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| FDG | |
|---|---|
| Name | 2-[18F]fluoro-2-deoxy-D-glucose |
| IUPAC name | (2R,3R,4S,5R)-2-(fluoro)-2-deoxy-D-glucopyranose |
| CAS number | 55620-10-1 |
| Formula | C6H11FO5 |
| Molar mass | 181.16 g·mol−1 |
FDG
FDG is a fluorinated glucose analogue widely used as a radiotracer in positron emission tomography. It combines a hexose scaffold derived from D-glucose with the positron-emitting radionuclide fluorine-18, enabling functional imaging of glucose metabolism in vivo. FDG has become central to clinical oncology, neurology, and cardiology through integration with imaging technologies and clinical practice guidelines.
FDG is a monosaccharide derivative structurally related to D-glucose and D-mannose employed in synthetic chemistry traditions exemplified by carbohydrate chemistry practiced in laboratories of Per-Olof Åstrand-era research and institutions such as Max Planck Society-affiliated groups. The molecule replaces the 2-hydroxyl group of glucose with fluorine, creating stability against hexokinase-catalyzed further metabolism like in studies by groups at University of California, San Francisco and Massachusetts Institute of Technology. Classical stereospecific syntheses use protected glucose derivatives and nucleophilic fluorination influenced by methods from W. von E. Doering and cross-disciplinary techniques that echo work at University of Oxford and University of Cambridge. Protecting group strategies trace conceptual lineage to protocols developed at ETH Zurich and Harvard University carbohydrate laboratories. Synthetic optimizations often reference catalytic systems and leaving-group manipulations tested at Stanford University and California Institute of Technology.
Radiolabeling of FDG uses the positron emitter fluorine-18 produced in cyclotrons such as those at Brookhaven National Laboratory, CERN, or university cyclotron centers like University of Pennsylvania. Nucleophilic substitution of a mannose triflate precursor with [18F]fluoride ions is a standard route, building on automated synthesis modules developed by companies and academic groups including GE Healthcare and teams at Siemens Healthineers. Quality control, radiochemical purity, and sterility testing follow regulatory frameworks from agencies including Food and Drug Administration and European Medicines Agency, and manufacturing often occurs in good manufacturing practice suites modeled after facilities at Mayo Clinic and Johns Hopkins University. Hot cell technology, pneumatic transfer systems, and radiochemistry modules reflect engineering contributions from Oak Ridge National Laboratory and industrial partners.
FDG-PET imaging is integral to oncologic staging, restaging, and therapy response assessment used in protocols established by consortia including National Comprehensive Cancer Network and trials coordinated at MD Anderson Cancer Center and Memorial Sloan Kettering Cancer Center. In neurology, FDG-PET contributes to differential diagnosis in centers such as Mayo Clinic and Cleveland Clinic, assisting differentiation among disorders characterized in literature from Alzheimer's Disease Neuroimaging Initiative and cohorts studied at Karolinska Institutet. Cardiac viability assessment with FDG-PET is performed in programs at University of Toronto and Mount Sinai Hospital. Multimodal imaging combining FDG-PET with computed tomography or magnetic resonance imaging has been advanced at institutions like Brigham and Women's Hospital and UCLH.
After intravenous administration, FDG is transported into cells by facilitative glucose transporters characterized in foundational work at Johns Hopkins University School of Medicine and phosphorylated by hexokinase to FDG-6-phosphate, a metabolic trap first elucidated in biochemical studies at Rockefeller University and Walter Reed Army Institute of Research. Physiologic biodistribution includes elevated uptake in brain, myocardium, kidneys, and bladder as documented in multicenter imaging trials involving European Association of Nuclear Medicine and Society of Nuclear Medicine and Molecular Imaging. Tumor uptake correlates with glycolytic activity observed in translational research at Dana-Farber Cancer Institute and Vanderbilt University Medical Center.
Radiation dosimetry estimates for FDG derive from biokinetic models and prospective measurements conducted by groups at International Commission on Radiological Protection and national radiological protection boards such as United Kingdom Health Security Agency and National Council on Radiation Protection and Measurements. Typical effective doses are informed by studies at World Health Organization-linked centers and dosimetry datasets from International Atomic Energy Agency. Safety procedures, handling, and waste management are implemented in line with protocols from Centers for Disease Control and Prevention and institutional radiation safety committees at hospitals like Massachusetts General Hospital.
Interpretation of FDG-PET requires expertise integrating imaging findings with clinical context and criteria promulgated by guideline bodies including European Society for Medical Oncology and American College of Radiology. False positives can arise from inflammatory processes as described in case series from Johns Hopkins Hospital and post-surgical inflammation reports at Guy's and St Thomas' NHS Foundation Trust, while false negatives occur in low-glycolytic tumors documented in studies from Royal Marsden Hospital and Institut Gustave Roussy. Standardized uptake value quantification and harmonization efforts have been pursued by multicenter studies involving Quantitative Imaging Biomarkers Alliance and trial networks at European Organisation for Research and Treatment of Cancer.
Research applications expand FDG utility in immuno-oncology trials at National Institutes of Health and biomarker studies at Fred Hutchinson Cancer Center, integration with radiomics and artificial intelligence developed by groups at MIT Media Lab and Google Health, and hybrid PET/MRI protocols piloted at Karolinska University Hospital and University College London. Comparative studies testing novel tracers in trials at Stanford Medicine and translational collaborations with industry partners such as AbbVie seek to refine indications and quantitative endpoints.
Category:Radiopharmaceuticals