The Korean Journal of Nuclear Medicine Technology (핵의학기술)

The Korean Society of Nuclear Medicine Technology (대한핵의학기술학회)
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Effect of Thermal Method on the Activation of Brown Adipose Tissue

온열 요법이 갈색지방세포 활성화에 미치는 영향

  • You, Yeon Wook (Department of Nuclear Medicine and Research Institute, National Cancer Center) ;
  • Lee, Chung Wun (Department of Nuclear Medicine and Research Institute, National Cancer Center) ;
  • Seon, Ahn Jeong (Department of Nursing and Research Institute, National Cancer Center) ;
  • Lee, Dong Eun (Department of Biostatistics Collaboration Team and Research Institute, National Cancer Center) ;
  • Moon, Jong Wun (Department of Nuclear Medicine and Research Institute, National Cancer Center) ;
  • Kim, Yun Cheol (Department of Nuclear Medicine and Research Institute, National Cancer Center) ;
  • Park, So Hyeon (Department of Nuclear Medicine and Research Institute, National Cancer Center) ;
  • Kim, Tae-Sung (Department of Nuclear Medicine and Research Institute, National Cancer Center)
  • Received : 2021.10.01
  • Accepted : 2021.10.29
  • Published : 2021.11.13
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Abstract

Purpose In 18F-FDG PET/CT, the absorption of 18F-FDG due to the activation of Brown Adipose Tissue (BAT) greatly interferes with the discrimination of lymph node malignant metastasis. Warming the patient's body temperature before and after injection of 18F-FDG to prevent FDG absorption by BAT is a safe and non-pharmacological approach. The purpose of this study was to identify and select patients with a high potential for BAT activation in advance, and to investigate whether BAT can inhibit FDG absorption when the body temperature is raised for a short time by directly applying heat to the target patient. Materials and Methods Among the patients who underwent 18F-FDG PET/CT at the National Cancer Center from January 2020 to December 2020, 825 female patients (415 in the thermal group, 410 in the non-thermal group) under 50 years old were included. The thermal group was administered heat for 10 minutes before injection of 18F-FDG. For statistical analysis, the Z test comparing the ratios between the two groups was used, and logistic regression analysis was performed to correct for important variables (BMI, outdoor temperature, blood sugar) according to the results of the previous retrospective study. Results Among 825 patients, 19 patients with BAT activated (Thermal group: 5(1.2%), Non-thermal group: 14(3.41%)) accounted for 2.3% of the total. As a result of performing the Z test to compare the ratios between the two groups, the activation of BAT in the thermal group was significantly decreased (P=0.034). In the univariate logistic regression analysis, the activation of BAT was also decreased in the thermal group (OR: 0.34, P<0.05). In the multivariate results, BAT activation increased in patients younger than 45 years old (OR: 4.46, P<0.05) and outdoor temperature less than 13.2 degrees (OR: 9.97, P<0.05). BAT activation tended to decrease in the thermal group, but there was no significant difference (OR: 0.37, P=0.066). Conclusion We confirmed that the activation of BAT tends to decrease by 62.5% in the group subjected to the thermal method, and it will be of great help in preventing FDG absorption of BAT more effectively in the future.

목적: 18F-FDG PET/CT에서 갈색지방세포(Brown fat 또는 Brown Adipose Tissue, 이하 BAT)의 활성화로 인한 FDG의 흡수는 림프절의 악성 전이 여부를 분별하는 데 큰 방해가 되며, 이로 인하여 재검사를 진행하는 번거로움을 초래할 수도 있다. BAT의 FDG 흡수를 방지하기 위해 18F-FDG 주사 전후 환자의 체온을 따뜻하게 하는 것은 안전하고도 비 약리적인 접근 방법이다. 본 연구에서는 BAT가 활성화될 가능성이 큰 환자를 미리 식별하여 선별한 후 대상 환자에게 직접적으로 열을 가하여 짧은 시간 동안 체온을 상승시켰을 때 BAT의 FDG 흡수를 억제할 수 있는지 알아보고자 하였다. 대상 및 방법: 2020년 1월부터 2020년 12월까지 1년간 국립암센터에서 18F-FDG PET/CT 검사를 시행한 환자 중 중복 검사를 포함한 825명(온열그룹 415명, 비온열그룹 410명)의 50세 이하 여성 환자를 대상으로 하였다. 온열 대상자에게는 18F-FDG의 주사 전 10분 동안 온열 요법을 시행하였다. 통계분석에는 두 그룹간의 비율을 비교하는 Z 검정을 이용하였고, 이전 후향적 연구 결과에 따른 중요 변수들(BMI, 외부기온, 혈당)을 보정하기 위하여 로지스틱 회귀분석을 수행하였다. 결과: 825명의 환자 중 BAT가 활성화된 환자는 19명(온열그룹 5명(1.2%), 비온열그룹 14명(3.41%))으로 전체 중 2.3%의 비율을 차지하였다. 두 그룹간의 비율 비교를 위하여 Z 검정을 시행한 결과, 온열그룹에서 BAT의 활성화가 유의한 차이로 감소하였다(P=0.034). 단변수 로지스틱 회귀분석에서도 온열그룹에서 BAT 활성화가 감소하였다(OR: 0.34, P<0.05). 반면, 45세 미만인 환자에게서(OR: 4.46, P<0.05), 외부기온 13.2도 미만에서(OR: 9.91, P<0.05) BAT 활성화가 증가하였다. 다변수 결과에서는, 45세 미만인 환자에게서(OR: 4.46, P<0.05), 외부기온 13.2도 미만에서(OR: 9.97, P<0.05) BAT 활성화가 증가하였고, 온열그룹에서 BAT 활성화가 감소하는 경향을 보였으나 유의한 차이는 없었다(OR: 0.37, P=0.066). 결론: 온열 요법을 시행한 그룹에서 BAT의 활성화가 62.5% 감소하는 경향성이 있음을 확인하였고, 앞으로 BAT의 FDG 흡수를 더 효과적으로 예방하는데 큰 도움이 될 것이라 사료된다.

Keywords

References

  1. Barrington SF, Maisey MN. Skeletal muscle uptake of fluorine-18-FDG: effect of oral diazepam. J Nucl Med 1996;37(7):1127-9.
  2. Parysow O, Mollerach AM, Jager V, et al. Low-dose oral propranolol could reduce brown adipose tissue F-18 FDG uptake in patients undergoing PET scans. Clin Nucl Med 32:351-357 https://doi.org/10.1097/01.rlu.0000259570.69163.04
  3. AGRAWAL A, NAIR N, and BAGHEL NS. A novel approach for reduction of brown fat uptake on FDG PET. BJR 2009; 82: 980
  4. Gelfand MJ, O'Hara SM, Curtwright LA, et al. Premedication to block [(18)F]FDG uptake in the brown adipose tissue of pediatric and adolescent patients. Pediatr Radiol 35:984-990 https://doi.org/10.1007/s00247-005-1505-8
  5. Sturkenboom MG, Hoekstra OS, Postema EJ, et al. A randomised controlled trial assessing the effect of oral diazepam on 18F-FDG uptake in the neck and upper chest region. Mol Imaging Biol 11:364-368 https://doi.org/10.1007/s11307-009-0207-2
  6. Christensen CR, Clark PB, Morton KA. Reversal of hypermetabolic brown adipose tissue in F-18 FDG PET imaging. Clin Nucl Med 31:193-196 https://doi.org/10.1097/01.rlu.0000204199.33136.05
  7. Hong, T.S., Shammas, A., Charron, M. et al. Brown adipose tissue 18F-FDG uptake in pediatric PET/CT imaging. Pediatr Radiol 41, 759-768 https://doi.org/10.1007/s00247-010-1925-y
  8. 최윤영, 장수진, 박순아, 김석기, 송호천. 종양환자에서 18F- Fluoro-2-Deoxyglucose PET/CT:대한핵의학회 절차지침. 대한핵의학회
  9. Boellaard, R. et al. FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur. J. Nucl. Med. Mol. Imaging 42, 328-354 https://doi.org/10.1007/s00259-014-2961-x
  10. 유연욱, 이충운, 정재훈, 김윤철, 이동은, 박소현, et al. 양전자방출단층촬영 시 갈색지방조직 활성화에 영향을 미치는 요인 분석. J Nucl Med Technol 2021;25:21-28
  11. A.M. Cypess, S. Lehman, G. Williams, I. Tal, D. Rodman, A.B. Goldfine et al. Identification and importance of brown adipose tissue in adult humans N. Engl. J. Med., 360, pp. 1509-1517 https://doi.org/10.1056/NEJMoa0810780
  12. W.D. van Marken Lichtenbelt, J.W. Vanhommerig, N.M. Smulders, J.M. a F.L. Drossaerts, G.J. Kemerink, N.D. Bouvy et al. Cold-activated brown adipose tissue in healthy men N. Engl. J. Med., 360, pp. 1500-1508 https://doi.org/10.1056/NEJMoa0808718
  13. K.A. Virtanen, M.E. Lidell, J. Orava, M. Heglind, R. Westergren, T. Niemi, et al. Functional brown adipose tissue in healthy adults N. Engl. J. Med., 360, pp. 1518-1525 https://doi.org/10.1056/NEJMoa0808949
  14. Zukotynski KA, Fahey FH, Laffin S, Davis R, Treves ST, Grant FD, et al. Constant ambient temperature of 24 degrees C significantly reduces FDG uptake by brown adipose tissue in children scanned during the winter. Eur J Nucl Med Mol Imaging 2009;36(4):602-6. https://doi.org/10.1007/s00259-008-0983-y
  15. Zukotynski KA, Fahey FH, Laffin S et al Seasonal variation in the effect of constant ambient temperature of 24℃ in reducing FDG uptake by brown adipose tissue in children. Eur J Nucl Med Mol Imaging 37:1854-1860 https://doi.org/10.1007/s00259-010-1485-2
  16. Garcia CA, Van Nostrand D, Atkins F, Acio E, Butler C, Esposito G, et al. Reduction of brown fat 2-deoxy-2-[F-18]fluoro-D-glucose uptake by controlling environmental temperature prior to positron emission tomography scan. Mol Imaging Biol 2006;8(1):24-9. https://doi.org/10.1007/s11307-005-0030-3
  17. Roberge, R. J. Venodilatation techniques to enhance vein puncture and intravenous cannulation Journal of Emergency Medicine, 27, 69-73. https://doi.org/10.1016/j.jemermed.2004.02.011
  18. Lim NY, Jeong HC, Lee SW, Kim WJ Effect of Heat Therapy to Superficial and Deep Body Temperatures according to Applying Dry and Moist Heats on Shoulder and Thigh J Korean Biol Nurs Sci 2011; 13(3): 269-275
  19. M.R. Boon, L.E.H. Bakker, R. a D. van der Linden, L. Pereira Arias-Bouda, F. Smit, H.J. Verberne, et al. Supraclavicular skin temperature as a measure of 18F-FDG uptake by BAT in human subjects PLoS One, 9, p. e98822 https://doi.org/10.1371/journal.pone.0098822
  20. B. Martinez-Tellez, G. Sanchez-Delgado, F.M. Acosta, J.M.A. Alcantara, M.R. Boon, P.C.N. Rensen, et al. Differences between the most used equations in BAT-human studies to estimate parameters of skin temperature in young lean men Sci. Rep., 7, p. 10530 https://doi.org/10.1038/s41598-017-10444-5
  21. A. a. J.J. van der Lans, M.J. Vosselman, M.J.W. Hanssen, B. Brans, W.D. van Marken Lichtenbelt Supraclavicular skin temperature and BAT activity in lean healthy adults J. Physiol. Sci., 66, pp. 77-83 https://doi.org/10.1007/s12576-015-0398-z
  22. P. Lee, R. Bova, L. Schofield, W. Bryant, W. Dieckmann, A. Slattery, et al. Greenfield Brown adipose tissue exhibits a glucose-responsive thermogenic biorhythm in humans Cell Metabol., 23, pp. 1-8 https://doi.org/10.1016/j.cmet.2015.11.001
  23. M.E. Symonds, K. Henderson, L. Elvidge, C. Bosman, D. Sharkey, A.C. Perkins, et al. Thermal imaging to assess age-related changes of skin temperature within the supraclavicular region co-locating with brown adipose tissue in healthy children J. Pediatr., 161, pp. 892-898 https://doi.org/10.1016/j.jpeds.2012.04.056