Pharmacological blockade with propranolol can suppress 18F-FDG uptake in brown fat, allowing non-invasive differentiation of benign hibernoma from malignant mediastinal masses.
May aid non-invasive hibernoma differentiation on FDG-PET; hypothesis-generating and requires prospective validation.
Positron Tomography/Computer Tomography (PET/CT) imaging of 18F-Fluorodeoxyglucose (18F-FDG) uptake is frequently used to recognize malignant nature of abnormal findings at anatomical investigations. However, several benign structures can mimic cancer glucose avidity. This case report pertains to a large mediastinal mass, incidentally detected on a coronary Computer Tomography (CT) study and showing heterogeneous signal hyperintensity in T1weighted sequences at a subsequent Magnetic Resonance Imaging (MRI). CT-guided biopsy failed to provide adequate specimen; 18F-FDG PET/CT documented an extremely high glucose analogue consumption (maximum Standardized Uptake Value: 29). In order to exclude every alternative possibility before attempting a potentially hazardous surgery, we hypothesized the possible presence of a hibernoma. To test this hypothesis, we verified the influence of sympathetic innervation on lesion uptake, by repeating 18F-FDG imaging under beta-blockade: this scan documented the complete disappearance of the anomalous tracer uptake. A 6-months follow-up scan documented stable lesion volume and persistently absent 18F-FDG uptake under the beta-blockers, thus presumably excluding the malignant nature of the increased tracer uptake.
No takes yet. Share an insight, caveat, or question.
Bongioanni F Pomposelli E (2015) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: