Abstract
The purpose of the study was to evaluate the hypothesis that patients having a vasovagal reaction (VVR) after blood vessel puncture show increased FDG accumulation in bilateral adrenal glands. Over the past 8years, 26 patients experienced a VVR after blood vessel puncture following intra-venous injection of FDG at our institution. Of the 26 patients, 16 underwent multiple-occasion FDG-PET/CT scans while suffering a VVR at only one examination. All 16 patients had no morphological abnormality in the adrenal glands on FDG-PET/CT and follow-up examination. For the 16, we retrospectively reviewed the FDG-PET/CT scan with respect to the adrenal glands and compared the result to that for the FDG-PET/CT scan of the same patient when there was no VVR event. We used both visual analysis and semi-quantitative analysis employing either maximum standardized uptake value (SUVmax) or adrenal-to-liver (A/L) SUVmax ratio. On visual analysis of the FDG-PET/CT with VVR, accumulations in both of the adrenal glands was judged positive, defined as higher than the hepatic accumulation, in 84% of the cases. The SUVmax in the right adrenal gland was 2.79±0.69 with VVR and 1.92±0.33 without VVR; this value in the left adrenal gland was 3.07±0.71 with VVR and 2.05±0.39 without. Mean SUVmax of both adrenal glands was 2.93±0.66 with VVR and 1.98±0.35 without. The A/L SUVmax ratio in the right adrenal gland was 1.02±0.26 with VVR and 0.69±0.11 without; this value in the left was 1.11±0.23 with VVR and 0.74±0.15 without. The mean A/L SUVmax ratio of both adrenal glands was 1.06±0.24 with VVR and 0.72±0.13 without. Each parameter with VVR was significantly higher than that without. For the two adrenal glands, the mean SUVmax with VVR was 48% higher than that without VVR. We confirmed the hypothesis that patients having a VVR after blood vessel puncture show increased FDG accumulation in their bilateral adrenal glands. This may reflect hyper-metabolism of the adrenal glands in synthesizing and secreting catecholamine.
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