Use of propranolol in [18F] FDG-PET/CT for differential diagnosis of brown fat in patient with a history of adenocarcinoma of the uterine cervix

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A y B) PET/TC basal. No se observa captación. C y D) PET/TC 3 meses tras el tratamiento. Se observan 2 lesiones focales hipermetabólicas en zona perirrenal (flechas blancas), sin traducción masa en TC. E y F) PET/TC 6 meses tras el tratamiento. Se mantiene hipercaptación en localizaciones previamente descritas (flechas de puntos)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Garcia Garcia, A.P. Caresia Aróztegui, S. Martínez Román" "autores" => array:3 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Garcia Garcia" ] 1 => array:2 [ "nombre" => "A.P." "apellidos" => "Caresia Aróztegui" ] 2 => array:2 [ "nombre" => "S." 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[99mTc]Tc-MIBI scintigraphy in the delayed phase in which the adenoma is not localized (right)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F. García García, N. Cassinello Fernández, J. Rodríguez Romera, R. Martí Fernández, M. Lapeña Rodríguez, R. Alfonso Ballester, R. Díaz Expósito, J. Ortega Serrano" "autores" => array:8 [ 0 => array:2 [ "nombre" => "F." "apellidos" => "García García" ] 1 => array:2 [ "nombre" => "N." "apellidos" => "Cassinello Fernández" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Rodríguez Romera" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "Martí Fernández" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Lapeña Rodríguez" ] 5 => array:2 [ "nombre" => "R." "apellidos" => "Alfonso Ballester" ] 6 => array:2 [ "nombre" => "R." "apellidos" => "Díaz Expósito" ] 7 => array:2 [ "nombre" => "J." "apellidos" => "Ortega Serrano" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S2253654X24000970" "doi" => "10.1016/j.remn.2024.500066" "estado" => "S200" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X24000970?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808924000946?idApp=UINPBA00004N" "url" => "/22538089/unassign/S2253808924000946/v1_202410061015/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S225380892400051X" "issn" => "22538089" "doi" => "10.1016/j.remnie.2024.500038" "estado" => "S200" "fechaPublicacion" => "2024-07-11" "aid" => "500038" "copyright" => "Sociedad Española de Medicina Nuclear e Imagen Molecular" "documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "Interesting images" "titulo" => "Cardiovascular [18F]F-FDG PET/MRI in the diagnosis of acute cardiomyopathy inflammatory" "tienePdf" => "en" "tieneTextoCompleto" => "en" "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "PET/RM cardiovascular con [18F]F-FDG en el diagnóstico de miocardiopatia aguda inflamatoria" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1209 "Ancho" => 850 "Tamanyo" => 88787 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Axial PET/MR fusion images and axial CMR black blood sequences. Hyperuptake of [18F]F-FDG in lower mid-apical segments and apex of LV which is thickened on CMR (A), with active focus on the anterior wall of the right ventricle, with slight thickening on CMR (B) and hyperuptake of the tracer in the left appendage, without practical translation in CMR (C). Axial PET/MR fusion images and axial CMR black blood sequences. Hyperuptake of [18F]F-FDG in lower mid-apical segments and apex of LV wich is thickened on CMR (A), with active focus on the anterior wall of the right ventricle, with slight thickening on CMR (B) and hyperuptake of the tracer in the left appendage, without practical translation in CMR (C)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.R. Garcia, R. Olivero, M. Panelo, L. Mont, L. Pinilla, M.E. Riera, A. Maceira" "autores" => array:7 [ 0 => array:2 [ "nombre" => "J.R." "apellidos" => "Garcia" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Olivero" ] 2 => array:2 [ "nombre" => "M." 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"apellidos" => "Maceira" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S2253654X24000519" "doi" => "10.1016/j.remn.2024.500038" "estado" => "S200" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X24000519?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S225380892400051X?idApp=UINPBA00004N" "url" => "/22538089/unassign/S225380892400051X/v1_202407110420/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Interesting images" "titulo" => "Use of propranolol in [18F] FDG-PET/CT for differential diagnosis of brown fat in patient with a history of adenocarcinoma of the uterine cervix" "tieneTextoCompleto" => true "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Garcia Garcia, A.P. Caresia Aróztegui, S. Martínez Román" "autores" => array:3 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Garcia Garcia" "email" => array:1 [ 0 => "garcigaalba@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A.P." "apellidos" => "Caresia Aróztegui" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "S." "apellidos" => "Martínez Román" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Obstetricia y Ginecología Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "PET/TC, Servicio de Medicina Nuclear, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Uso de propranolol en [18F]FDG-PET/TC para diagnóstico diferencial de grasa parda en paciente con antecedente de adenocarcinoma de cérvix uterino" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1443 "Ancho" => 1733 "Tamanyo" => 218843 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "[18F]FDG PET/CT staging and follow-up at 3 and 6 months post-treatment, section at the level of the pelvis. A) PET/CT fusion prior to the start of treatment. Hyperuptake is observed in the cervix (white circle). B) CT with cervical tumor lesion. C;E) PET/CT fusion at 3 and 6 months respectively, showing metabolic response (dotted circles). D;F) Follow-up CT with disappearance of the tumor mass." ] ] ] "textoCompleto" => "We present a case of a 42-year-old woman with no relevant medical history, diagnosed with stage IB3 cervical adenocarcinoma treated with chemoradiotherapy. The follow-up PET/CT scan 3 months after treatment showed complete metabolic response of the primary tumor (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Two focal, isolated, hypermetabolic images (SUVmax of 3.9 g/mL and 4.6 g/mL respectively) in the left pararenal area were notable, with no morphological translation on CT. The study was repeated 6 months after treatment after placement of a thermal blanket during the period of incorporation of [18F]FDG, without achieving the disappearance of the hyperuptake images (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>Suspecting that the isolated foci in the pararenal fat were brown fat, despite their unusual location, and to rule out tumor recurrence, a new PET/CT was performed 2 months after the last follow-up, after preparation with 50 mg of oral Propranolol 1 h before the injection of [18F]FDG. This made the hyperenhancement images in the PET disappear, indicating that it was brown fat (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).<elsevierMultimedia ident="fig0015"></elsevierMultimedia>Brown fat plays an important role in thermogenesis, regulated by the sympathetic nervous system through receptors β-adrenergic. The antagonists β-non-selective adrenergics, such as Propranolol, inhibit sympathetic stimulation of brown fat, reducing its absorption of [18F]FDG, without affecting tumor uptake.<a class="elsevierStyleCrossRef" href="#bib0005">1</a>Activated brown fat can make difficult the interpretation of [18F]FDG PET/CT by simulating tumor uptake.<a class="elsevierStyleCrossRefs" href="#bib0010">2,3</a> Its distribution is usually symmetrical, laterocervical, supraclavicular or, rarely, mediastinal paravertebral. The originality of this case lies in the existence of brown fat activity in the perirenal region in an isolated and asymmetric manner.<a class="elsevierStyleCrossRef" href="#bib0005">1</a>We conclude that the blockade β-adrenergic before PET/CT [18F]FDG can be very useful in the differential diagnosis of hypermetabolic images compatible with brown fat deposits, reliably ruling out tumor recurrence." "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1443 "Ancho" => 1733 "Tamanyo" => 218843 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "[18F]FDG PET/CT staging and follow-up at 3 and 6 months post-treatment, section at the level of the pelvis. A) PET/CT fusion prior to the start of treatment. Hyperuptake is observed in the cervix (white circle). B) CT with cervical tumor lesion. C;E) PET/CT fusion at 3 and 6 months respectively, showing metabolic response (dotted circles). D;F) Follow-up CT with disappearance of the tumor mass." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1118 "Ancho" => 2667 "Tamanyo" => 286214 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "[18F]FDG PET/CT at baseline and controls at 3 and 6 months post-treatment, sections at renal level. A;B) PET/CT at baseline. No uptake is observed. C;D) PET/CT 3 months after treatment. Two focal hypermetabolic lesions are observed in the perirenal area (white arrows), with no mass translation on CT. E;F) PET/CT 6 months after treatment. Hyperuptake is maintained in previously described locations (dotted arrows)." ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1317 "Ancho" => 1867 "Tamanyo" => 237531 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "[18F]FDG PET/CT before and after preparation with Propranolol. A) MIP (maximum intensity projection). Uptake in the laterocervical (black arrow) and perinephric (red arrows) areas. Hypermetabolic images isolated in the perinephric area (white arrows), without morphological translation. B) MIP after preparation with Propranolol. No uptake is observed in the perinephric (dotted red arrows) or laterocervical (dotted black arrow) areas." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Low-dose oral propranolol could reduce brown adipose tissue F-18 FDG uptake in patients undergoing PET scans" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "O. Parysow" 1 => "A.M. Mollerach" 2 => "V. Jager" 3 => "S. Racioppi" 4 => "J. Roman" 5 => "V.H. Gerbaudo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.rlu.0000259570.69163.04" "Revista" => array:6 [ "tituloSerie" => "Clin Nucl Med" "fecha" => "2007" "volumen" => "32" "paginaInicial" => "351" "paginaFinal" => "357" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17452860" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of propranolol on 18F-fluorodeoxyglucose uptake in brown adipose tissue in children and young adults with neoplastic diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.L. Brady" 1 => "K.K. Wong" 2 => "M. Doubrovin" 3 => "Y. Han" 4 => "Y. Li" 5 => "S. Wu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11307-020-01547-z" "Revista" => array:6 [ "tituloSerie" => "Mol Imaging Biol" "fecha" => "2021" "volumen" => "23" "paginaInicial" => "260" "paginaFinal" => "269" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33067751" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Functional imaging of brown fat in mice with 18F-FDG micro-PET/CT" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "X. Wang" 1 => "L.J. Minze" 2 => "Z.Z. Shi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3791/4060" "Revista" => array:4 [ "tituloSerie" => "J Vis Exp" "fecha" => "2012" "volumen" => "23" "paginaInicial" => "4060" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22538089/unassign/S2253808924000971/v1_202410061014/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/22538089/unassign/S2253808924000971/v1_202410061014/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808924000971?idApp=UINPBA00004N"]

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The Revista Española de Medicina Nuclear e Imagen Molecular (Spanish Journal of Nuclear Medicine and Molecular Imaging), was founded in 1982, and is the official journal of the Spanish Society of Nuclear Medicine and Molecular Imaging, which has more than 700 members. The Journal, which publishes 6 regular issues per year, has the promotion of research and continuing education in all fields of Nuclear Medicine as its main aim. For this, its principal sections are Originals, Clinical Notes, Images of Interest, and Special Collaboration articles. The works may be submitted in Spanish or English and are subjected to a peer review process. In 2009, it became the leading Spanish journal in the field of Medical Imaging on having an Impact Factor , awarded by the Journal Citation Reports.

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Rev Esp Med Nucl Imagen Mol. 2024;43:23-30

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