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Effect of Propranolol on 18F-Fluorodeoxyglucose Uptake in Brown Adipose Tissue in Children and Young Adults with Neoplastic Diseases

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Abstract

Purpose

To evaluate the effectiveness of propranolol at mitigating FDG uptake in brown adipose tissue (BAT) of pediatric patients with known or suspected malignancies.

Methods

PET/CT scans of 3 cohorts of patients treated from 2005 to 2017 were scored for the presence of FDG uptake by BAT at 7 sites: right or left neck/supraclavicular area, right or left axilla, mediastinum, posterior thorax, and abdomen/pelvis. Uptake was scored as follows: 0, none; 1, mild uptake < liver; 2, moderate uptake = liver; and 3, intense uptake > liver. Group 1 consisted of 323 patients (630 scans) who had no specific preparation to mitigate FDG uptake by BAT. Group 2 consisted of 345 patients (705 scans) who underwent only warming in an uptake room with a fixed temperature at 24 °C. Group 3 consisted of 622 patients (1457 scans) who underwent warming. In group 3, patients 8 years and older, 471 patients (1114 scans), were also pre-medicated with oral propranolol 60 min before injection of FDG. Generalized estimation equation, using the logit link method, was used to model the relationship between the incidence of BAT score > 0, in any site, as a function of age, sex, seasonal effect, and body surface area (BSA).

Results

In patients aged 8 years or older, the incidence of BAT uptake was 35–44 % and declined to 15 % with propranolol. BAT was most frequent in the neck (26 %), axilla (18 %), posterior thorax (18 %), mediastinum (14 %), and abdomen/pelvis (8 %); BAT was less common in warm months (p = 0.001). No substantial benefit was shown with pre-injection warming alone. No significant effect was found for age, sex, or BSA separately. When BAT uptake was present, it was usually intense.

Conclusion

Propranolol preparation minimizes FDG uptake by BAT and should be considered routine for pediatric FDG PET/CT cancer-related protocols in children, adolescents, and young adults.

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Acknowledgments

The authors thank the nuclear medicine technologists Leigh Ann Davis (Supervisor), William Davis, Tiffany Holman, and Shannon James for their help with this study; Vella Laws-Bell for assistance in preparing the manuscript; and Cherise Guess, PhD, ELS, for scientific editing.

Funding

This study was supported, in part, by the American Lebanese Syrian Associated Charities (ALSAC) and National Cancer Institute (NCI) Award Number 5R25CA023944 (CBC salary support).

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Authors and Affiliations

  1. Department of Radiology, Cincinnati Children’s Hospital Medical Center & University of Cincinnati, Cincinnati, OH, USA

    Samuel L. Brady

  2. Department of Radiology, Division of Nuclear Medicine, C.S. Mott Children’s Hospital, University of Michigan Hospital, Ann Arbor, MI, USA

    Ka Kit Wong

  3. Department of Diagnostic Imaging, Division of Nuclear Medicine, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Mail Stop 220, Memphis, TN, 38105, USA

    Mikhail Doubrovin, A. K. M. Moinul Hossain, Charles B. Chism, Mihir H. Naik & Barry L. Shulkin

  4. Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Yuanyuan Han, Yimei Li & Shengjie Wu

  5. Division of Anesthesiology, Department of Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Michael Rossi

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  1. Samuel L. Brady
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Correspondence to Barry L. Shulkin.

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The local Institutional Review Board for the Conduct of Studies in Human Subjects approved the study protocol and waived the requirement for individual consent in this retrospective analysis.

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Samuel L. Brady and Ka Kit Wong are co-first authors.

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Brady, S.L., Wong, K.K., Doubrovin, M. et al. Effect of Propranolol on 18F-Fluorodeoxyglucose Uptake in Brown Adipose Tissue in Children and Young Adults with Neoplastic Diseases. Mol Imaging Biol 23, 260–269 (2021). https://doi.org/10.1007/s11307-020-01547-z

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