title: Anatomical Grading for Metabolic Activity of Brown Adipose Tissue.
abstract: BACKGROUND
  Recent advances in obesity research suggest that BAT activity, or absence thereof, may be an important factor in the growing epidemic of obesity and its manifold complications. It is thus important to assess larger populations for BAT-activating and deactivating factors. 18FDG-PET/CT is the standard method to detect and quantify metabolic BAT activity, however, the manual measurement is not suitable for large studies due to its time-consuming nature and poor reproducibility across different software and devices.
  
  
  RESULTS
  In a retrospective study, 1060 consecutive scans of 1031 patients receiving a diagnostic 18FDG-PET/CT were examined for the presence of active BAT. Patients were classified according to a 3-tier system (supraclavicular, mediastinal, infradiaphragmatic) depending on the anatomical location of their active BAT depots, with the most caudal location being the decisive factor. The metabolic parameters (maximum activity, total volume and total glycolysis) were measured on a standard PET/CT workstation. Mean age of the population was 60±14.6y. 41.61% of patients were female. Metabolically active BAT was found in 53 patients (5.1%). Female, younger and leaner patients tended to have more active BAT, higher metabolic activity and more caudally active BAT. In total, 15 patients showed only supraclavicular, 27 additional mediastinal, and 11 infradiaphragmal activity. Interestingly, the activation of BAT always followed a cranio-caudal gradient. This anatomical pattern correlated with age and BMI as well as with all metabolic parameters, including maximum and total glycolysis (p<0.001).
  
  
  CONCLUSIONS
  Based on our data we propose a simple method to grade or quantify the degree of BAT amount/activity in patients based on the most caudally activated depot. As new modalities for BAT visualization may arise in the future, this system would allow direct comparability with other modalities, in contrary to the PET-metrics, which are restricted to 18FDG-PET/CT.
authors.affiliation: Department of Nuclear Medicine, University Hospital of Zurich, Zurich, Switzerland.|Department of Diagnostic and Interventional Radiology, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Anton S
authors.initials: AS
authors.lastname: Becker
authors.affiliation: Department of Nuclear Medicine, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Hannes W
authors.initials: HW
authors.lastname: Nagel
authors.affiliation: Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Wolfrum
authors.affiliation: Department of Nuclear Medicine, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Irene A
authors.initials: IA
authors.lastname: Burger
mesh_terms: D002001:Adipose Tissue, Brown / Q000000981:diagnostic imaging* / Q000378:metabolism*; D000328:Adult; D000368:Aged; D005260:Female; D019298:Glucose-6-Phosphate / Q000008:administration & dosage / Q000031:analogs & derivatives*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000000981:diagnostic imaging* / Q000401:mortality*; D049268:Positron-Emission Tomography; D011859:Radiography
chemical_list: C047515:2-fluoro-2-deoxyglucose-6-phosphate; D019298:Glucose-6-Phosphate