Detection of cholangiocarcinoma in primary sclerosing cholangitis by positron emission tomography

Keiding, Susanne; Hansen, Søren B.; Rasmussen, Henrik Højgaard; Gee, Antony D.; Kruse, A; Roelsgaard, Klaus; Tage-Jensen, U; Dahlerup, Jens Frederik

doi:10.1002/hep.510280316

Cited by 190 publications

(78 citation statements)

References 22 publications

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“…18 F]FDG-PET data (17,18). Rate-constant values were multiplied by steady-state plasma glucose concentrations achieved during the clamp to derive glucose uptake (mol ⅐ min Ϫ1 ⅐ ml Ϫ1 ) (19,20).…”

Section: Methodsmentioning

confidence: 99%

Effects of Metformin and Rosiglitazone Monotherapy on Insulin-Mediated Hepatic Glucose Uptake and Their Relation to Visceral Fat in Type 2 Diabetes

et al. 2003

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OBJECTIVE -Impaired insulin-mediated hepatic glucose uptake (HGU) has been implicated in the hyperglycemia of type 2 diabetes. We examined the effects of metformin (2 g/day) and rosiglitazone (8 mg/day) monotherapy on HGU and its relation to subcutaneous fat, visceral fat (VF), and whole-body insulin-mediated glucose metabolism in type 2 diabetic patients.RESEARCH DESIGN AND METHODS -Glucose uptake was measured before and after 26 weeks of treatment using positron emission tomography with [18 F]2-fluoro-2-deoxyglucose during euglycemic hyperinsulinemia; fat depots were quantified by magnetic resonance imaging.RESULTS -Fasting plasma glucose levels were significantly decreased after either rosiglitazone (Ϫ0.9 Ϯ 0.5 mmol/l) or metformin treatment (Ϫ1.1 Ϯ 0.5 mmol/l) in comparison with placebo; only metformin was associated with weight loss (P Ͻ 0.02 vs. placebo). When controlling for the latter, the placebo-subtracted change in whole-body glucose uptake averaged Ϫ1 Ϯ 4 mol ⅐ min Ϫ1 ⅐ kg Ϫ1 in metformin-treated patients (NS) and ϩ9 Ϯ 3 mol ⅐ min Ϫ1 ⅐ kg Ϫ1 in rosiglitazone-treated patients (P ϭ 0.01). Both rosiglitazone and metformin treatment were associated with an increase in HGU; versus placebo, the change reached statistical significance when controlling for sex (placebo-subtracted values ϭ ϩ0.008 Ϯ 0.004 mol ⅐ min Ϫ1 ⅐ kg Ϫ1 ⅐ pmol/l Ϫ1 , P Ͻ 0.03, for metformin; and ϩ0.007 Ϯ 0.004, P Ͻ 0.07, for rosiglitazone). After treatment with either drug, insulin-mediated VF glucose uptake (VFGU) was higher than with placebo. In the whole dataset, changes in HGU were negatively related to changes in HbA 1c (r ϭ 0.43, P ϭ 0.01) and positively associated with changes in VFGU (r ϭ 0.48, P Ͻ 0.01).CONCLUSIONS -We conclude that both metformin and rosiglitazone monotherapy increase HGU in type 2 diabetes; direct drug actions, better glycemic control, and enhanced VF insulin sensitivity are likely determinants of this phenomenon. Diabetes Care 26:2069 -2074, 2003T he ability of insulin to stimulate hepatic glucose uptake (HGU) is impaired in patients with type 2 diabetes (1), contributing to the development of hyperglycemia. The defect appears to involve the first steps of glucose uptake and metabolism in the liver, eventually leading to decreased glycogen synthesis (1). These findings are in line with the notion that glucokinase is ratelimiting for glucose entry into the liver (2) and that genetic defects of glucokinase activity associated with human maturityonset diabetes of young (MODY-2) lead to decreased HGU and glycogen synthesis (3). In acquired forms of diabetes, hepatic glucokinase activity was decreased in liver biopsies obtained from obese type 2 diabetic individuals (4), and the direct HGUmediated pathway of glycogen synthesis was reduced in poorly controlled type 1 diabetic individuals (5) and in modestly hyperglycemic type 2 diabetic patients (1). The mechanisms underlying these findings are not completely understood. Insulin has been hypothesized to be the main regulator of these enzymatic steps (1,6). Therefor...

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Section: Methodsmentioning

confidence: 99%

Effects of Metformin and Rosiglitazone Monotherapy on Insulin-Mediated Hepatic Glucose Uptake and Their Relation to Visceral Fat in Type 2 Diabetes

et al. 2003

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“…2). In more difficult cases, positron emission tomography (PET) with [18F]2-deoxy-D-glucose may be useful, 56,57 although false-positive scans have been reported. 58 Finally, it is noted that an ill-defined focal sclerosis of the bile ducts without classic features of PSC occurs, and in most surgical series 10% of patients undergoing resection for presumed cholangiocarcinoma have this benign disease.…”

Section: Clinical Presentation and Diagnosis Of Cholangiocarcinomamentioning

confidence: 99%

“…PET scans also add to the diagnostic yield. 57 In contrast to cholangiocarcinoma in the absence of PSC, MRI scans are not helpful in this setting. 60 …”

Section: Clinical Presentation and Diagnosis Of Cholangiocarcinomamentioning

confidence: 99%

Cholangiocarcinoma: Current Concepts and Insights

Gores¹

2003

Hepatology

259

205

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“…55 A combination of more than one imaging procedure may have a greater diagnostic accuracy, 59 particularly when image-guided biopsies are taken. Positron emission tomography is a new, exciting technology that looks promising in the detection of small cholangiocarcinomas in patients with PSC, 60 although further studies are needed to define its role in the management of these patients.…”

Section: Malignancymentioning

confidence: 99%

Primary sclerosing cholangitis

1999

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Detection of cholangiocarcinoma in primary sclerosing cholangitis by positron emission tomography

Abstract: Primary sclerosing cholangitis (PSC) predisposes to cholangiocarcinoma (CC),

Cited by 190 publications

References 22 publications

Effects of Metformin and Rosiglitazone Monotherapy on Insulin-Mediated Hepatic Glucose Uptake and Their Relation to Visceral Fat in Type 2 Diabetes

Effects of Metformin and Rosiglitazone Monotherapy on Insulin-Mediated Hepatic Glucose Uptake and Their Relation to Visceral Fat in Type 2 Diabetes

Cholangiocarcinoma: Current Concepts and Insights

Primary sclerosing cholangitis

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