Metformin related diffuse bowel activity on 18-FDG PET

Case contributed by Vikas Shah
Diagnosis almost certain


Follow up imaging for lymphoma.

Patient Data

Age: 50 years
Gender: Female


Nuclear medicine

Planar PET image shows intense activity in the bowel, particularly involving small bowel loops in the right lower quadrant, and the sigmoid colon. Normal activity is also present in the urinary bladder. No abnormal nodal uptake.

Case Discussion

Diffuse uptake of 18-FDG by the bowel may be seen in infection, inflammation and malignancy. However, it also occurs when the patient is taking metformin for type II diabetes mellitus. Metformin increases glucose uptake in the bowel, and cessation of metformin for up to 2 days prior to the imaging can help reduce bowel uptake of 18-FDG.

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