Intestinal Glycolysis Visualized by FDG PET/CT Correlates With Glucose Decrement After Gastrectomy

Abstract

Gastrectomy method is known to influence glucose homeostasis. 18F-fluorodeoxyglucose (FDG) PET/CT acquired after gastrectomy often reveals newly developed physiologic small bowel uptake. We correlated newly developed small bowel FDG uptake and glucose homeostasis in post-gastrectomy gastric cancer patients. We retrospectively analyzed 239 non-diabetic patients who underwent staging and follow-up FDG PET/CT before and after gastrectomy for gastric cancer. Post-operative small bowel glycolysis was quantified by recording intestinal total lesion glycolysis (TLG). TLG was assessed with regard to surgical method (Billroth I, II [BI, BII], Roux-en-Y [RY]), fasting glucose decrement (≥10 mg/dL), and other clinical factors. Patients’ weight, fasting glucose, cholesterol, TLG, and body fat significantly decreased after surgery. Glucose decrement was significantly associated with fasting glucose, surgical methods, total cholesterol, TLG, and total body fat on univariate analysis. Multivariate analysis showed that BII surgery (odds ratio: 6.51) and TLG (odds ratio: 3.17) were significantly correlated with glucose decrement. High small bowel glycolysis (TLG>42.0) correlated with glucose decrement in RY patients. Newly developed small bowel glycolysis on post-gastrectomy FDG PET/CT is correlated with glucose decrement. These findings suggest a potential role of FDG PET/CT in the evaluation of small bowel glycolysis and glucose control.