Impact of blood glucose, diabetes, insulin, and obesity on standardized uptake values in tumors and healthy organs on 18F-FDG PET/CT

Nucl Med Biol. 2013 Feb;40(2):206-13. doi: 10.1016/j.nucmedbio.2012.10.014. Epub 2012 Dec 8.


Introduction: Chronically altered glucose metabolism interferes with (18)F-FDG uptake in malignant tissue and healthy organs and may therefore lower tumor detection in (18)F-FDG PET/CT. The present study assesses the impact of elevated blood glucose levels (BGL), diabetes, insulin treatment, and obesity on (18)F-FDG uptake in tumors and biodistribution in normal organ tissues.

Methods: (18)F-FDG PET/CT was analyzed in 90 patients with BGL ranging from 50 to 372 mg/dl. Of those, 29 patients were diabetic and 21 patients had received insulin prior to PET/CT; 28 patients were obese with a body mass index >25. The maximum standardized uptake value (SUV(max)) of normal organs and the main tumor site was measured. Differences in SUV(max) in patients with and without elevated BGLs, diabetes, insulin treatment, and obesity were compared and analyzed for statistical significance.

Results: Increased BGLs were associated with decreased cerebral FDG uptake and increased uptake in skeletal muscle. Diabetes and insulin diminished this effect, whereas obesity slightly enhanced the outcome. Diabetes and insulin also increased the average SUV(max) in muscle cells and fat, whereas the mean cerebral SUV(max) was reduced. Obesity decreased tracer uptake in several healthy organs by up to 30%. Tumoral uptake was not significantly influenced by BGL, diabetes, insulin, or obesity.

Conclusions: Changes in BGLs, diabetes, insulin, and obesity affect the FDG biodistribution in muscular tissue and the brain. Although tumoral uptake is not significantly impaired, these findings may influence the tumor detection rate and are therefore essential for diagnosis and follow-up of malignant diseases.

MeSH terms

  • Biological Transport / drug effects
  • Blood Glucose / metabolism*
  • Diabetes Complications / diagnostic imaging
  • Diabetes Complications / drug therapy
  • Diabetes Complications / metabolism*
  • Diabetes Complications / physiopathology
  • Female
  • Fluorodeoxyglucose F18 / metabolism*
  • Humans
  • Insulin / pharmacology*
  • Kidney / physiopathology
  • Liver / physiopathology
  • Male
  • Middle Aged
  • Multimodal Imaging*
  • Neoplasms / diagnostic imaging
  • Neoplasms / drug therapy
  • Neoplasms / metabolism*
  • Neoplasms / physiopathology
  • Obesity / complications*
  • Positron-Emission Tomography*
  • Reference Standards
  • Retrospective Studies
  • Tomography, X-Ray Computed*


  • Blood Glucose
  • Insulin
  • Fluorodeoxyglucose F18