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Background <p>Standard ASNC guidelines for 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) myocardial viability imaging often yield suboptimal image quality in patients with diabetes mellitus, primarily due to altered glucose-insulin kinetics. This study evaluated an optimized fast-track (OFT) patient preparation protocol designed to improve image quality and reduce preparation time in diabetic patients with coronary artery disease (CAD).</p> Methods <p>We conducted a prospective, randomized controlled trial involving 50 diabetic patients with known CAD. Patients were stratified based on diabetes duration, fasting blood sugar (FBS), and HbA1C levels, then assigned to either a standard preparation group or the OFT protocol group prior to undergoing 18F-FDG PET imaging. Image quality was assessed qualitatively using a visual grading scale and semi-quantitatively using the myocardium-to-blood pool (M/B) standardized uptake value ratio. Patient preparation time (PPT) was measured from oral glucose administration to 18F-FDG injection.</p> Results <p>The OFT group demonstrated a higher proportion of interpretable scans (92% vs 64%; <i>p</i> = 0.017) and significantly greater M/B ratios (mean ± SD: 12.44 ± 5.37 vs 7.23 ± 3.42; <i>p</i> &lt; 0.001) compared to the standard group. Median PPT was also significantly shorter in the OFT group (82&#xa0;min) than in the standard group (95&#xa0;min; <i>p</i> = 0.003).</p> Conclusions <p>The optimized fast-track protocol significantly improves image quality and reduces patient preparation time in diabetic individuals undergoing 18F-FDG PET myocardial viability imaging. This protocol offers a practical and effective alternative to the standard ASNC approach, with potential for integration into routine clinical practice.</p>

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An Optimized Fast Track Protocol to Enhance the Image Quality of 18F-FDG PET Myocardial Viability Imaging in Diabetic CAD Patients: A Randomized Controlled Trial

  • 期刊论文

  • 发表日期：

    2026年4月14日

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  • Alok Mandal,
  • Sameer Taywade,
  • Vijayaraghavan R. L,
  • Althaf Majeed,
  • Onjal Taywade,
  • Rajesh Kumar

摘要

Background

Standard ASNC guidelines for 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) myocardial viability imaging often yield suboptimal image quality in patients with diabetes mellitus, primarily due to altered glucose-insulin kinetics. This study evaluated an optimized fast-track (OFT) patient preparation protocol designed to improve image quality and reduce preparation time in diabetic patients with coronary artery disease (CAD).

Methods

We conducted a prospective, randomized controlled trial involving 50 diabetic patients with known CAD. Patients were stratified based on diabetes duration, fasting blood sugar (FBS), and HbA1C levels, then assigned to either a standard preparation group or the OFT protocol group prior to undergoing 18F-FDG PET imaging. Image quality was assessed qualitatively using a visual grading scale and semi-quantitatively using the myocardium-to-blood pool (M/B) standardized uptake value ratio. Patient preparation time (PPT) was measured from oral glucose administration to 18F-FDG injection.

Results

The OFT group demonstrated a higher proportion of interpretable scans (92% vs 64%; p = 0.017) and significantly greater M/B ratios (mean ± SD: 12.44 ± 5.37 vs 7.23 ± 3.42; p < 0.001) compared to the standard group. Median PPT was also significantly shorter in the OFT group (82 min) than in the standard group (95 min; p = 0.003).

Conclusions

The optimized fast-track protocol significantly improves image quality and reduces patient preparation time in diabetic individuals undergoing 18F-FDG PET myocardial viability imaging. This protocol offers a practical and effective alternative to the standard ASNC approach, with potential for integration into routine clinical practice.