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LETTER TO THE EDITOR
Year : 2019  |  Volume : 34  |  Issue : 2  |  Page : 176-177  

Oral administration of 18F-fluorodeoxyglucose as a possible and acceptable alternative route in patients with difficult intravenous access


Department of Nuclear Medicine and PET, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication8-Apr-2019

Correspondence Address:
Dr. Madhavi Tripathi
Department of Nuclear Medicine and PET, All India Institute of Medical Sciences, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnm.IJNM_17_19

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How to cite this article:
Tupalli A, Harish NN, Kumar A, Thankarajan AS, Tripathi M, Chandrasekhar B. Oral administration of 18F-fluorodeoxyglucose as a possible and acceptable alternative route in patients with difficult intravenous access. Indian J Nucl Med 2019;34:176-7

How to cite this URL:
Tupalli A, Harish NN, Kumar A, Thankarajan AS, Tripathi M, Chandrasekhar B. Oral administration of 18F-fluorodeoxyglucose as a possible and acceptable alternative route in patients with difficult intravenous access. Indian J Nucl Med [serial online] 2019 [cited 2019 Jun 16];34:176-7. Available from: http://www.ijnm.in/text.asp?2019/34/2/176/255611



Sir,

A 58-year-old male, known case of plasmablastic lymphoma, presented to our department for 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (18 F-FDG PET/CT) for response evaluation post five cycles of chemotherapy.

Despite multiple efforts, an intravenous access could not be established because of anasarca. 15 mCi of 18 F-FDG was diluted in 10-ml water in a disposable plastic cup, and the patient was administered the dose orally. Subsequently, the PET scan was acquired after 90 min, which showed normal physiologic distribution in the brain, kidneys, and urinary bladder along with activity visualized in the mouth and large bowel as well. Pathological uptake was noted and was compared with the previous scans [Figure 1]a and [Figure 1]b. All the previously FDG-avid sites were seen in the present scan also along with new lesions with FDG uptake, indicating progressive disease [Figure 1]c and [Figure 1]d.
Figure 1: (a) Maximum intensity projection of baseline 18F-fluorodeoxyglucose positron emission tomography/computed tomography scan (September 2018) acquired after intravenous injection. Black arrow shows the location of disease. (b) Coronal 18F-fluorodeoxyglucose positron emission tomography/computed tomography fused (baseline – September 2018) showing disease involving the left humerus and left axilla. (c) Maximum intensity projection of response evaluation 18F-fluorodeoxyglucose positron emission tomography/computed tomography (January 2019) acquired after giving fluorodeoxyglucose orally. Red arrow shows the location of disease (progression compared to baseline scan). (d) Coronal fused 18F-fluorodeoxyglucose positron emission tomography/computed tomography-response evaluation showing disease progression in comparison to baseline (b)

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We reviewed literature and found a study done by Nair et al.,[1] on two healthy volunteers and 7 patients, who underwent PET/CT after oral as well as intravenous routes of 18 F-FDG administration. They concluded that oral 18 F-FDG scan can successfully be substituted for intravenous 18 F-FDG scan. A case has also been described by Franc et al.,[2] in which a solitary pulmonary nodule was evaluated by PET/CT after oral administration of 18 F-FDG because the patient had poor intravenous access.

Although the oral route is acceptable in assessing the lesions involving the head and neck, thorax, and peripheral sites (appendicular skeleton), it would be inappropriate to evaluate diseases of gastrointestinal (GI) tract, as majority of the administered dose persists in the GI tract. As the amount of dose absorbed through the GI tract cannot be predicted, quantitation would be unreliable and the scan needs to be acquired as late as possible as absorption from oral route would be erratic (preferable after at least 90 min).

We therefore conclude that oral administration of 18 F-FDG is an acceptable alternative route for PET studies in patients with difficulty in establishing intravenous access with a word of caution as stated above.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Nair N, Agrawal A, Jaiswar R. Substitution of oral (18)F-FDG for intravenous (18)F-FDG in PET scanning. J Nucl Med Technol 2007;35:100-4.  Back to cited text no. 1
    
2.
Franc B, Carlisle MR, Segall G. Oral administration of F-18 FDG to evaluate a single pulmonary nodule by positron emission tomography in a patient with poor intravenous access. Clin Nucl Med 2003;28:541-4.  Back to cited text no. 2
    


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