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14.12.2017 | Original Article

Volume-based glucose metabolic analysis of FDG PET/CT: The optimum threshold and conditions to suppress physiological myocardial uptake

Journal of Nuclear Cardiology
MD, PhD Osamu Manabe, MD Markus Kroenke, MD Tadao Aikawa, MSc Atsuto Murayama, MD, PhD Masanao Naya, MD, PhD Atsuro Masuda, MD, PhD Noriko Oyama-Manabe, MD, PhD Kenji Hirata, MD, PhD Shiro Watanabe, MD, PhD Tohru Shiga, MD, PhD Chietsugu Katoh, MD, PhD Nagara Tamaki
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Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s12350-017-1122-6) contains supplementary material, which is available to authorized users.
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Osamu Manabe and Markus Kroenke contributed equally to this article.



FDG PET/CT plays a significant role in the diagnosis of inflammatory heart diseases and cardiac tumors. We attempted to determine the optimal FDG uptake threshold for volume-based analyses and to evaluate the relationship between the myocardial physiological uptake volume in FDG PET and several clinical factors.


A total of 190 patients were retrospectively analyzed. The cardiac metabolic volume (CMV) was defined as a volume within the boundary determined by a threshold (SUVmean of blood pool × 1.5).


The SUVmean of the blood pool measured in the descending aorta (DA) (r = 0.86, intraclass correlation coefficient [ICC] = 0.93, P < 0.0001) and that in the left ventricle (LV) cavity (r = 0.87, ICC = 0.90, P < 0.0001) showed high inter-operator reproducibility. However, the SUVmean in the LV cavity showed a significant correlation with the CMV (P = 0.0002, r = 0.26). The CMV in the patients who fasted < 18 hours were significantly higher (49.7  ±  73.2 vs. 18.0  ±  53.8 mL, P = 0.0013) compared to the patients with > 18-hour fasting. The multivariate analysis demonstrated that only the fasting period > 18 hours was independently associated with CMV = 0.


Our findings revealed that the DA is suitable to decide the threshold for the volume-based analysis. The fasting time was significantly associated with the cardiac FDG uptake.

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