Clinical Practice Guidelines for Brain PET Imaging Using [18F]FDG (EANM, 2022)

European Association of Nuclear Medicine

These are some of the highlights of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

February 02, 2022

Guidelines for brain PET Imaging using [18F]FDG were published in January 2022 by the European Association of Nuclear Imaging in the European Journal of Nuclear Medicine and Molecular Imaging.[1]

[18F]FDG-PET is recommended to support the diagnosis of Alzheimer disease in mild cognitive impairment, the diagnosis of dementia with Lewy bodies, and the diagnosis of frontotemporal lobar degeneration.

In the case of PET/MR, patient safety regarding the magnetic field should be checked before MRI, including the presence of incompatible devices, such as pacemakers, neurostimulators, cochlear implants, non-MRI–compatible metal implants, and pumps; if there is doubt about ocular metal pieces, a low-dose radiograph can be performed.

In women who are known or suspected to be pregnant, a critical decision must be made regarding whether the benefits outweigh the possible harm. Women should not breastfeed for 24 hr after application of PET tracer.

Patients should fast for at least 4-6 hr for optimal uptake of cerebral [18F]FDG.

Sedation, if necessary, should be performed as late as possible, with the intention to administer [18F]FDG at least 15 min before sedation.

Patients should be able to lie still for 15 min to 1 hr.

Current medications, and the timing of last administration, should be recorded. This information, including duration and dosage, is particularly relevant for sedatives, psychotropic pharmaceuticals, antiseizure medication, and corticosteroids.

Blood glucose levels should be checked before [18F]FDG administration. When hyperglycemia is present (>160 mg/dl; >8.9 nmol/L), there is increased competition of elevated plasma glucose with [18F]FDG on carrier enzyme and, because it is usually associated with high intracellular glucose levels, on hexokinase enzyme.

Before the scanning procedure, patients should void their bladder for maximum comfort during the study and to reduce radiation dose. To minimize radiation exposure, it is also advisable for the patient to drink water and void the bladder again after completion of the scanning session.

For static scans, patients should be positioned comfortably in a quiet, dimly lit room at least 15 min before [18F]FDG administration and during uptake of [18F]FDG (at least 20 min). The cannula for IV administration should be in place at least 10 min before [18F]FDG administration. Patients should be instructed not to speak, read, listen to music/sounds, or otherwise be active. Patients should be awake.


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