Pre-medication to block [18F]FDG uptake in the brown adipose tissue of pediatric and adolescent patients
Pre-medication to block [18F]FDG uptake in the brown adipose tissue of pediatric and adolescent patients
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DOI：
10.1007/s00247-005-1505-8
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发表时间：
2005-10-01
影响因子：
2.3
通讯作者：
MacLean, JR
中科院分区：
文献类型：
--
作者：
Gelfand, MJ;O'Hara, SM;MacLean, JR
背景：在儿童和青少年的正电子发射断层扫描 (PET) 扫描中，15-20% 注意到棕色脂肪组织中 [F-18]2-脱氧-2-葡萄糖 (FDG) 的放射性药物摄取。一份报告表明，中等剂量口服地西泮可以部分或完全阻止棕色脂肪组织中 FDG 的摄取。目的：确定除中等剂量口服地西泮外，术前用药是否可以充分阻断棕色脂肪组织中的 [F-18]FDG 摄取。材料和方法：对 69 名患有各种实体瘤的儿科患者进行了 118 项 [F-18]FDG PET 身体成像研究。成像时的平均年龄为 12.9 岁（范围 1.2-22.6 岁），并且针对 10 岁以下的患者进行了 33 项研究。男孩进行了 76 次，女孩进行了 42 次。使用专用 PET 相机对患者进行成像。 88 项研究中进行了术前用药：45 项接受静脉注射芬太尼（0.75-1.0 μg/kg），34 项接受低剂量口服地西泮（0.06 mg/kg），9 项接受中剂量口服地西泮（0.10 mg/kg）。 30 名患者未接受任何术前用药，其中 7 名患者在研究前 12 小时内因疼痛而服用阿片类药物。检查了颈部和胸部的六个身体区域的棕色脂肪组织中的 [F-18]FDG 摄取情况。棕色脂肪中 FDG 的摄取按视觉分级：0 表示没有 FDG 摄取，1 表示低度摄取，2 表示中度摄取，3 表示强烈摄取。 2 级和 3 级视觉被认为可能干扰颈部和胸部的图像解释。使用泊松分布通过多元回归分析数据。结果：棕色脂肪组织中的 [F-18]FDG 摄取最常见于颈部外侧区域以及肺部上方和外侧（分别在 36 项和 39 项研究中）。在肋椎交界处附近（15 项研究）、7 项研究中的上颈和中央颈以及 2 项研究中的前纵隔中也发现了摄取。在 19 项研究中，棕色脂肪组织的摄取被认为可能干扰图像解释（视觉等级 2 和 3）——23 项研究中的 6 项（26.1%）在未预先用药且未使用阿片类药物止痛后，34 项研究中的 10 项（29.4%）低剂量口服地西泮后，9 例中的 0 例 (0%) 中剂量口服地西泮后，45 例静脉注射芬太尼后，有 3 例 (6.7%) 发生，7 例用于镇痛的阿片类药物后，7 例中有 0 例 (0%)。与无药物（P=0.0039）和低剂量地西泮（P=0.0024）相比，静脉注射芬太尼降低了棕色脂肪组织的等级。与无药物相比，低剂量地西泮没有效果（P=0.984）。对于用于止痛的中等剂量安定和阿片类药物的统计测试数据不足。 10岁以下儿童的吸收等级低于10岁以上儿童（P=0.019）。摘要：静脉注射芬太尼预用药可降低棕色脂肪组织中干扰 [F-18]FDG 摄取的频率，这似乎是现有标准预用药、中等剂量口服地西泮的有效替代方案。
Background: Radiopharmaceutical uptake of [F-18]2-deoxy-2-glucose (FDG) in brown adipose tissue is noted on 15-20% of positron emission tomography (PET) scans in children and adolescents. One report suggests that moderate-dose oral diazepam can partly or completely block FDG uptake in brown adipose tissue. Objective: To determine whether [F-18]FDG uptake in brown adipose tissue can be adequately blocked by pre-medication other than moderate-dose oral diazepam. Materials and methods: One hundred and eighteen [F-18]FDG PET body imaging studies were performed in 69 pediatric patients with a variety of solid tumors. The mean age at the time of imaging was 12.9 years (range 1.2-22.6 years), and 33 studies were performed in patients younger than 10 years old. Seventy-six were performed in boys and 42 in girls. Patients were imaged using a dedicated PET camera. Pre-medication was given in 88 studies: 45 received intravenous fentanyl (0.75-1.0 mu g/kg), 34 received low-dose oral diazepam (0.06 mg/kg) and 9 received moderate-dose oral diazepam (0.10 mg/kg). Thirty patients received no pre-medication, 7 of whom were known to have received opiates for pain during the 12 h before the study. Six body regions in the neck and chest were reviewed for [F-18]FDG uptake in brown adipose tissue. Uptake of FDG in brown fat was visually graded: 0 for no FDG uptake, 1 for low-grade uptake, 2 for moderate uptake, and 3 for intense uptake. Visual grades 2 and 3 were considered to interfere potentially with image interpretation in the neck and chest. Data were analyzed by multivariate regression using a Poisson distribution. Results: [F-18]FDG uptake in brown adipose tissue was most often seen in the lateral neck region and superior and lateral to the lungs (in 36 and 39 studies, respectively). Uptake was also seen near the costovertebral junctions (15 studies), in the superior and central neck in 7 studies and in the anterior mediastinum in 2. Brown adipose tissue uptake was thought to interfere potentially with image interpretation (visual grades 2 and 3) in 19 studies-in 6 of 23 (26.1%) studies after no pre-medication and no opiates for pain, in 10 of 34 (29.4%) after low-dose oral diazepam, in 0 of 9 (0%) after moderate-dose oral diazepam, in 3 of 45 (6.7%) after intravenous fentanyl, and in 0 of 7 (0%) after opiates prescribed for pain. Intravenous fentanyl reduced the grade of brown adipose tissue compared to no drug (P=0.0039) and low-dose diazepam (P=0.0024). Low-dose diazepam had no effect when compared to no drug (P=0.984). There were inadequate data for statistical testing of moderate-dose valium and opiates prescribed for pain. Children younger than 10 years had lower uptake grades (P=0.019) than those older than 10 years. Summary: The frequency of interfering [F-18]FDG uptake in brown adipose tissue is reduced by intravenous fentanyl pre-medication, which appears to be an effective alternative to the existing standard pre-medication, moderate-dose oral diazepam.