1. 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

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

3. 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

4. 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

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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. STUDY DESIGN Data Analysis
Software - Advantage Workstation Ver. 4.3 ( GE Healthcare )
ROI ( Region Of Interest ) 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

13. 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 < / † 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

14. 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

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

16. 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

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