Question of the day: Which of the following statement is false?

Question:

Which of the following statement is false?

	1. Temperature-controlled environment settings during FDG uptake phase is an effective maneuver to reduce BAT uptake
	2. Patients may be prepared with the high-fat low-carbohydrate diet to lower frequency of hypermetabolic BAT uptake on FDG PET scans during the winter months.
	3. Fusion PET/CT does not improve accurate anatomic localization of this hypermetabolic fat
	4. Benzodiazepine premedication is not 100% efficacious in abolishing the aforementioned activity

Answer:

The correct answer for the question "Which of the following statement is false?" is:

3. Fusion PET/CT does not improve accurate anatomic localization of this hypermetabolic fat

Explanation

Thirdly, temperature-controlled environment settings during FDG uptake phase is another effective method to minimize the USA-Fat artifact (3, 8). (With the advent of precise localization with fusion PET/CT (2,3,5), it has been now possible to resolve this issue by accurate anatomic localization of this hypermetabolic fat). In a recently published retrospective study (23), patients who were prepared with the high-fat low-carbohydrate diet had a significantly lower frequency of hypermetabolic BAT uptake on FDG PET scans during the winter months (p<0.0002) compared to those patients who were prepared by fasting

From the manuscript:
Asymmetric 18F-FDG Uptake in the Infradiaphragmatic Brown Adipose Tissue (BAT) Mimicking Adrenal Metastasis: A Relatively Rare Site of Brown Fat and a Potential Source for False Positive FDG-PET Study
Radiology Case. 2009 Oct; 3(10):19-22

This article belongs to the Nucs section.

From the manuscript

Asymmetric 18F-FDG Uptake in the Infradiaphragmatic Brown Adipose Tissue (BAT) Mimicking Adrenal Metastasis: A Relatively Rare Site of Brown Fat and a Potential Source for False Positive FDG-PET Study

Free full text article: Asymmetric 18F-FDG Uptake in the Infradiaphragmatic Brown Adipose Tissue (BAT) Mimicking Adrenal Metastasis: A Relatively Rare Site of Brown Fat and a Potential Source for False Positive FDG-PET Study

Abstract
FDG uptake in the metabolically active brown adipose tissue (BAT) is a source of significant concern while interpreting FDG-PET studies. It is also of great interest due to its potential implications for obesity research. In this communication, we describe hitherto unreported asymmetric BAT uptake in the abdomen, persisting after diazepam intervention in the repeat PET study on a separate day. The patient did not have any evidence of disease even at 24 months` follow up. The present case is a useful addition to the current body of literature of false positive FDG-PET due to BAT uptake in unusual location and underscores the importance of high index of suspicion and careful correlation, whenever one comes across an unusual PET finding in a given clinical situation. This assumes important diagnostic value particularly when it coexists in the setting of malignancy where the disease can be falsely upstaged by misinterpretation. The literature relevant to the report is discussed and a schema is suggested for correct interpretation.

References

1. Hany TF, Gharehpapagh E, Kamel EM, Buck A, Himms- Hagen J, von Schulthess GK. Brown adipose tissue: a factor to consider in symmetrical tracer uptake in the neck and upper chest region. Eur J Nucl Med Mol Imaging 2002 Oct;29(10):1393-8
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