FDG altered biodistribution in white adipose tissue, a rare entity: case report and review of the literature.

William Y Raynor, Stephen J Sozio, Jeffrey S Kempf
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Abstract

Purpose: Altered 18F-fluorodeoxyglucose (FDG) biodistribution due to patient factors such as exercise and inadequate fasting are well established causes of limited diagnostic efficacy. In addition, medications such as G-CSF are known to affect uptake of FDG by bone marrow and spleen. In this study, we present a case of increased white adipose uptake in a pediatric lymphoma patient who recently received high dose dexamethasone and review the relevant literature regarding this rare and poorly understood pattern of altered FDG biodistribution.

Methods: A 14-year-old male patient diagnosed with B-cell lymphoblastic lymphoma underwent FDG-PET/CT for restaging shortly after completing an induction chemotherapy regimen. Images revealed diffuse FDG uptake localizing to white adipose tissue, attributed to the 29-day course of dexamethasone which was completed two days prior. A diagnostically adequate study with relative normalization of FDG biodistribution was obtained seven days later.

Results: In our review of the literature, diffuse FDG uptake by white fat is a rare occurrence and has only been reported by a few case reports and early observational studies. In addition to patients receiving corticosteroids, other cases of medication-induced adipose remodeling such as patients receiving highly active antiretroviral therapy have been documented with similar patterns of increased white adipose tissue activity.

Conclusion: Corticosteroid-induced white fat uptake of FDG is a rare phenomenon that can limit diagnostic accuracy of FDG-PET/CT and necessitate repeat imaging. Current evidence suggests that a wait period of at least one week after discontinuation of corticosteroids is sufficient to allow for decreased white fat uptake and increased diagnostic accuracy.

白色脂肪组织中的 FDG 生物分布改变,一种罕见病例:病例报告和文献综述。
目的:运动和空腹不足等患者因素导致的 18F-氟脱氧葡萄糖(FDG)生物分布改变是诊断效果有限的公认原因。此外,已知 G-CSF 等药物会影响骨髓和脾脏对 FDG 的吸收。在本研究中,我们介绍了一例最近接受大剂量地塞米松治疗的儿童淋巴瘤患者白脂肪摄取增加的病例,并回顾了有关这种罕见且鲜为人知的 FDG 生物分布改变模式的相关文献:一名被诊断为B细胞淋巴细胞淋巴瘤的14岁男性患者在完成诱导化疗后不久接受了FDG-PET/CT检查,以进行重新分期。图像显示白色脂肪组织局部弥漫性 FDG 摄取,这与两天前完成的为期 29 天的地塞米松疗程有关。七天后进行了诊断充分的研究,FDG 生物分布相对正常化:在我们查阅的文献中,白色脂肪弥漫性摄取 FDG 的情况非常罕见,仅有少数病例报告和早期观察性研究报道过。除了接受皮质类固醇治疗的患者外,其他由药物引起的脂肪重塑病例,如接受高活性抗逆转录病毒治疗的患者,也有类似的白色脂肪组织活性增加的报道:结论:皮质类固醇诱导的白色脂肪摄取 FDG 是一种罕见现象,会限制 FDG-PET/CT 的诊断准确性,因此有必要重复成像。目前的证据表明,停用皮质类固醇后至少一周的等待期足以使白色脂肪摄取减少并提高诊断准确性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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