Application of 18F-FDG brain PET for survival prediction in a rat model of hanging-induced hypoxic brain injury

Daehee Kim, Woon Jeong Lee, Hye Won Lee, Bom Sahn Kim, Seon Hee Woo, Hai Jeon Yoon

Research output: Contribution to journalArticlepeer-review


Background: Accurate prediction of survival outcomes after hanging is a crucial and challenging issue in comatose survivors. In this preclinical study, we evaluated the potential utility of using brain glucose metabolism as measured by fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) for survival prediction in a rat model of hanging-induced hypoxic brain injury (HBI). Methods: HBI was induced by mechanical hanging using Sprague Dawley rats. 18F-FDG brain PET images were acquired in 26 HBI rats three hours post-injury (3 h post-injury) and 4 controls. During the 1 month follow-up period, HBI rats were further classified as survivors (n = 15) and nonsurvivors (n = 11). Between-group regional (standardized uptake values normalized to the reference whole brain = SUVRWB, cerebellum = SUVRCB, and pons = SUVRpons) and voxel-based analyses were performed. The prognostic value of the SUVR was tested for overall survival (OS). In addition, diffusion-weighted imaging (DWI) was performed in 2 controls and 5 HBI rats (3 survivors, 2 nonsurvivors, 3 h post), and an apparent diffusion coefficient (ADC) map was generated. Results: The nonsurvivor group showed a significantly lower SUVRWB, SUVRCB, and SUVRpons of the cerebral cortices than the survivor group (all p < 0.001). Voxel-based comparison also demonstrated significant reduction in the nonsurvivor group compared with the survivor group (family-wise error-corrected p < 0.05). However, there was no significant difference between controls and survivors. Of 3 reference regions, the SUVRpons demonstrated the largest difference between the survivor and nonsurvivor groups. With an optimal cutoff value of 1.12 (AUC 0.952, p < 0.001), the SUVRpons predicted survival outcomes with a sensitivity of 81.8% and specificity of 100%. The OS of the low SUVRpons group was significantly shorter than that the high SUVRpons group (p < 0.001). The mean ADC values of each brain region showed no significant difference according to survival outcomes. Conclusions: These results suggest the potential utility of 18F-FDG brain PET for predicting survival in hanging-induced HBI.

Original languageEnglish
Pages (from-to)570-578
Number of pages9
JournalAnnals of Nuclear Medicine
Issue number6
StatePublished - Jun 2022

Bibliographical note

Funding Information:
This work was supported by the National Research Foundation (NRF) funded by the Ministry of Education of Korea (2020R1A2C1102046, Daehee Kim; 2019R1G1A1100299, Seon Hee Woo; 2021R1A2C1093636, Hai-Jeon Yoon) and a Grant of Translational R&D Project through Institute for Bio-Medical convergence, Incheon St. Mary’s Hospital, The Catholic University of Korea (Seon Hee Woo; IBC2019-14).

Publisher Copyright:
© 2022, The Author(s) under exclusive licence to The Japanese Society of Nuclear Medicine.


  • Asphyxia
  • Brain injuries
  • Fluorodeoxyglucose F18
  • Positron emission tomography computed tomography
  • Prognosis


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