ArticleAnnals of nuclear medicine2026
Utility of serum blood ketone levels and other risk factors for inadequate myocardial glucose suppression ketogenic FDG-PET/CT: a prospective and retrospective cohort study.
Article in Annals of nuclear medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
objectivesIncomplete myocardial glucose suppression (MGS) in ketogenic 18F-FDG-PET/CT is a common problem that reduces the diagnostic accuracy in detecting myocardial inflammation. This study assesses the usefulness of a dietary logbook, blood ketone testing and risk factors for inadequate MGS.
methodsRetrospective (2022-2024) and prospective (2024-2025) analysis was performed on all patients who underwent a ketogenic 18F-FDG-PET/CT at two tertiary hospitals. All patients were instructed to follow > 24-hour ketogenic diet and > 12-hour fast before imaging. In April 2024, blood ketone testing, a dietary logbook, and improved dietary guidelines were introduced.
resultsAfter introducing the dietary logbook and improved dietary guidelines, inadequate MGS rates decreased from 26% to 17% (95 patients 2022-2024 vs. 92 patients 2024-2025)(p-value 0.14). Mean blood ketone levels were significantly lower in patients with incomplete MGS (0.34mmol/L vs. 0.76mmol/L, p-value 0.04). On univariate analysis, significant risk factors for inadequate MGS included prednisolone use (75% vs. 14.9%, OR: 17.1 [95%CI 1.65-177.04], p = 0.009), low blood ketones (≤ 0.3mmol/L)(OR: 5.77 [95%CI 1.69-19.68], p = 0.003) and female sex (27.5% vs. 9.6% in males, OR: 3.57 [95%CI 1.12-11.3], p = 0.025). Multivariate analysis confirmed prednisolone use, low ketones (≤ 0.3mmol/L) and < 24-hour ketogenic diet as independent risk factors for inadequate MGS. Rates of inadequate MGS were 50%, 26% and 7% for patients with blood ketone levels of 0.1, 0.2-0.3 and ≥ 0.4mmol/L, respectively. All patients on prednisolone with ketones ≤ 0.3mmol/L had inadequate MGS.
conclusionsDietary logbook and clear instructions improve adherence. Low ketones, prednisolone use and short ketogenic preparation are risk factors for inadequate MGS.
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