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.

中文翻译：

---

普萘洛尔对患有肿瘤性疾病的儿童和青年棕色脂肪组织中 18F-氟脱氧葡萄糖摄取的影响

目的

评估普萘洛尔在减轻已知或疑似恶性肿瘤儿科患者棕色脂肪组织 (BAT) 中 FDG 摄取方面的有效性。

方法

对 2005 年至 2017 年接受治疗的 3 组患者进行 PET/CT 扫描，通过 BAT 在 7 个部位对 FDG 摄取进行评分：右侧或左侧颈部/锁骨上区域、右侧或左侧腋窝、纵隔、后胸和腹部/骨盆. 摄取评分如下：0，无；1、轻度摄取<肝脏；2、中度摄取=肝脏；3、强烈摄取>肝脏。第 1 组由 323 名患者（630 次扫描）组成，他们没有具体准备来减轻 BAT 对 FDG 的吸收。第 2 组由 345 名患者（705 次扫描）组成，他们仅在 24 °C 固定温度的摄取室中进行了加温。第 3 组由 622 名患者（1457 次扫描）组成，他们接受了加温。在第 3 组中，8 岁及以上的患者，471 名患者（1114 次扫描）也在注射 FDG 前 60 分钟口服普萘洛尔进行预先用药。广义估计方程，

结果

在 8 岁或以上的患者中，BAT 摄取的发生率为 35-44%，而普萘洛尔则降至 15%。BAT 最常见于颈部 (26 %)、腋窝 (18 %)、后胸 (18 %)、纵隔 (14 %) 和腹部/骨盆 (8 %)；BAT 在温暖的月份不太常见（p  = 0.001）。单独注射前加热没有显示出实质性的好处。分别对年龄、性别或 BSA 没有发现显着影响。当存在 BAT 吸收时，通常是强烈的。

结论

普萘洛尔制剂可最大限度地减少 BAT 对 FDG 的吸收，应将其视为儿童、青少年和年轻人的儿科 FDG PET/CT 癌症相关方案的常规方案。