Effect of Propranolol on 18F-Fluorodeoxyglucose Uptake in Brown Adipose Tissue in Children and Young Adults with Neoplastic Diseases

Mol Imaging Biol. 2021 Apr;23(2):260-269. doi: 10.1007/s11307-020-01547-z. Epub 2020 Oct 16.


Purpose: To evaluate the effectiveness of propranolol at mitigating FDG uptake in brown adipose tissue (BAT) of pediatric patients with known or suspected malignancies.

Methods: PET/CT scans of 3 cohorts of patients treated from 2005 to 2017 were scored for the presence of FDG uptake by BAT at 7 sites: right or left neck/supraclavicular area, right or left axilla, mediastinum, posterior thorax, and abdomen/pelvis. Uptake was scored as follows: 0, none; 1, mild uptake < liver; 2, moderate uptake = liver; and 3, intense uptake > liver. Group 1 consisted of 323 patients (630 scans) who had no specific preparation to mitigate FDG uptake by BAT. Group 2 consisted of 345 patients (705 scans) who underwent only warming in an uptake room with a fixed temperature at 24 °C. Group 3 consisted of 622 patients (1457 scans) who underwent warming. In group 3, patients 8 years and older, 471 patients (1114 scans), were also pre-medicated with oral propranolol 60 min before injection of FDG. Generalized estimation equation, using the logit link method, was used to model the relationship between the incidence of BAT score > 0, in any site, as a function of age, sex, seasonal effect, and body surface area (BSA).

Results: In patients aged 8 years or older, the incidence of BAT uptake was 35-44 % and declined to 15 % with propranolol. BAT was most frequent in the neck (26 %), axilla (18 %), posterior thorax (18 %), mediastinum (14 %), and abdomen/pelvis (8 %); BAT was less common in warm months (p = 0.001). No substantial benefit was shown with pre-injection warming alone. No significant effect was found for age, sex, or BSA separately. When BAT uptake was present, it was usually intense.

Conclusion: Propranolol preparation minimizes FDG uptake by BAT and should be considered routine for pediatric FDG PET/CT cancer-related protocols in children, adolescents, and young adults.

Keywords: Brown adipose tissue; FDG; PET/CT; Pediatric; Propranolol.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adipose Tissue, Brown / drug effects
  • Adipose Tissue, Brown / metabolism*
  • Adipose Tissue, Brown / pathology
  • Administration, Oral
  • Adolescent
  • Adrenergic beta-Antagonists / administration & dosage
  • Child
  • Child, Preschool
  • Cold Temperature
  • Female
  • Fluorodeoxyglucose F18 / administration & dosage
  • Fluorodeoxyglucose F18 / pharmacokinetics*
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Neoplasms / diagnostic imaging*
  • Neoplasms / metabolism
  • Neoplasms / pathology
  • Positron Emission Tomography Computed Tomography / methods*
  • Propranolol / administration & dosage*
  • Radiopharmaceuticals / pharmacokinetics
  • Tissue Distribution
  • Young Adult


  • Adrenergic beta-Antagonists
  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18
  • Propranolol