PET-BT GÖRÜNTÜLEME SIRASINDA SEDOANALJEZİ UYGULANAN ÇOCUK HASTALARDA KAHVERENGİ YAĞ DOKUSUNDA F18-FDG TUTULUMUNUN DEĞERLENDİRİLMESİ

Amaç: Pozitron emisyon tomografisi-Bilgisayarl› tomografi (PET-BT) baflta onkoloji alan›nda olmak üzere pek çok alanda görüntülemede kullan›lmaktad›r. Flor-18 ile iflaretli fluorodeoksiglikoz (F18-FDG) görüntülemede en s›k kullan›lan radyofarmasötiktir. F18-FDG PET-BT’de s›k görülen varyasyonlardan biri, yalanc› pozitif yorumlamaya neden olan kahverengi ya¤ dokusu (KYD) tutulumudur. Özelikle PET ve BT görüntülerinin eflleflmemesi de¤erlendirmeyi zorlaflt›rmaktad›r. Baz› yöntemlerin KYD’de F18-FDG tutulumunu engelledi¤ini bildiren çal›flmalar bulunmaktad›r. Bu çal›flmada amac›m›z çocukluk yafl grubunda sedoanaljezi eflli¤inde F18-FDG PET-BT yap›lan hastalarda KYD tutulumunu de¤erlendirmektir. Yöntem: Oda ›s›s›nda F18-FDG uygulanarak sedoanaljezi eflli¤inde PET-BT görüntüleme yap›lan hastalar retrospektif olarak incelendi. Hastalar›n demografik verileri (yafl, cinsiyet, tan›, a¤›rl›k, açl›k kan flekeri), PET-BT endikasyonu, kullan›lan sedoanaljezik ilaçlar ve dozu retrospektif olarak taranarak elde edildi. Hastalar›n görüntüleri bir nükleer t›p hekimi taraf›ndan de¤erlendirildi. KYD’nin en yo¤un oldu¤u 6 bölge (boyun, omuz bölgesi, aksilla, mediasten, kostovertebral bileflkeler, subdiyafragmatik alan) incelendi. KYD’de F18-FDG tutulumunun varl›¤› görsel olarak “var-yok” fleklinde de¤erlendirildi. Bulgular: ‹ki hastada diyaframa uyan alanda diyafram kas tutulumu ile uyumlu oldu¤u düflünülen diffüz artm›fl F18-FDG tutulumu izlendi, KYD tutulumu düflünülmedi. Yirmi iki hastada 6 bölgede zemin aktivite düzeyinde F18-FDG tutulumu izlendi, KYD tutulumu olmad›¤› tespit edildi. Sonuç: Çocuk yafl grubunda F18-FDG PET-BT tetkikinde rutin olarak sedoanaljezi uygulamas›n›n KYD tutulumunu engelledi¤i, bu sayede yalanc› pozitif yorumlanmay› önledi¤i, F18-FDG PET-BT görüntülerinin optimal de¤erlendirilmesine katk›da bulundu¤u kan›s›nday›z.

EVALUATION OF F18-FDG UPTAKE OF BROWN FAT TISSUE ON SEDOANALGESIA APPLIED CHILDREN DURING PET-CT IMAGING

Objective: Positron emission tomography-computed tomography (PET-CT) is a frequently used imaging procedure especially in oncology. The most commonly used radiopharmaceutical is fluorodeoxyglucose labelled with fluoro-18 (F18-FDG). The involvement of brown fat tissue (BFT) is one of the variants which causes false-positive interpretation during F18-FDG PET-CT. It is difficult to evaluate non-matching PET and CT images. Some studies have reported that F18-FDG uptake is inhibited in some cases due to BFT. Our aim was to evaluate BFT involvement during F18-FDG PET-CT under sedoanalgesia in paediatric patients. Method: Patients undergoing PET-CT imaging with F18-FDG in the room temperature under sedoanalgesia were retrospectively reviewed. The demographic data (age, sex, diagnosis, weight, fasting blood glucose) of the patients and, PET-CT indications, sedoanalgesia type were noted. The images where BFT, involvement by a nuclear medicine medicine physician, is highly expected such as neck, shoulder region, axilla, mediastinum, costovertebral junctions, subdiaphragmatic area. The presence of F18-FDG uptake was also assessed as present and absent. Results: In two patients, diffuse by increased F18-FDG uptake was evaluated to be compatible with diaphragm muscle involvement due to respiratory causes. However this involvement wasn’t interpreted as due to BFT involvement. F18-FDG uptake in base activity levels was observed in 6 regions in 22 patients. Conclusion: We believe that F18-FDG PET-CT shold be routinely performed with sedoanalgesia in the pediatric age group to prevent false-positive and assure an optimal assessment.

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