A Third of the Radiotracer Dose: Two Decades of Progress in Pediatric [F]fluorodeoxyglucose PET/CT and PET/MR Imaging

Overview

Journal Eur Radiol

Specialty Radiology

Date 2023 Oct 19

PMID 37855853

Authors

Stephan Waelti

Stephan Skawran

Thomas Sartoretti

Moritz Schwyzer

Antonio G Gennari

Cacilia Mader

Valerie Treyer

Christian J Kellenberger

Irene A Burger

Thomas Hany

Alexander Maurer

Martin W Huellner

Michael Messerli

Affiliations

Soon will be listed here.

Abstract

Objectives: To assess the evolution of administered radiotracer activity for F-18-fluorodeoxyglucose (18F-FDG) PET/CT or PET/MR in pediatric patients (0-16 years) between years 2000 and 2021.

Methods: Pediatric patients (≤ 16 years) referred for 18F-FDG PET/CT or PET/MR imaging of the body during 2000 and 2021 were retrospectively included. The amount of administered radiotracer activity in megabecquerel (MBq) was recorded, and signal-to-noise ratio (SNR) was measured in the right liver lobe with a 4 cm volume of interest as an indicator for objective image quality. Descriptive statistics were computed.

Results: Two hundred forty-three children and adolescents underwent a total of 466 examinations. The median injected 18F-FDG activity in MBq decreased significantly from 296 MBq in 2000-2005 to 100 MBq in 2016-2021 (p < 0.001), equaling approximately one-third of the initial amount. The median SNR ratio was stable during all years with 11.7 (interquartile range [IQR] 10.7-12.9, p = 0.133).

Conclusions: Children have benefited from a massive reduction in the administered 18F-FDG dose over the past 20 years without compromising objective image quality.

Clinical Relevance Statement: Radiotracer dose was reduced considerably over the past two decades of pediatric F-18-fluorodeoxyglucose PET/CT and PET/MR imaging highlighting the success of technical innovations in pediatric PET imaging.

Key Points: • The evolution of administered radiotracer activity for F-18-fluorodeoxyglucose (18F-FDG) PET/CT or PET/MR in pediatric patients (0-16 years) between 2000 and 2021 was assessed. • The injected tracer activity decreased by 66% during the study period from 296 megabecquerel (MBq) to 100 MBq (p < 0.001). • The continuous implementation of technical innovations in pediatric hybrid 18F-FDG PET has led to a steady decrease in the amount of applied radiotracer, which is particularly beneficial for children who are more sensitive to radiation.

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References

Freebody J, Wegner E, Rossleigh M . 2-deoxy-2-((18)F)fluoro-D-glucose positron emission tomography/computed tomography imaging in paediatric oncology. World J Radiol. 2014; 6(10):741-55. PMC: 4209422. DOI: 10.4329/wjr.v6.i10.741. View

Harrison D, Parisi M, Shulkin B . The Role of F-FDG-PET/CT in Pediatric Sarcoma. Semin Nucl Med. 2017; 47(3):229-241. DOI: 10.1053/j.semnuclmed.2016.12.004. View

Kluge R, Kurch L, Georgi T, Metzger M . Current Role of FDG-PET in Pediatric Hodgkin's Lymphoma. Semin Nucl Med. 2017; 47(3):242-257. DOI: 10.1053/j.semnuclmed.2017.01.001. View

Uslu L, Donig J, Link M, Rosenberg J, Quon A, Daldrup-Link H . Value of 18F-FDG PET and PET/CT for evaluation of pediatric malignancies. J Nucl Med. 2015; 56(2):274-86. DOI: 10.2967/jnumed.114.146290. View

Gungor T, Engel-Bicik I, Eich G, Willi U, Nadal D, Hossle J . Diagnostic and therapeutic impact of whole body positron emission tomography using fluorine-18-fluoro-2-deoxy-D-glucose in children with chronic granulomatous disease. Arch Dis Child. 2001; 85(4):341-5. PMC: 1718940. DOI: 10.1136/adc.85.4.341. View

Garg G, DaSilva R, Bhalakia A, Milstein D . Utility of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography in a child with chronic granulomatous disease. Indian J Nucl Med. 2016; 31(1):62-4. PMC: 4746847. DOI: 10.4103/0972-3919.172366. View

Theobald I, Fischbach R, Hulskamp G, Franzius C, Frosch M, Roth J . [Pulmonary aspergillosis as initial manifestation of septic granulomatosis (chronic granulomatous disease, CGD) in a premature monozygotic female twin and FDG-PET diagnosis of spread of the disease]. Radiologe. 2002; 42(1):42-5. DOI: 10.1007/s117-002-8116-0. View

Meller J, Sahlmann C, Scheel A . 18F-FDG PET and PET/CT in fever of unknown origin. J Nucl Med. 2007; 48(1):35-45. View

Baum S, Fruhwald M, Rahbar K, Wessling J, Schober O, Weckesser M . Contribution of PET/CT to prediction of outcome in children and young adults with rhabdomyosarcoma. J Nucl Med. 2011; 52(10):1535-40. DOI: 10.2967/jnumed.110.082511. View

10.

Ricard F, Cimarelli S, Deshayes E, Mognetti T, Thiesse P, Giammarile F . Additional Benefit of F-18 FDG PET/CT in the staging and follow-up of pediatric rhabdomyosarcoma. Clin Nucl Med. 2011; 36(8):672-7. DOI: 10.1097/RLU.0b013e318217ae2e. View

11.

London K, Stege C, Cross S, Onikul E, Graf N, Kaspers G . 18F-FDG PET/CT compared to conventional imaging modalities in pediatric primary bone tumors. Pediatr Radiol. 2011; 42(4):418-30. DOI: 10.1007/s00247-011-2278-x. View

12.

Boktor R, Omar W, Mousa E, Attia I, Refaat A, Eltawdy M . A preliminary report on the impact of ¹⁸F-FDG PET/CT in the management of paediatric head and neck cancer. Nucl Med Commun. 2011; 33(1):21-8. DOI: 10.1097/MNM.0b013e32834c3ebe. View

13.

Halalsheh H, Kaste S, Navid F, Bahrami A, Shulkin B, Rao B . The role of routine imaging in pediatric cutaneous melanoma. Pediatr Blood Cancer. 2018; 65(12):e27412. PMC: 6193828. DOI: 10.1002/pbc.27412. View

14.

Theruvath A, Rashidi A, Nyalakonda R, Avedian R, Steffner R, Spunt S . Ferumoxytol magnetic resonance imaging detects joint and pleural infiltration of bone sarcomas in pediatric and young adult patients. Pediatr Radiol. 2021; 51(13):2521-2529. PMC: 8602726. DOI: 10.1007/s00247-021-05156-y. View

15.

Biassoni L, Easty M . Paediatric nuclear medicine imaging. Br Med Bull. 2017; 123(1):127-148. DOI: 10.1093/bmb/ldx025. View

16.

Cheng G, Servaes S, Zhuang H . Value of (18)F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography scan versus diagnostic contrast computed tomography in initial staging of pediatric patients with lymphoma. Leuk Lymphoma. 2012; 54(4):737-42. DOI: 10.3109/10428194.2012.727416. View

17.

Jadvar H, Connolly L, Fahey F, Shulkin B . PET and PET/CT in pediatric oncology. Semin Nucl Med. 2007; 37(5):316-31. DOI: 10.1053/j.semnuclmed.2007.04.001. View

18.

London K, Cross S, Onikul E, Dalla-Pozza L, Howman-Giles R . 18F-FDG PET/CT in paediatric lymphoma: comparison with conventional imaging. Eur J Nucl Med Mol Imaging. 2010; 38(2):274-84. DOI: 10.1007/s00259-010-1619-6. View

19.

Colleran G, Kwatra N, Oberg L, Grant F, Drubach L, Callahan M . How we read pediatric PET/CT: indications and strategies for image acquisition, interpretation and reporting. Cancer Imaging. 2017; 17(1):28. PMC: 5678769. DOI: 10.1186/s40644-017-0130-8. View

20.

Foucault A, Ancelet S, Dreuil S, Caer-Lorho S, Ducou le Pointe H, Brisse H . Childhood cancer risks estimates following CT scans: an update of the French CT cohort study. Eur Radiol. 2022; 32(8):5491-5498. DOI: 10.1007/s00330-022-08602-z. View