A reduced liver 18F-FDG uptake may be related to hypoalbuminemia in patients with malnutrition

• Published in: Annals of nuclear medicine Vol. 33; no. 9; pp. 689 - 696
• Main Authors: Otomi, Yoichi, Otsuka, Hideki, Terazawa, Kaori, Kondo, Mihoko, Arai, Yuta, Yamanaka, Moriaki, Otomo, Maki, Abe, Takashi, Shinya, Takayoshi, Harada, Masafumi
• Format: Journal Article
• Language: English
• Published: Singapore Springer Singapore 01.09.2019; Springer Nature B.V
• Subjects: Albumin; Albumins; Blood; Computed tomography; Fluorine isotopes; Imaging; Liver; Malnutrition; Medical imaging; Medicine; Medicine & Public Health; Nuclear Medicine; Original Article; Positron emission; Positron emission tomography; Radiology; Regression analysis; Serum albumin; Tomography; Tumors; Hypoalbuminemia; Albumin; FDG; Malnutrition; Liver
• ISSN: 0914-7187; 1864-6433; 1864-6433
• DOI: 10.1007/s12149-019-01377-2

Objective 18 F-FDG PET/CT is a hybrid imaging method widely used as a useful, noninvasive imaging modality for evaluating various neoplastic diseases. When assessing the tumor uptake, the liver and the mediastinal blood pool are often used as a reference region. In daily clinical practice, the 18 F-FDG uptake in the liver sometimes appears to decrease on PET images of patients with malnutrition. The purpose of this study was to investigate whether or not the liver 18 F-FDG uptake is decreased in patients with malnutrition. Methods We retrospectively analyzed 246 patients who underwent 18 F-FDG PET/CT from January 2018 to June 2018 and whose blood serum albumin was measured within 1 month of PET/CT. We compared the liver uptake and mediastinal blood uptake of patients with low serum albumin level (< 4.0 g/dl) and hypoalbuminemia (< 3.5 g/dl) with those with a normal serum albumin level (≥ 4.0 g/dl). Correlations between the liver and mediastinal blood uptake and the serum albumin level were also calculated. Results The maximum standardized uptake value (SUV max ) and mean standardized uptake value (SUV mean ) of the liver in 117 patients with low serum albumin were 3.1 ± 0.5 and 2.3 ± 0.3, respectively, while they were 2.9 ± 0.4, 2.0 ± 0.3 in 29 patients with hypoalbuminemia; these values were all significantly lower than the respective ones (3.4 ± 0.5, 2.5 ± 0.4) in 129 patients with normal serum albumin (all p  < 0.001). The SUV mean of the mediastinal blood uptake in patients with hypoalbuminemia and normal serum albumin were 1.6 ± 0.2 and 1.7 ± 0.3, respectively ( p  = 0.053). The serum albumin level demonstrated a significantly positive, moderate correlation with the liver SUV mean , showing a regression line of y  = 0.31 x  + 1.1 ( r  = 0.41, p  < 0.001). Conclusion The liver 18 F-FDG uptake tended to decrease in patients with hypoalbuminemia. In the patients with malnutrition, the mediastinal blood pool may be a more stable reference than the liver for evaluating the tumor activity because hypoalbuminemia is considered to less strongly influence the mediastinal blood pool than that in the liver.