An International Survey Investigating the Incidence and Management of Brown Fat Uptake on18F-FDG PET/CT at Children’s Hospitals and Interventions for Mitigation

IF 1 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Journal of nuclear medicine technology Pub Date : 2023-12-13 DOI:10.2967/jnmt.123.266536
William C. Gaylord, Andrew T. Trout, Anthony N. Audino, Jennifer A. Belsky
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Abstract

Brown fat can present challenges in patients with cancer who undergo 18 F-FDG PET scans. Uptake of 18 F-FDG by brown fat can obscure or appear similar to active oncologic lesions, causing clinical challenges in PET interpretation. Small, retrospective studies have reported environmental and pharmacologic interventions for suppressing brown fat uptake on PET; however, there is no clear consensus on best practices. We sought to characterize practice patterns for strategies to mitigate brown fat uptake of 18 F-FDG during PET scanning. Methods: A survey was developed and distributed via e-mail LISTSERV to members of the Children ’ s Oncology Group diagnostic imaging committee, the Society for Nuclear Medicine and Molecular Imaging pediatric imaging council, and the Society of Chiefs of Radiology at Children ’ s Hospitals between April 2022 and February 2023. Responses were stored anony-mously in REDCap, aggregated, and summarized using descriptive statistics. Results: Fifty-fi ve complete responses were submitted: 51 (93%) faculty and fellow-level physicians, 2 (4%) technologists, and 2 (4%) respondents not reporting their rank. There were 43 unique institutions represented, including 5 (12%) outside the United States. Thirty-eight of 41 (93%) institutions that responded on environmental interventions reported using warm blankets in the infusion and scanning rooms. Less than a third ( n 5 13, 30%) of institutions reported use of a pharmacologic intervention, with propranolol ( n 5 5, 38%) being most common, followed by fentanyl ( n 5 4, 31%), diazepam ( n 5 2, 15%), and diazepam plus pro-pranolol ( n 5 2, 15%). Selection criteria for pharmacologic intervention varied, with the most common criterion being brown fat uptake on a prior scan ( n 5 6, 45%). Conclusion: Clinical practices to mitigate brown fat uptake on pediatric 18 F-FDG PET vary widely. Simple environmental interventions including warm blan-kets or increasing the temperature of the injection and scanning rooms were not universally reported. Less than a third of institutions use pharmacologic agents for brown fat mitigation.
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一项国际调查,调查儿童医院 18F-FDG PET/CT 中棕色脂肪摄取的发生率和管理情况以及缓解措施
棕色脂肪会给接受 18 F-FDG PET 扫描的癌症患者带来挑战。棕色脂肪对 18 F-FDG 的摄取可能会掩盖或类似于活动性肿瘤病灶,从而给 PET 解释带来临床挑战。一些小型的回顾性研究报告了抑制 PET 上棕色脂肪摄取的环境和药物干预措施;但是,对于最佳做法还没有明确的共识。我们试图描述在 PET 扫描过程中减轻棕色脂肪对 18 F-FDG 摄取的策略的实践模式。方法:在 2022 年 4 月至 2023 年 2 月期间,我们编制了一份调查问卷,并通过电子邮件 LISTSERV 分发给儿童肿瘤学组诊断成像委员会、核医学和分子成像学会儿科成像委员会以及儿童医院放射科主任学会的成员。回复以匿名方式存储在 REDCap 中,进行汇总并使用描述性统计进行总结。结果:提交了 50 份完整的回复:51 位(93%)教职员工和研究员级别的医生、2 位(4%)技术人员以及 2 位(4%)未报告其级别的受访者。共有 43 家机构代表,其中 5 家(12%)在美国境外。在 41 家就环境干预措施做出回复的机构中,有 38 家(93%)报告在输液室和扫描室使用了保暖毯。不到三分之一(13 家,占 30%)的机构报告使用了药物干预,其中普萘洛尔(5 家,占 38%)最为常见,其次是芬太尼(4 家,占 31%)、地西泮(2 家,占 15%)和地西泮加普萘洛尔(2 家,占 15%)。药物干预的选择标准各不相同,最常见的标准是先前扫描中的棕色脂肪摄取量(5 6 人,45%)。结论:减轻小儿 18 F-FDG PET 棕色脂肪摄取的临床实践差异很大。简单的环境干预措施,包括温暖的毛巾或提高注射室和扫描室的温度,并未得到普遍报道。只有不到三分之一的机构使用药物来减轻棕色脂肪摄取。
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来源期刊
Journal of nuclear medicine technology
Journal of nuclear medicine technology RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-
CiteScore
1.90
自引率
15.40%
发文量
57
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