Glucose metabolism in brain tumours can be estimated using [18F]2-fluorodeoxyglucose positron emission tomography and a population-derived input function scaled using a single arterialised venous blood sample

The aim of this study was to assess simplified methods for deriving input functions for estimating glucose metabolism using 18F-FDG-PET. Nine glioma patients underwent paired 18F-FDG-PET scans as part of a phase II study and the data used to estimate the metabolic rate of glucose (MRGlu) using a population-derived input function (arterial data from 14 scans) scaled using a single arterial blood sample taken at 20 min. Paired studies were performed in four further glioma patients with stable disease at least four months following radiotherapy to determine whether scaling the population-derived input function using a 20-min arterialised venous or venous sample further simplified the method. The heated hand method was used to obtain arterialised venous blood that approximated arterial blood. In the 9 phase II glioma patients, there was a good, statistically significant correlation between the MRGlu values estimated using the individual arterial input functions and the single arterial sample scaled population-derived input functions (r2=0.88, p<0.001, n=36). Blood samples collected during three scans on two of the stable disease patients showed no significant difference between the arterialised venous and arterial plasma concentrations of 18F (p>0.1, n=15) when the degree of arterialisation of the blood was monitored and maintained using a thermocouple. A significant difference was found between the plasma arterial and venous levels of 18F. There was an excellent correlation between MRGlu estimated using an arterial input function and a population-derived input function scaled using a single arterialised venous blood sample (r2=0.98, n=12). The method was reproducible with less than 4.4% variation between repeat tumour scans. Therefore, a population-derived input function scaled using a single arterialised venous blood sample at 20 min can be used for estimating MRGlu using 18F-FDG PET in glioma patients.