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Brown Fat Imaging with ¹⁸F-6-Fluorodopamine PET/CT, ¹⁸F-FDG PET/CT, and ¹²³I-MIBG SPECT: A Study of Patients Being Evaluated for Pheochromocytoma

¹ Department of Nuclear Medicine, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland; and ² Pediatric and Reproductive Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland

Correspondence: For correspondence contact: Jorge A. Carrasquillo, MD, 1275 York Ave., New York, NY 10021. E-mail: carrasj1{at}mskcc.org

Several radiopharmaceuticals such as ¹⁸F-FDG, ¹²³I-metaiodobenzylguanidine (MIBG), and ^99mTc-tetrofosmin have demonstrated uptake in brown adipose tissue (BAT). It is important to recognize these normal variants so that they are not misinterpreted as a significant pathologic state. In addition, these radiopharmaceuticals may shed light on BAT physiology. ¹⁸F-6-fluorodopamine (F-DA) is being used as a PET radiopharmaceutical to image adrenergic innervation and suspected pheochromocytoma. Past reports have suggested that BAT is increased in pheochromocytoma patients. Methods: The images of 96 patients evaluated with ¹⁸F-F-DA or ¹⁸F-FDG PET/CT for known or suspected pheochromocytoma were reviewed retrospectively to determine whether localized uptake of a pattern typically associated with BAT was present. When available, contemporaneous images obtained using ¹²³I-MIBG were also reviewed for the presence of BAT. Results: Of 67 patients imaged with ¹⁸F-F-DA, BAT was found in 17.9%. Of 83 patients imaged with ¹⁸F-FDG, 19.2% had BAT. Discordant findings related to uptake in BAT were often seen in patients studied with ¹⁸F-FDG, ¹⁸F-F-DA, or ¹²³I-MIBG. Overall, 26 (27.0%) of 96 patients showed BAT on at least 1 of the 3 imaging modalities. Conclusion: ¹⁸F-F-DA can image BAT, most likely by localizing to sympathetic innervations in a manner similar to ¹²³I-MIBG. Patients with pheochromocytoma may have a greater BAT tissue mass or activation because of elevated levels of circulating catecholamines. Quantitative PET with ¹⁸F-FDG and ¹⁸F-F-DA may have a role in in vivo studies of BAT physiology in humans or animal models.

Key Words: PET • PET/CT • brown fat • ¹⁸F-FDG • ¹²³I-MIBG • ¹⁸F-fluorodopamine

COPYRIGHT © 2007 by the Society of Nuclear Medicine, Inc.

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				R. B. Iyer, C. C. Guo, and N. Perrier Adrenal Pheochromocytoma with Surrounding Brown Fat Stimulation Am. J. Roentgenol., January 1, 2009; 192(1): 300 - 301. [Full Text] [PDF]