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Cerebral blood flow and glucose metabolism in healthy volunteers measured using a high-resolution PET scanner

Marc C Huisman1, Larissa W van Golen2*, Nikie J Hoetjes1, Henri N Greuter1, Patrick Schober3, Richard G Ijzerman2, Michaela Diamant2 and Adriaan A Lammertsma1

Author Affiliations

1 Department of Nuclear Medicine & PET Research, VU University Medical Center, Amsterdam, 1081, HV, The Netherlands

2 Diabetes Center/Department of Internal Medicine, VU University Medical Center, Amsterdam, 1081, HV, The Netherlands

3 Department of Anesthesiology, VU University Medical Center, Amsterdam, 1081, HV, The Netherlands

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EJNMMI Research 2012, 2:63  doi:10.1186/2191-219X-2-63

Published: 20 November 2012

Abstract

Background

Positron emission tomography (PET) allows for the measurement of cerebral blood flow (CBF; based on [15O]H2O) and cerebral metabolic rate of glucose utilization (CMRglu; based on [18 F]-2-fluoro-2-deoxy-D-glucose ([18 F]FDG)). By using kinetic modeling, quantitative CBF and CMRglu values can be obtained. However, hardware limitations led to the development of semiquantitive calculation schemes which are still widely used. In this paper, the analysis of CMRglu and CBF scans, acquired on a current state-of-the-art PET brain scanner, is presented. In particular, the correspondence between nonlinear as well as linearized methods for the determination of CBF and CMRglu is investigated. As a further step towards widespread clinical applicability, the use of an image-derived input function (IDIF) is investigated.

Methods

Thirteen healthy male volunteers were included in this study. Each subject had one scanning session in the fasting state, consisting of a dynamic [15O]H2O scan and a dynamic [18 F]FDG PET scan, acquired at a high-resolution research tomograph. Time-activity curves (TACs) were generated for automatically delineated and for manually drawn gray matter (GM) and white matter regions. Input functions were derived using on-line arterial blood sampling (blood sampler derived input function (BSIF)). Additionally, the possibility of using carotid artery IDIFs was investigated. Data were analyzed using nonlinear regression (NLR) of regional TACs and parametric methods.

Results

After quality control, 9 CMRglu and 11 CBF scans were available for analysis. Average GM CMRglu values were 0.33 ± 0.04 μmol/cm3 per minute, and average CBF values were 0.43 ± 0.09 mL/cm3 per minute. Good correlation between NLR and parametric CMRglu measurements was obtained as well as between NLR and parametric CBF values. For CMRglu Patlak linearization, BSIF and IDIF derived results were similar. The use of an IDIF, however, did not provide reliable CBF estimates.

Conclusion

Nonlinear regression analysis, allowing for the derivation of regional CBF and CMRglu values, can be applied to data acquired with high-spatial resolution current state-of-the-art PET brain scanners. Linearized models, applied to the voxel level, resulted in comparable values. CMRglu measurements do not require invasive arterial sampling to define the input function.

Trial registration

ClinicalTrials.gov NCT00626080

Keywords:
Cerebral blood flow; Cerebral metabolic rate of glucose consumption; [18 F]FDG; Full kinetic analysis; [15O]H2O; High-resolution research tomograph; Image-derived input function; Parametric images