measurements may limit generalizability; the observational design cannot establish causality.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1007/s00259-018-4194-x

Cites

116 of 116 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

18 of 54 cited sources checked · 7 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    In normal conditions, blood glucose should return to normal levels during the 2 h after ingestion.

    “As in normal conditions (i.e., no insulin resistance), blood glucose should return to normal levels during the 2 h after ingestion [95,96].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [95] Yip WCY, et al. Prevalence of pre-diabetes across ethnicities: a review of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) for classification of dysglycaemia. Nutrients. 2017;9(11). source
    • cites [96] Simonson GD, Kendall DM. Diagnosis of insulin resistance and associated syndromes: the spectrum from the metabolic syndrome to type 2 diabetes mellitus. Coron Artery Dis. 2005;16(8):465–72. source
  • Premisecitation

    During hyperglycemia, the liver is the major site of glucose utilization, accounting for uptake of approximately 50% of ingested glucose.

    “During hyperglycemia, liver is the major site of glucose utilization, accounting for uptake of approximately 50% of the ingested glucose [102-104].”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [102] Adeva-Andany MM, et al. Liver glucose metabolism in humans. Biosci Rep. 2016;36(6):e00416. source

      The Introduction (page unavailable) says that, in healthy individuals after meals, the liver is a major site of glucose utilization and accounts for a variable one-third to 50–60% of ingested glucose. This supports approximately 50% as a reported estimate, but the paper does not establish that proportion for hyperglycemia generally or consistently identify the liver as the largest site. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [103] Ferrannini E, et al. The disposal of an oral glucose load in healthy subjects. A quantitative study. Diabetes. 1985;34(6):580–8. source
    • cites [104] Woerle HJ, et al. Pathways for glucose disposal after meal ingestion in humans. Am J Physiol Endocrinol Metab. 2003;284(4):E716–25. source
  • Premisecitation

    A significant and increasing proportion of patients who undergo PET scan are in a hyperglycemic state.

    “A significant and increasing proportion of patients who undergo PET scan are in a hyperglycemic state.Diabetes [32,33], medications such as corticosteroids [34,35] or chemotherapy agents [36,37], and anxiety [38] are the leading causes of high blood glucose levels (BGL) in patients undergoing PET-scan.”
    Quote in the paperNot a substantial claim1 of 6 sources checked
    • cites [32] Niccoli-Asabella A, et al. 18F-FDGPET/CT: diabetes and hyperglycaemia. Nucl Med Rev Cent East Eur. 2013;16(2):57–61. source

      The Material and methods section reports hyperglycaemia in 1,698 of 13,063 PET/CT patients (13%), supporting a significant proportion. The Results section does not establish that the proportion among all PET/CT patients was increasing: its rise from 56.7% to 79% concerns the share of rescheduled patients with hyperglycaemia, while the overall rescheduling rate fell. Page numbers were not provided in our copy. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [33] Cho NH, et al. IDF diabetes atlas: global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018;138:271–81. source
    • cites [34] Clement S, et al. Management of diabetes and hyperglycemia in hospitals. Diabetes Care. 2004;27(2):553–91. source
    • cites [35] Bonaventura A, Montecucco F. Steroid-induced hyperglycemia: an underdiagnosed problem or clinical inertia? A narrative review. Diabetes Res Clin Pract. 2018;139:203–20. source
    • cites [36] Beyan C, et al. Severe hyperglycemia as a complication of big ICE chemotherapy in a patient with acute myeloblastic leukemia. Haematologia (Budap). 2002;32(4):505–8.
    • cites [37] Walker ED. Hyperglycemia. A complication of chemotherapy in children. Cancer Nurs. 1988;11(1):18–22. source
  • Findingown data

    When regression analyses were restricted to lung tumors, no significant relationship was found between BGL and SUVmax in multivariate analysis (p = 0.505).

    “When the regression analyses were restricted to tumors of lung origin (338 individual SUV max measurements), still no significant relationship was found between BGL and SUV in both univariate (p = 0.079) and multivariate analysis (p = 0.505).”
    Quote in the paperNot a substantial claim
  • Findingown data

    In univariate regression analysis, there was a significant inverse correlation between pre-scan BGL and brain SUVmean (p < 0.001, r = -0.58, r2 = 0.34).

    “In univariate regression analysis (Table 3) there was a significant inverse correlation between pre-scan BGL and SUV max (p < 0.001, r = -0 .42,r 2 = 0.18) (Fig. 3) and SUV mean (p < 0.001, r = -0.58,r 2 = 0.34) (Fig. 4).”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 28
  • May combine two claims. 28

  • Classified as probably not a substantial claim.

    Premisecitation

    Some GLUTs are insulin-dependent transporters, such as GLUT4 in skeletal muscle.

    “Moreover, some of these GLUTs are insulin-dependent transporters such as GLUT4 in skeletal muscle [30,31], which may facilitate glucose and 18 F-FDG cell uptake in patients with high insulin level, and may result in diminishing glucose and 18 F-FDG cell uptake in insulin resistance status.”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [30] Ishiki M, Klip A. Minireview: recent developments in the regulation of glucose transporter-4 traffic: new signals, locations, and partners. Endocrinology. 2005;146(12):5071–8. source
    • cites [31] Gould GW, Holman GD. The glucose transporter family: structure, function and tissue-specific expression. Biochem J. 1993;295(Pt 2):329–41. source

  • May combine two claims.

    Interpretationcitation

    In malignant tumors, transportation and metabolism of glucose lack controls because of the autonomous nature of malignancies, so hyperglycemia would not have a significant effect on tumors.

    “However, in malignant tumors transportation and metabolism of glucose lack such controls because of the autonomous nature of malignancies [27,84].Thus, hyperglycemia may lead to competition between endogenous glucose and FDG in normal cells but would not have significant effect on tumors.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [27] Macheda ML, Rogers S, Best JD. Molecular and cellular regulation of glucose transporter (GLUT) proteins in cancer. J Cell Physiol. 2005;202(3):654–62. source

      The Abstract (page not available) reports increased glucose uptake and deregulated GLUT expression in malignant cells, supporting part of the premise. But the paper also describes regulation of tumor glucose uptake by hypoxia and other factors; its “Glucose uptake in tumors” section does not establish that hyperglycemia has no significant effect on tumors or their FDG uptake. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [84] Yamamoto T, et al. Over-expression of facilitative glucose transporter genes in human cancer. Biochem Biophys Res Commun. 1990;170(1):223–30. source
    • The authors state this as an assumption: In a hyperglycemic state, GLUTs will be saturated by excess unlabeled glucose.

  • May combine two claims.

    Premisecitation

    GLUT-1 is the main expressed GLUT in red blood cell membrane and is not insulin dependent.

    “It could be explained by the fact that GLUT-1 is the main expressed GLUT in red blood cell (RBC) membrane which is not insulin dependent [22,110]; thus, insulin resistance would not affect FDG uptake in RBCs.”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [22] Wood IS, Trayhurn P. Glucose transporters (GLUT and SGLT): expanded families of sugar transport proteins. Br J Nutr. 2003;89(1):3–9. source

      The Class I facilitative transporters section says GLUT1 is expressed particularly in erythrocytes, while the Perspective calls GLUT1 a constitutive transporter and distinguishes it from insulin-responsive GLUT4. The paper does not establish that GLUT1 is the main GLUT in the red-blood-cell membrane. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [110] Joost HG, Thorens B. The extended GLUT-family of sugar/polyol transport facilitators: nomenclature, sequence characteristics, and potential function of its novel members (review). Mol Membr Biol. 2001;18(4):247–56. source

      The Introduction (page unavailable) says GLUT1 transports glucose into erythrocytes, and “Sub-classes of the extended GLUT family” lists erythrocytes among GLUT1’s characteristic tissues. The paper does not explicitly say GLUT1 is the main transporter in red blood cell membranes or that its activity there is insulin-independent; it discusses insulin-sensitive localization for GLUT4 instead. (LLM, conf=0.82)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In a study of 13,063 patients who underwent FDG-PET scan, pre-scan BGL was higher than 200 mg/dl in 1,698 subjects (13%).

    “In a study of 13,063 patients who underwent FDG-PET scan, pre-scan BGL was higher than 200 mg/dl in 1698 subjects (13%) [32].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [32] Niccoli-Asabella A, et al. 18F-FDGPET/CT: diabetes and hyperglycaemia. Nucl Med Rev Cent East Eur. 2013;16(2):57–61. source

  • May combine two claims.

    Premisecitation

    In a Web-based survey of PET/CT users, 128 PET users responded, cut-off values varied from 150 to 250 mg/dl, and 7% of sites used no cut-off.

    “In a Web-based survey of PET/CT users [41], 128 PET users from medical centers in the Americas, Europe, Asia Pacific, and Middle East responded to the question regarding the pre-scan BGL cut-off used in their centers.Cut-off values varied from 150 to 250 mg/dl (8.3-13.9mmol/l), and 7% of the sites used no cut-off.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [41] Beyer T, Czernin J, Freudenberg LS. Variations in clinical PET/CT operations: results of an international survey of active PET/CT users. J Nucl Med. 2011;52(2):303–10. source

      The Results (p. 2) report 128 responses to the Web-based survey, and the PET/CT Protocols section (p. 3) reports glucose cutoffs of 150–250 mg/dL and no cutoff at 7% of sites. The paper does not establish that all 128 respondents answered the specific glucose-cutoff question. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    EANM guidelines suggest that if the plasma glucose level is higher than or equal to 200 mg/dl, the FDG PET/CT study should be rescheduled.

    “European Association of Nuclear Medicine (EANM) [40] guidelines suggest if the plasma glucose level is higher than or equal to 200 mg/dl, the FDG PET/CT study should be rescheduled.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [40] Boellaard R, et al. FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging. 2015;42(2):328–54. source

      The “For clinical studies” section gives the threshold as ≥11 mmol/L (about 200 mg/dL), but says the study should be rescheduled or the patient excluded, depending on the circumstances and trial. The citing sentence omits that alternative and presents rescheduling as the sole recommendation. (LLM, conf=0.89)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The study adhered to the PRISMA statement recommendations during reporting of its findings.

    “We adhered to the recommendations outlined in the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement [47] during reporting of the current study's findings.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [47] Liberati A, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6(7):e1000100. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    EANM guidelines recommend a lower acceptable upper pre-scan BGL for research purposes, between 126 and 150 mg/dl.

    “EANM guidelines recommend a lower acceptable upper pre-scan BGL for research purposes (i.e., between 126 and 150 mg/dl).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [40] Boellaard R, et al. FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging. 2015;42(2):328–54. source

  • May combine two claims.

    Premisecitation

    Patients with higher BMI have more fat tissue, which has a relatively low glucose uptake during the fasting state.

    “Moreover, patients with higher BMI have more fat tissue, which has a relatively low glucose uptake during fasting state [91,92].”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [91] Kershaw EE, Flier JS. Adipose tissue as an endocrine organ. J Clin Endocrinol Metab. 2004;89(6):2548–56. source
    • cites [92] Ferrannini E, et al. Effect of fatty acids on glucose production and utilization in man. J Clin Invest. 1983;72(5):1737–47. source

      The Subjects section describes healthy volunteers within 20% of desirable body weight, not patients grouped by BMI. The Discussion addresses how free fatty acids affect glucose uptake chiefly in muscle; our copy does not address whether higher-BMI patients have more fat tissue or whether fat tissue has relatively low glucose uptake during fasting. Searches for adipose-tissue uptake and BMI or adiposity found no passage establishing those points. (LLM, conf=0.74)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    The prominent type of muscle glucose transporter is GLUT4, which is insulin-dependent, in contrast to tumors, which mainly overexpress Glut-1 and Glut-3 transporters that are not insulin-sensitive.

    “The prominent type of muscle glucose transporter is GLUT4, which is insulin-dependent [30,31,93], in contrast to tumors which mainly overexpress Glut-1 and Glut-3 transporters, which are not insulin-sensitive [27,29,94].”
    Quote in the paperSubstantial claim3 of 6 sources checked
    • cites [30] Ishiki M, Klip A. Minireview: recent developments in the regulation of glucose transporter-4 traffic: new signals, locations, and partners. Endocrinology. 2005;146(12):5071–8. source
    • cites [31] Gould GW, Holman GD. The glucose transporter family: structure, function and tissue-specific expression. Biochem J. 1993;295(Pt 2):329–41. source

      The “GLUT 4: the insulin-responsive glucose transporter” section identifies GLUT4 in muscle and says insulin recruits it to the cell surface. Table 1 lists GLUT1 in transformed cells, but it does not establish that tumors mainly overexpress both GLUT1 and GLUT3 or that those tumor transporters are not insulin-sensitive. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [93] Ismail-Beigi F. Metabolic regulation of glucose transport. J Membr Biol. 1993;135(1):1–10. source
    • cites [27] Macheda ML, Rogers S, Best JD. Molecular and cellular regulation of glucose transporter (GLUT) proteins in cancer. J Cell Physiol. 2005;202(3):654–62. source

      The Abstract says GLUT4 moves to the muscle-cell membrane in response to insulin and describes GLUT1 and/or GLUT3 overexpression as characteristic of malignant cells. It does not establish that GLUT4 is the predominant muscle transporter or explicitly state that both GLUT1 and GLUT3 are insulin-insensitive. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
    • cites [29] Medina RA, Owen GI. Glucose transporters: expression, regulation and cancer. Biol Res. 2002;35(1):9–26. source
    • cites [94] Marom EM, et al. Correlation of FDG-PET imaging with Glut-1 and Glut-3 expression in early-stage non-small cell lung cancer. Lung Cancer. 2001;33(2–3):99–107. source

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Current available PET-scan preparation protocols suggest rescheduling the scan or consideration of rapid-acting insulin injection prior to PET scan or scan rescheduling in patients with hyperglycemia ranging from 120 mg/dl to 200 mg/dl, and recommend inconsistent and diverse cut-offs for insulin injection or scan rescheduling.

    “Current available PET-scan preparation protocols suggest rescheduling the scan or consideration of rapid-acting insulin injection prior to PET scan or scan rescheduling in patients with hyperglycemia ranging from 120 mg/dl to 200 mg/dl, and recommend inconsistent and diverse cut-offs for insulin injection or scan rescheduling [39,40].”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [39] Delbeke D, et al. Procedure guideline for tumor imaging with 18F-FDG PET/CT 1.0. J Nucl Med. 2006;47(5):885–95.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [40] Boellaard R, et al. FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging. 2015;42(2):328–54. source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    14.3% of the included patients were hyperglycemic.

    “The selected studies included 13 prospective and 16 retrospective studies, reporting a total of 20,807 SUV measurements (total 14,879 SUV max and 5928 SUV mean ) in 8380 patients (14.3% hyperglycemic) between 1992 and 2018 (Table 1).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The included studies reported 20,807 SUV measurements (14,879 SUVmax and 5,928 SUVmean) in 8,380 patients.

    “The selected studies included 13 prospective and 16 retrospective studies, reporting a total of 20,807 SUV measurements (total 14,879 SUV max and 5928 SUV mean ) in 8380 patients (14.3% hyperglycemic) between 1992 and 2018 (Table 1).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In ANOVA, all hyperglycemic groups had significantly higher blood pool SUVmean compared with the euglycemic group, except the mild hyperglycemic group (110-125 mg/dl) (MD = 0.06, p = 0.756).

    “In thewANOVA test, all hyperglycemic groups had significantly higher SUV max and SUV mean in comparison with the euglycemic group, except for the mild hyperglycemic group(110-125 mg/dl) for SUV mean (MD = 0.06, p = 0.756) (Table 5).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductnone given

    The main sources of bias were use of hospital controls (euglycemic patients) and lack of scan reviewer blinding to pre-scan BGL.

    “The main sources of bias were first the use of hospital controls (euglycemic patients) and second, lack of scan reviewer blinding to pre-scan BGL of subjects.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Quality assessment indicated that 9 of 29 studies (31%) had medium risk of bias and 20 of 29 (69%) had low risk of bias.

    “Quality assessment of included studies based on the Newcastle-Ottawa Scale indicated that nine out of 29 studies (31%) carried medium risk for bias, and 20 out of 29 studies (69%) were judged to have low risk of bias.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    ANOVA was not performed for tumor SUVmean because the number of patients in different BGL groups was not sufficient.

    “ANOVA test was not performed for SUV mean of tumor since the number of patients in different BGL groups was not sufficient (Table 5).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The main expressed GLUTs in the blood-brain barrier and neurons are GLUT-1 and GLUT-3, which are not insulin-sensitive.

    “Moreover the main expressed GLUTs in blood-brain barrier and neurons are GLUT-1 and GLUT-3 which are not insulin-sensitive [100, 101]; thus, hyperinsulinemia during hyperglycemia would not have any effects on FDG uptake in brain.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [100] Pardridge WM, Boado RJ, Farrell CR. Brain-type glucose transporter (GLUT-1) is selectively localized to the blood–brain barrier. Studies with quantitative western blotting and in situ hybridization. J Biol Chem. 1990;265(29):18035–40. source
    • cites [101] Vannucci SJ, Maher F, Simpson IA. Glucose transporter proteins in brain: delivery of glucose to neurons and glia. Glia. 1997;21(1):2–21. source

  • May combine two claims.

    Interpretationreasoning

    Pre-scan hyperglycemia can potentially lead to a distorted tumor-to-target uptake ratio and hence decrease the sensitivity of the PET scan.

    “Thus, pre-scan hyperglycemia can potentially lead into a distorted tumor-to-target uptake ratio, and hence decrease the sensitivity of the PET scan.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: In a hyperglycemic state, GLUTs will be saturated by excess unlabeled glucose.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Multiple linear regression analysis was performed with SUVmax or SUVmean as dependent variable and pre-scan BGL, sex, age, BMI, presence of diabetes mellitus diagnosis, injected dose of FDG, and time interval between FDG injection and imaging as independent variables.

    “Multiple linear regression analysis was performed with SUV max or SUV mean as dependent variable and pre-scan BGL, sex, age, BMI, presence of diabetes mellitus diagnosis, injected dose of FDG, and time interval between FDG injection and imaging as independent variables.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Two reviewers independently extracted data from included studies using a pre-specified and piloted data extraction sheet.

    “Two reviewers independently extracted data from included studies using a pre-specified and piloted data extraction sheet.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Insulin injection may increase background FDG uptake and therefore decrease PET scan sensitivity.

    “On the other hand, unnecessary interventions aimed at lowering the BGL are time-and resources-consuming, including insulin injection, which may also increase background FDG uptake and therefore decrease PET scan sensitivity [42].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [42] Zhao S, et al. Effects of insulin and glucose loading on FDG uptake in experimental malignant tumours and inflammatory lesions. Eur J Nucl Med. 2001;28(6):730–5. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Other factors theoretically capable of confounding the effect of BGL on SUV could not be incorporated into the analysis, such as scanner resolution, reconstruction methods, region of interest measurements, exact duration of fasting, and serum levels of insulin.

    “Nevertheless, there are some other factors theoretically capable of confounding the effect of BGL on SUV that could not be incorporated into our analysis, such as scanner resolution, reconstruction methods, region of interest measurements (a segmentation type processes or a fixed size region for SUV mean of tumors), exact duration of fasting, and serum levels of insulin.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Disagreements in data extraction were resolved through discussion between the two authors, and if necessary a third senior investigator extracted the data and discussed the results with reviewers to reach consensus.

    “Disagreements were resolved through discussion between the two authors, and if necessary, a third senior investigator (APM) extracted the data and then discussed the results with reviewers in order to reach consensus.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Patients in euglycemic and hyperglycemic groups were not paired by sex, age, BMI, injected dose of FDG, time interval between FDG injection and imaging, and diagnosis of diabetes, but this information was available for most individual data and was taken into account in multivariate analyses.

    “Although patients in euglycemic and hyperglycemic groups were not paired by sex, age, BMI, injected dose of FDG, time interval between FDG injection and imaging, and diagnosis of diabetes, this information was available for most of the individual data and was taken into account in our multivariate analyses.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Two independent reviewers, blind to journals and authors, screened titles and abstracts and then full texts to identify studies eligible for inclusion.

    “After omitting duplicate citations, two independent reviewers (ME and MHK), blind to the journals and authors, screened titles and abstracts and then full texts to identify studies eligible for inclusion.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Hyperglycemia may lead to competition between endogenous glucose and FDG in normal cells but would not have a significant effect on tumors.

    “Thus, hyperglycemia may lead to competition between endogenous glucose and FDG in normal cells but would not have significant effect on tumors.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: In a hyperglycemic state, GLUTs will be saturated by excess unlabeled glucose.

  • May combine two claims.

    Interpretationreasoning

    Whatever the mechanism of uptake, the proportion of glucose in the circulation that is FDG decreases as blood glucose increases, so there is always competition between FDG and endogenous glucose.

    “Whatever the mechanism of uptake, the proportion of glucose in the circulation that is FDG will decrease the higher the blood glucose; in other words there is always competition, albeit 'passive'.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The study was not able to investigate the effect of BGL on sensitivity and specificity of PET scan in diagnosis of malignant lesions.

    “Second, we were not able to investigate the effect of BGL on sensitivity and specificity of PET scan in diagnosis of malignant lesions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    SNMMI guidelines recommend rescheduling the scan if BGL is greater than a wide range of 150-200 mg/dl.

    “Society of Nuclear Medicine and Molecular Imaging (SNMMI) [39] guidelines recommend rescheduling the scan if BGL is greater than a wide range of 150-200 mg/dl.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [39] Delbeke D, et al. Procedure guideline for tumor imaging with 18F-FDG PET/CT 1.0. J Nucl Med. 2006;47(5):885–95.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    All malignant lesions had to be confirmed by biopsy or surgical histopathology.

    “All malignant lesions had to be confirmed by biopsy or surgical histopathology.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    The brain results could be explained by competition of FDG and glucose on membrane GLUTs in the blood-brain barrier.

    “These results also could be explained by the competition of FDG and glucose on the membrane GLUTs in the blood-brain barrier.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Hyperinsulinemia during hyperglycemia would not have any effects on FDG uptake in the brain because the main expressed GLUTs in the blood-brain barrier and neurons are GLUT-1 and GLUT-3, which are not insulin-sensitive.

    “Moreover the main expressed GLUTs in blood-brain barrier and neurons are GLUT-1 and GLUT-3 which are not insulin-sensitive [100, 101]; thus, hyperinsulinemia during hyperglycemia would not have any effects on FDG uptake in brain.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [100] Pardridge WM, Boado RJ, Farrell CR. Brain-type glucose transporter (GLUT-1) is selectively localized to the blood–brain barrier. Studies with quantitative western blotting and in situ hybridization. J Biol Chem. 1990;265(29):18035–40. source
    • cites [101] Vannucci SJ, Maher F, Simpson IA. Glucose transporter proteins in brain: delivery of glucose to neurons and glia. Glia. 1997;21(1):2–21. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The systematic review and meta-analysis was conducted in accordance with guidelines recommended in the Cochrane Handbook for Systematic Reviews.

    “This systematic review and meta-analysis study was conducted in accordance with guidelines recommended in Cochrane Handbook for Systematic Reviews [46].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [46] Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from: www.handbook.cochrane.org.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Studies gaining three or fewer scores on the Newcastle-Ottawa Scale were considered high risk of bias and were excluded from analysis.

    “Studies with between seven and nine scores and between four and six scores were deemed to have low risk and medium risk respectively, and studies gaining three or fewer scores were considered as having a high risk of bias and were excluded from analysis.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    Studies were excluded when any condition could interfere with the relationship between pre-scan BGL and SUVs, including SUVs normalized to BGL or lean body mass instead of body weight, or patients who received insulin or oral anti-hyperglycemic within 4 h prior to PET scan.

    “Moreover, studies were excluded when there was any condition that could interfere with the relationship between pre-scan BGL and SUVs, including SUVs that were normalized to BGL or lean body mass instead of body weight, or patients who had received insulin or any oral anti-hyperglycemic within 4 h prior to PET scan.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Studies were identified through electronic search of MEDLINE, Embase, and Cochrane library databases using a sensitive search strategy.

    “Studies were identified through electronic search of MEDLINE (PubMed), Embase and Cochrane library databases, using a sensitive search strategy.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Two authors independently assessed quality of included studies using the Newcastle-Ottawa Scale for cross-sectional and case-control studies.

    “Two authors independently assessed quality of included studies using Newcastle-Ottawa Scale for cross-sectional and case-control studies [48].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [48] Wells G, Shea B, O'Connell D, Peterson JE, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa, Ottawa Hospital Research Institute; 2000

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    The prominent hepatic GLUT is GLUT-2, a bidirectional glucose transporter that allows fluxes of glucose in and out of cells based on its diffusion gradient and is not a saturable transporter.

    “Moreover, prominent hepatic GLUT is GLUT-2 which is a bidirectional glucose transporter that allows fluxes of glucose in and out the cells based on its diffusion gradient, and is not a saturable transporter [107].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [107] Karim S, Adams DH, Lalor PF. Hepatic expression and cellular distribution of the glucose transporter family. World J Gastroenterol. 2012;18(46):6771–81. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Potentially missed additional citations were manually searched using reference lists of included articles.

    “Furthermore, potentially missed additional citations were manually searched using reference lists of included articles.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    18F-FDG-6-P is not a substrate for G-6-P isomerase; therefore, it is trapped inside cells and detected by the PET scanner.

    “Unlike G-6-P, 18 F-FDG-6-P is not a substrate for G-6-P isomerase; therefore, it is trapped inside the cells and detected by the PET scanner [24][25][26].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [24][25][26]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Identification of unpublished work was attempted by contacting experts and authors of included studies.

    “Identification of unpublished work was attempted by contacting experts and authors of included studies.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    Blood glucose level had to be measured prior to PET scan, immediately before intravenous FDG administration, after at least 4 h of fasting.

    “Blood glucose level had to be measured prior to PET scan, immediately before the intravenous administration of FDG, after at least 4 h of fasting.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    No limitations were applied for language or year of publications.

    “No limitations were applied for language or year of publications.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Insulin resistance counteracts shifting of glucose to muscle cells by diminishing GLUT4 expression, suppressing glycolysis, and increasing glucose-6-phosphate levels.

    “Several studies have shown that insulin resistance counteracts shifting of glucose to muscle cells by diminishing GLUT4 expression, suppressing glycolysis, and increasing glucose-6-phosphate levels [97][98][99], all of which lead to increased fasting BGLs.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [97][98][99]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Muscle metabolism is age- and sex-dependent.

    “In line with this, studies have indicated that muscle metabolism is age-and sex-dependent [86][87][88], and the ability of insulin to stimulate glucose transporters in muscles is impaired in diabetes and impaired glucose tolerance [89,90].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [86][87][88]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationown data

    When BGL is above 200 mg/dl, there is the possibility of decreased tumor-to-target uptake ratio and hence impaired scan sensitivity.

    “as there is the possibility of decreased tumor-to-target uptake ratio and hence impaired scan sensitivity.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    The current approach may lead to insulin-induced FDG shunting from tumors to muscles, thus decreasing tumor to background FDG uptake ratio.

    “or the possibility of insulin-induced FDG shunting from tumors to muscles, thus decreasing tumor to background FDG uptake ratio [42,112,113].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [42] Zhao S, et al. Effects of insulin and glucose loading on FDG uptake in experimental malignant tumours and inflammatory lesions. Eur J Nucl Med. 2001;28(6):730–5. source
    • cites [112] Bertoldo A, et al. Interactions between delivery, transport, and phosphorylation of glucose in governing uptake into human skeletal muscle. Diabetes. 2006;55(11):3028–37. source
    • cites [113] James DE. Targeting of the insulin-regulatable glucose transporter (GLUT-4). Biochem Soc Trans. 1994;22(3):668–70. source

  • May combine two claims.

    Premisecitation

    The current approach of rescheduling or insulin injection for hyperglycemia 120-200 mg/dl may lead to increased costs, inconvenience for patients, unnecessary postponing of PET scan, and delays in diagnosis of potential malignancies.

    “This approach may lead to increased costs, inconvenience for patients, unnecessary postponing of PET scan, and delays in diagnosis of potential malignancies”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [42] Zhao S, et al. Effects of insulin and glucose loading on FDG uptake in experimental malignant tumours and inflammatory lesions. Eur J Nucl Med. 2001;28(6):730–5. source
    • cites [112] Bertoldo A, et al. Interactions between delivery, transport, and phosphorylation of glucose in governing uptake into human skeletal muscle. Diabetes. 2006;55(11):3028–37. source
    • cites [113] James DE. Targeting of the insulin-regulatable glucose transporter (GLUT-4). Biochem Soc Trans. 1994;22(3):668–70. source

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The results and recommendations should not be considered for acute post-prandial hyperglycemia.

    “It should be noted that our results and recommendations should not be considered for acute post-prandial hyperglycemia”
    Quote in the paperSubstantial claim
50 of 50

  • The authors state this as an assumption.

    In a hyperglycemic state, GLUTs will be saturated by excess unlabeled glucose.

    “As GLUTs transport both 18 F-FDG and unlabeled glucose, it is assumed that in a hyperglycemic state GLUTs will be saturated by excess unlabeled glucose [27][28][29]”

  • The paper relies on this without support.

    No systematic review and meta-analysis has yet quantitatively evaluated the effect of pre-scan BGL on FDG uptake.

    “To the best of our knowledge, no systematic review and meta-analysis has yet quantitatively evaluated the effect of pre-scan BGL on FDG uptake.”

  • The paper relies on this without support.

    The inconsistency between different guidelines originates from a lack of robust and credible evidence.

    “The inconsistency between different guidelines, which originates from lack of robust and credible evidence, has resulted in a diverse range of accepted prescan BGLs in clinical PET imaging.”

  • The paper relies on this without support.

    The SUV measurements from the included studies are comparable across different PET scanners, protocols, and institutions.

    “Based on this systematic review and meta-analysis of individual patient data, patients who are still hyperglycemic after at least 4 h of fasting would have significantly lower FDG uptake in brain and muscle and significantly higher FDG uptake in liver and mediastinal blood pool in comparison with euglycemic patients.”

  • The paper relies on this without support.

    A fasting duration of at least 4 h is sufficient to ensure that the measured BGL reflects a fasting hyperglycemic state and not recent food intake.

    “Based on this systematic review and meta-analysis of individual patient data, patients who are still hyperglycemic after at least 4 h of fasting would have significantly lower FDG uptake in brain and muscle and significantly higher FDG uptake in liver and mediastinal blood pool in comparison with euglycemic patients.”
5 of 5

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Non-labeled endogenous blood glucose competitively inhibits 18F-FDG uptake and hence poses an inversely linear effect on SUVmax.

    “Non-labeled endogenous blood glucose competitively inhibits 18F-FDG uptake, and hence it poses an inversely-linear effect on SUVmax.[4]”

    From Intrapatient variability of 18F-FDG uptake in normal tissues (2022) · cites this paper as [4]

    The Introduction describes competition between endogenous glucose and 18F-FDG, and the Brain and Muscle sections report inverse associations between blood glucose and SUVmax. But the Discussion reports positive associations in liver and blood pool and no significant association in tumors, so the claimed inverse effect is not general. Page numbers are unavailable in our copy. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Patient physiology and constitution influence the biodistribution of radiopharmaceuticals, especially [18F]FDG, mainly affecting standardized uptake values (SUV) in normal organs such as liver, brain, lung, skeletal muscles, and blood pool.

    “The patient’s physiology and constitution influence the biodistribution of radiopharmaceuticals, especially of [18F]FDG, although they mainly affect standardized uptake values (SUV) in normal organs, such as the liver, brain, lung, skeletal muscles, and blood pool [1].”

    From Influences on PET Quantification and Interpretation (2022) · cites this paper as [1]

    The Clinical points and conclusions section (page unavailable) reports that fasting hyperglycemia changes [18F]FDG uptake in the brain, muscle, liver, and mediastinal blood pool. The paper addresses blood glucose specifically, not patient physiology and constitution broadly or radiopharmaceuticals generally; its lung measurements concern lung tumors, not normal lung. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • In a number of normal organs, SUV corrected for body mass is positively correlated with body mass index (BMI).

    “In a number of normal organs, the SUV corrected for body mass is positively correlated with the body mass index (BMI) [1,2,3].”

    From Influences on PET Quantification and Interpretation (2022) · cites this paper as [1]

    The Statistical analysis section lists BMI as a predictor of SUV, and Table 4 (Clinical points and conclusions; page unavailable) reports significant BMI associations for several normal-organ SUV measurements. The table gives p-values but not the direction of those associations, so our copy does not establish that they are positive. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

  • Tumor SUVmax and SUVmean were not shown to vary systematically with the above-named physiological factors in a large meta-analysis of >20,000 individuals.

    “Notably, tumor SUVmax and SUVmean were not shown to vary systematically with the above-named physiological factors in a large meta-analysis of >20.000 individuals [1].”

    From Influences on PET Quantification and Interpretation (2022) · cites this paper as [1]

    The Tumor section and Table 4 report no significant multivariable associations between tumor SUVmax or SUVmean and the factors analyzed. However, the paper reports 20,807 SUV measurements, not >20,000 individuals; its tumor analysis included 631 SUVmax and 159 SUVmean measurements. The Tumor section also reports a significant univariate association with blood glucose and lower SUVmax in tumors when blood glucose exceeded 200 mg/dl. (LLM, conf=0.90)

    Experimental — accuracy not yet measured

  • Raising blood glucose and/or insulin levels increases [18F]FDG uptake in liver, skeletal muscles, and myocardium mainly via GLUT2 and GLUT4.

    “Conversely, raising blood glucose and/or insulin levels increases [18F]FDG uptake in the liver, skeletal muscles, and myocardium mainly via GLUT2 and 4 [1,6,22].”

    From Influences on PET Quantification and Interpretation (2022) · cites this paper as [1]

    The Liver section reports higher liver FDG uptake with higher blood glucose and identifies GLUT2 as a prominent hepatic transporter. The Muscle and Clinical points and conclusions sections report the opposite of the claimed glucose effect in patients still hyperglycemic after at least four hours of fasting: muscle FDG uptake was lower. The paper discusses insulin-sensitive GLUT4 and allows that uptake might rise in acute hyperglycemia, but does not establish the claimed increase across all three tissues; the retrieved passages do not address myocardial uptake. Page numbers were unavailable in our copy. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Abstract overstates blood-pool SUV mean differences

    Minor

    The abstract says every hyperglycemic group had significantly higher blood-pool SUVs, but the blood-pool results identify a nonsignificant SUV mean difference in the mild-hyperglycemia group.

  • Reported measurement sources exceed the final total

    Minor

    The two reported sources provide 721 + 21,122 = 21,843 SUV measurements, but the paper reports 20,807 included measurements. It does not account for the 1,036-measurement difference.

    Reported 20807 · recomputed 21843

  • Abstract overstates muscle SUV mean differences

    Minor

    The abstract says every hyperglycemic group had significantly lower muscle SUVs, while the muscle results say this was true for only two of four groups for SUV mean.

  • The conclusion assigns 110 mg/dl to two glucose categories

    Minor

    The methods classify 110 mg/dl as mild hyperglycemia, whereas the conclusion calls a BGL of 110 mg/dl euglycemic.

4 of 4

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. Carrasco-Sanchez FJ, et al. Stress-induced hyperglycemia on complications in non-critically elderly hospitalized patients. Rev Clin Esp. 2018;218(5):223–31.
  2. World Health Organization. Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia. Geneva, World Health Organisation; 2006.

Cited by

Sorted by citations

Related

Authors
Eskian, M., Alavi, A., Khorasanizadeh, M., Viglianti, B. L., Jacobsson, H., Barwick, T. D., Meysamie, A., Yi, S. K., Iwano, S., Bybel, B., Caobelli, F., Lococo, F., Gea, J., Sancho-Muñoz, A., Schildt, J., Tatcı, E., Lapa, C., Keramida, G., Peters, M., Boktor, R. R., John, J., Pitman, A. G., Mazurek, T., & Rezaei, N.
Affiliations
  • Universal Scientific Education and Research Network (IR)
  • Hospital of the University of Pennsylvania (US)
  • University of Michigan (US)
  • Karolinska Institutet (SE)
  • Imperial College Healthcare NHS Trust (GB)
  • Tehran University of Medical Sciences (IR)
  • University of Arizona (US)
  • Nagoya University (JP)
  • University of Manitoba (CA)
  • University Hospital of Basel (CH)
  • Santa Maria Nuova Hospital (IT)
  • Hospital Del Mar (ES)
  • Helsinki University Hospital (FI)
  • Universitätsklinikum Würzburg (DE)
  • Royal Brompton & Harefield NHS Foundation Trust (GB)
  • Cairo University (EG)
  • St Thomas' Hospital (GB)
  • The University of Notre Dame Australia (AU)
  • Medical University of Warsaw (PL)
Corresponding author
Alavi, Abass
ORCID
Venue
European Journal of Nuclear Medicine and Molecular Imaging
Publisher
Springer Science and Business Media LLC
Published
2018-10-22
Volume
46
Issue
1
Pages
224-237
ISSN
  • 1619-7070 (ISSN-L)
  • 1619-7089
DOI
10.1007/s00259-018-4194-x
OpenAlex
W2897842442
Cited by
109
References
116
Citations by year
2026: 12 · 2025: 12 · 2024: 16 · 2023: 14 · 2022: 18 · 2021: 9 · 2020: 16 · 2019: 12
FWCI
1.44
Type
journal article
Language
en
Open access
Licence
Locations
  • European Journal of Nuclear Medicine and Molecular Imaging (publishedVersion)
  • PubMed (publishedVersion)
  • Työväentutkimus Vuosikirja (submittedVersion, other-oa)
  • OPUS (Augsburg University) (submittedVersion)
Topics
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Medical Imaging Techniques and Applications
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiopharmaceutical Chemistry and Applications
Keywords
blood glucose, hyperglycemia, standardized uptake value, 18F-FDG PET, SUVmax, SUVmean, glucose metabolism, brain, liver, blood pool, muscle, tumors, FDG uptake
MeSH terms
Blood Glucose, Humans, Radiopharmaceuticals, Fluorodeoxyglucose F18, Positron-Emission Tomography

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-11.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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