Case Author(s): Feiyu Xue, M.D., Ph.D. and Jerold W. Wallis, M.D. , 6/28/04 . Rating: #D3, #Q3

Diagnosis: Brown fat uptake on MIBG scintigraphy

Brief history:

3-year-old boy with history of neuroblastoma


Whole body MIBG scintigraphy, 5/5/04

View main image(mb) in a separate image viewer

Full history/Diagnosis is available below

Diagnosis: Brown fat uptake on MIBG scintigraphy

Full history:

3-year-old boy with history of neuroblastoma, treated with chemotherapy, radiation chemotherapy, and stem cell transplant. He presents for follow-up evaluation.


2.1 mCi MIBG i.v.


There is no evidence of recurrent or metastatic disease. Normal uptake is seen in salivary glands, heart and liver. Increased activity in the region of upper chest laterlly is seen; this is a normal variant, likely due to brown fat.


The increased activity in the region upper chest laterally is due to brown fat. Similar activity is seen on an earlier study on 10/29/03 (see follow up image). Brown fat plays an important role in cold-induced and diet-induced thermogenesis. Children have abundant brown fat in the region of neck and upper chest. The thermogenesis of brown fat is regulated mainly by the sympathetic nervous system (via -adrenergic receptors). An animal study demonstrate localization of tracer in the brown fat tissue in mice after I.V. injection of I-125 MIBG (1). Increased activity seen on MIBG scan is thought due to binding of tracer to -adrenergic receptors in brown fat (2).

References: (1) Okuyama C, Sakane N, Yoshida T, Shima K, Kurosawa H, Kumamoto K, Ushijima Y, Nishimura T. (123)I- or (125)I-metaiodobenzylguanidine visualization of brown adipose tissue. J Nucl Med. 2002 Sep;43(9):1234-40.

(2) Okuyama C, Ushijima Y, Kubota T, Yoshida T, Nakai T, Kobayashi K, Nishimura T. 123I-Metaiodobenzylguanidine uptake in the nape of the neck of children: likely visualization of brown adipose tissue. J Nucl Med. 2003 Sep;44(9):1421-5.

View followup image(mb). Whole body MIBG scintigraphy, 10/29/03

Major teaching point(s):

Be aware that activity in anterior neck and upper chest in brown fat can be normal findings on MIBG scintigraphy.

ACR Codes and Keywords:

References and General Discussion of MIBG Scintigraphy (Anatomic field:Genitourinary System, Category:Misc)

Search for similar cases.

Edit this case

Add comments about this case

Return to the Teaching File home page.

Case number: mb007

Copyright by Wash U MO