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. 2025 Nov;55(12):2643-2650.
doi: 10.1007/s00247-025-06381-5. Epub 2025 Sep 4.

Does the addition of fentanyl premedication impact brown fat uptake in children undergoing a warming protocol for FDG PET?

Mariama Lukulay  1 , Pradipta Debnath  2 , Christopher G Anton  1   2 , Yinan Li  1   2 , Adam F Prasanphanich  1   2 , Susan E Sharp  1   2 , Bin Zhang  1   2 , Andrew T Trout  1   2 , Cara E Morin  3   4
Affiliations

Does the addition of fentanyl premedication impact brown fat uptake in children undergoing a warming protocol for FDG PET?

Mariama Lukulay et al. Pediatr Radiol. 2025 Nov.

Abstract

Background: Fentanyl is used in some pediatric practices with a goal of suppressing 18F-fluorodeoxyglucose (18F-FDG) uptake in brown fat.

Objective: The purpose of this study was to examine the frequency, intensity, and distribution of brown fat uptake in warmed children undergoing 18F-FDG PET/CT with and without premedication with fentanyl. MATERIALS AND METHODS: This retrospective study included children (< 18 years old) who underwent 18F-FDG-PET from 2014 to 2024 at a center that routinely warms patients and uses intravenous fentanyl for brown fat suppression for most patients. Three radiologists assessed the presence, intensity, and location of brown fat uptake. Chi-square test and two-sample t-test were used to compare the demographics and brown fat uptake between premedication and non-premedication groups.

Results: Among 873 18F-FDG-PETs, 595 (68%) were performed with fentanyl premedication and warming and 278 (32%) were conducted with warming alone. Brown fat uptake was observed in 46 (5.3%) FDG-PETs, 32/595 (5.4%) in the premedicated group and 14/278 (5.0%) in the non-premedicated group (P = 0.83). No differences were found in brown fat intensity or location based on premedication status. Age (14.5 vs. 8.5; P < 0.001) and BMI (20.1 vs. 17.7; P < 0.001) were significantly associated with brown fat uptake.

Conclusion: Fentanyl premedication does not significantly affect brown fat uptake frequency, intensity, or location in warmed children undergoing 18F-FDG-PET.

Keywords: Computed tomography; Fentanyl; Positron emission tomography.

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Conflict of interest statement

Declarations. Conflicts of interest: Ms. Lukulay has no declarations of interest Dr. Debnath has no declarations of interest. Dr. Anton has no declarations of interest. Dr. Li has no declarations of interest. Dr. Prasanphanich has no declarations of interest. Dr. Sharp has no declarations of interest. Dr. Zhang has no declarations of interest. Dr. Trout has previously consulted for GE Healthcare related to PET imaging. Dr. Trout has PET-related research support from GE Healthcare and unrelated research support from Siemens Healthineers and Perspectum Inc. No support was received for the current work. Dr. Morin has no declarations of interest.

Figures

Fig. 1
Fig. 1
Examples of the Deauville-analog scoring system used to grade brown fat uptake intensity (arrows). All images are maximum uptake projection images from 18F-FDG-PET exams. a Score 2, uptake less than mediastinal blood pool; a 15-year-old female with thrombotic thrombocytopenic purpura; b score 3, uptake greater than mediastinal blood pool and less than liver; a 16-year-old male with suspected lymphoma; c score 4, uptake moderately more than liver; a 15-year-old male with suspected lymphoma; d score 5, uptake markedly more than liver; a 16-year-old male with Hodgkin lymphoma
Fig. 2
Fig. 2
Distribution of locations of brown fat uptake found in patients with no premedication (blue) and those who received fentanyl premedication (orange)
See this image and copyright information in PMC

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