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Prevention of Brown Adipose Tissue Activation in 18F-FDG PET/CT of Breast Cancer Patients Receiving Neoadjuvant Systemic Therapy

Tjeerd S. Aukema, Wouter V. Vogel, Cees A. Hoefnagel and Renato A. Valdés Olmos
Journal of Nuclear Medicine Technology March 2010, 38 (1) 24-27; DOI: https://doi.org/10.2967/jnmt.109.065557

Article Figures & Data

Figures

  • FIGURE 1. 
    FIGURE 1. 

    18F-FDG PET/CT showing extended uptake of 18F-FDG in fat-containing spaces of body in gray and white (A). This BAT uptake is seen only on axial fused PET/CT (B, D, F, and H), without abnormalities on CT (C, E, G, and I) in neck (B and C), supraclavicular area (D and E), mediastinal and paravertebral areas (F and G), and paraaortic area (H and I).

  • FIGURE 2. 
    FIGURE 2. 

    Coronal maximum-intensity-projection PET image (A) shows extended BAT uptake of 18F-FDG in neck, supraclavicular, axillary, mediastinal, paravertebral, and abdominal regions in breast cancer patient with axillary metastases. Second PET study of same patient (B) performed 1 wk later after preparation with diazepam and controlled room temperature shows no BAT uptake of 18F-FDG. Note on PET/CT scan that initial 18F-FDG uptake of BAT disappears (C) and only hypermetabolic lymph metastasis in left axilla is seen (D).

Tables

  • TABLE 1

    Characteristics of Patients with BAT Uptake of 18F-FDG

    BAT location areasIntervention*Visual score†
    Cervical and supraclavicularNo3
    Cervical, supraclavicular, axillary, and mediastinalNo3
    Axillary, paravertebral, perirenal, and prehepaticNo3
    Cervical, supraclavicular, axillary, paraspinal, and mediastinalNo2
    Cervical, supraclavicular, axillary, and mediastinalYes2

    • ↵* Consisted of orally administering 10 mg of diazepam 1 h before image acquisition.

    • ↵† Evaluated using a 4-point system, with higher score indicating more intense uptake.

  • TABLE 2

    Characteristics of the 2 Cohort Groups

    Breast cancer patientsMean age (y)Mean BMIMean visual score of 18F-FDG uptake in BAT
    Treated according to previous protocol54260.16
    Treated according to new protocol*55260.04
    P0.76†0.60†0.18‡

    • ↵* Oral administration of 10 mg of diazepam 1 h before image acquisition.

    • ↵† Independent-sample t test.

    • ↵‡ Fisher exact test.

  • TABLE 3

    Protocol to Reduce 18F-FDG Uptake in BAT in Breast Cancer Patients Undergoing 18F-FDG PET/CT

    Preparation protocolTime of administration in relation to PET/CT acquisition
    High-fat, very-low-carbohydrate diet (22)Night before and morning of imaging
    No smoking (23)Day of imaging
    Constant temperature of 22–24°C in injection room (17,18)15−30 min before intravenous tracer administration and during 1 h in resting room
    Oral administration of 20 mg of propranolol (20) or 10 mg of diazepam15−30 min before intravenous tracer administration
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