18F-FDG Colonic Uptake by Oral Anti-Diabetic Drugs in PET/CT Scan Dept. of Nuclear Medicine, Severance Hosp. Yonsei University Health System Sang Gyu Kim, Hoon-Hee Park, Jung Yul Kim, Young Kag Bahn Han Sang Lim, Jae Sam Kim, Chang Ho Lee Department Of Nuclear Medicine, Sang-Gyu Kim 1

INTRODUCTION Diabetes Mellitus ? Hyperglycemia Abnormal Insulin Pancreas Hyperglycemia Blood Vessel Abnormal Insulin Diabetes Department Of Nuclear Medicine, Sang-Gyu Kim 2

INTRODUCTION Type 2 DM Type 1 DM Insulin-Dependent Diabetes Mellitus IDDM NonInsulin-Dependent Diabetes Mellitus NIDDM Department Of Nuclear Medicine, Sang-Gyu Kim 3

PURPOSE Improves glucose tolerance in type 2 diabetes mellitus patients Lowers both basal and postprandial plasma glucose Decreases hepatic glucose production Improves insulin sensitivity by increasing peripheral glucose uptake and utilization Substantially excreted by the kidney Half-life of Metformin is approximately 6.2 hours Department Of Nuclear Medicine, Sang-Gyu Kim

PURPOSE Metformin Department Of Nuclear Medicine, Sang-Gyu Kim 5

STUDY DESIGN Patient Population Study Case Period - January 2008 ~ August 2009 Group 1 ( Experimental Group - Type 2 DM ) Group 1-a ( Include Metformin ) : 60 patients Group 1-b ( Exclude Metformin ) : 60 patients Group 2 ( Control Group - Non DM ) : 60 patients Study Case Patients Age - Group 1-a : 59.2±8.3 years old Group 1-b : 57.4±9.5 years old Group 2 : 55.2±12.8 years old Department Of Nuclear Medicine, Sang-Gyu Kim 6

STUDY DESIGN Patient Population Exclusion - Type 1 DM Under 18 years old Colorectal and/or Peritoneal Carcinoma Inflammatory Bowel Disease Gastrointestinal Symptoms Other factors of patients did not concerned Except for Metformin taking Department Of Nuclear Medicine, Sang-Gyu Kim 7

STUDY DESIGN Discovery STe (GE Healthcare) CT Component Reconstruction PET Component - BGO Crystal / 3D Acquisition - Intrinsic Resolution : 6 mm FWHM - Longitudinal FOV : 157 mm CT Component - 8 Slices - Slice Thickness : 2 mm Reconstruction - Recon Method : Iterative Mode - Subsets : 28 / Iterations : 2 Department Of Nuclear Medicine, Sang-Gyu Kim 8

Drink Water Sufficiently STUDY DESIGN Patients Preparation Drink Water Sufficiently 24 Hours prior to the scan 6 Hours prior to the scan 12 Hours prior to the scan Department Of Nuclear Medicine, Sang-Gyu Kim 9

STUDY DESIGN Patient Flow List Waiting I.V. B.S.T. FDG Injection Enhancement Channel Waiting I.V. B.S.T. FDG Injection Resting Voiding Department Of Nuclear Medicine, Sang-Gyu Kim 10

STUDY DESIGN Image Acquisition PET Scan CT Scan Scout View 15 ~ 20 min 30 ~ 40 sec 10 ~ 20 sec 5 ~ 10 min Patient Flow List 2.5 min/bed, Emission 140 kV, 30 mA 120 kV, 10 mA PET Scan CT Scan Scout View Patient Preparation Department Of Nuclear Medicine, Sang-Gyu Kim 11

STUDY DESIGN Data Analysis Software - Advantage Workstation Ver. 4.3 ( GE Healthcare ) ROI ( Region Of Interest ) - 500 mm2 2 Nuclear Physician and 1 Radiologic Technologist Ascending Colon Transverse Colon Descending Colon SUVmax ( Mean±SD ) Statistics - Program: SPSS Ver. 17. ( SPSS inc., USA ) Descriptive Statistics ONEWAY ANOVA Method - LSD P Value < 0.05 Department Of Nuclear Medicine, Sang-Gyu Kim 12

RESULTS Table 1. Maximum Standardized Uptake Values 6.2 ± 3.6 Group 1 ( Type 2 DM ) † Group 2 *† Group 1-a * Group 1-b ( Non DM ) Ascending 6.2 ± 3.6 3.1 ± 1.4 2.0 ± 0.9 Transverse 4.4 ± 2.9 2.1 ± 1.0 1.7 ± 0.9 Descending 5.5 ± 2.4 3.2 ± 1.8 2.2 ± 1.9 * Group 1-a, Group 1-b : P < 0.001 / † Group 1-a, Group 2 : P < 0.001 Group 1 : Experimental Group ( Type 2 DM ) Group 1-a : Include Metformin Group 1-b : Exclude Metformin Group 2 : Control Group ( Non DM ) Department Of Nuclear Medicine, Sang-Gyu Kim 13

RESULTS Box Plot. Group Comparison - SUVmax A D T D T A D T A * A : Ascending Colon, T : Transverse Colon, D : Descending Colon Group 1-a A D T Group 1-b D T A Group 2 D T A ( Include Metformin ) ( Exclude Metformin ) ( Non DM ) Department Of Nuclear Medicine, Sang-Gyu Kim 14

RESULTS Include Metformin Exclude Metformin Department Of Nuclear Medicine, Sang-Gyu Kim 15

CONCLUSION Limitation Conclusion There was a limitation that we did not have the data comparing when patients took antidiabetic drug and when patients did not take it for the same patients. Conclusion The effect of the intake of Metformin was observed from the SUV on region of large bowel in this study. Thus, it could be helpful for the results by identifying the ingredient of antidiabetic drug before the examination and the possibility of interpretation of false-positive will be reduced. This will be considered to helpful to the study of comparison with other ingredient of antidiabetic drug. Department Of Nuclear Medicine, Sang-Gyu Kim 16

Dept. of Nuclear Medicine, Severance Hosp. Yonsei University Health System Department Of Nuclear Medicine, Sang-Gyu Kim