Drugs and Cardiac FDG Uptake

Certain drugs and patient factors can affect cardiac uptake of FDG.

Drug	Effect	Comment
Insulin	↑	Similar to the effect of eating close to FDG administration. Will also cause diffuse increase in muscle uptake and a decrease in liver uptake.
Bezafibrate	↑	Fibrate drug used for hyperlipidemia.
Benzodiazepines	↑
Levothryoxine	↓
Metformin	↓	Shown above. Increases colonic FDG uptake and can result in a competitive decrease in cardiac FDG uptake.

In addition to the above, certain patient factors can increase cardiac FDG uptake: Male gender, younger patients (< 30 years), fasting duration of <5 hours, and patients with heart failure tend to have higher cardiac FDG uptake.

References

• Israel O, Weiler-Sagie M, Rispler S, Bar-Shalom R, Frenkel A, Keidar Z, Bar-Shalev A, Strauss HW. PET/CT quantitation of the effect of patient-related factors on cardiac 18F-FDG uptake. J Nucl Med. 2007 Feb;48(2):234-9.
• Maurer AH, Burshteyn M, Adler LP, Steiner RM. How to differentiate benign versus malignant cardiac and paracardiac 18F FDG uptake at oncologic PET/CT. Radiographics. 2011 Sep-Oct;31(5):1287-305.