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Evaluation of pediatric malignancies using total-body PET/CT with half-dose [18F]-FDG

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Abstract

Purpose

To explore the impact of a true half dose of [18F]-FDG on image quality in pediatric oncological patients undergoing total-body PET/CT and investigate short acquisition times with half-dose injected activity.

Methods

One hundred pediatric oncological patients who underwent total-body PET/CT using the uEXPLORER scanner after receiving a true half dose of [18F]-FDG (1.85 MBq/kg) were retrospectively enrolled. The PET images were first reconstructed using complete 600-s data and then split into 300-s, 180-s, 60-s, 40-s, and 20-s duration groups (G600 to G20). The subjective analysis was performed using 5-point Likert scales. Objective quantitative metrics included the maximum standard uptake value (SUVmax), SUVmean, standard deviation (SD), signal-to-noise ratio (SNR), and SNRnorm of the background. The variabilities in lesion SUVmean, SUVmax, and tumor-to-background ratio (TBR) were also calculated.

Results

The overall image quality scores in the G600, G300, G180, and G60 groups were 4.9 ± 0.2, 4.9 ± 0.3, 4.4 ± 0.5, and 3.5 ± 0.5 points, respectively. All the lesions identified in the half-dose images were localized in the G60 images, while 56% of the lesions could be clearly identified in the G20 images. With reduced acquisition time, the SUVmax and SD of the backgrounds were gradually increased, while the TBR values showed no statistically significant differences among the groups (all p > 0.1). Using the half-dose images as a reference, the variability in the lesion SUVmax gradually increased from the G180 to G20 images, while the lesion SUVmean remained stable across all age groups. SNRnorm was highly negatively correlated with age.

Conclusion

Total-body PET/CT with a half dose of [18F]-FDG (1.85 MBq/kg, estimated whole-body effective dose: 1.76–2.57 mSv) achieved good performance in pediatric patients, with sufficient image quality and good lesion conspicuity. Sufficient image quality and lesion conspicuity could be maintained at a fast scanning time of 60 s with half-dose activity.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Code availability

The code applied during and/or analyzed during the current study is available from the corresponding author upon reasonable request.

References

  1. Boellaard RD-BR, Oyen WJ, Giammarile F, Tatsch K, Eschner W, et al. European Association of Nuclear Medicine (EANM). FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging. 2015;42:28–54. https://doi.org/10.1007/s00259-014-2961-x.

    Article  CAS  Google Scholar 

  2. Fahey FHTS, Adelstein SJ. Minimizing and communicating radiation risk in pediatric nuclear medicine. J Nucl Med. 2011;52:1240–51. https://doi.org/10.2967/jnumed.109.069609.

    Article  PubMed  Google Scholar 

  3. 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;36:672–7. https://doi.org/10.1097/RLU.0b013e318217ae2e.

    Article  PubMed  Google Scholar 

  4. Fahey FH, Goodkind A, MacDougall RD, Oberg L, Ziniel SI, Cappock R, et al. Operational and dosimetric aspects of pediatric PET/CT. J Nucl Med. 2017;58:1360–6. https://doi.org/10.2967/jnumed.116.182899.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Turpin S, Martineau P, Levasseur MA, Meijer I, Décarie JC, Barsalou J, et al. 18F-Flurodeoxyglucose positron emission tomography with computed tomography (FDG PET/CT) findings in children with encephalitis and comparison to conventional imaging. Eur J Nucl Med Mol Imaging. 2019;46:1309–24. https://doi.org/10.1007/s00259-019-04302-x.

    Article  PubMed  Google Scholar 

  6. Chawla SC, Federman N, Zhang D, Nagata K, Nuthakki S, McNitt-Gray M, et al. Estimated cumulative radiation dose from PET/CT in children with malignancies: a 5-year retrospective review. Pediatr Radiol. 2010;40:681–6. https://doi.org/10.1007/s00247-009-1434-z.

    Article  PubMed  Google Scholar 

  7. Mercolini F, Zucchetta P, Jehanno N, Corradini N, Van Rijn RR, Rogers T, et al. Role of (18)F-FDG-PET/CT in the staging of metastatic rhabdomyosarcoma: a report from the European paediatric Soft tissue sarcoma Study Group. Eur J cancer (Oxford, England: 1990). 2021;155:155–62. https://doi.org/10.1016/j.ejca.2021.07.006.

    Article  CAS  Google Scholar 

  8. Nievelstein RA, Quarlesvanufford HM, Kwee TC, Bierings MB, Ludwig I, Beek FJ, et al. Radiation exposure and mortality risk from CT and PET imaging of patients with malignant lymphoma. Eur Radiol. 2012;22:1946–54. https://doi.org/10.1007/s00330-012-2447-9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Alessio AM, Farrell MB, Fahey FH. Role of reference levels in nuclear medicine: a report of the SNMMI Dose Optimization Task Force. J Nucl Med. 2015;56:1960–4. https://doi.org/10.2967/jnumed.115.160861.

    Article  PubMed  Google Scholar 

  10. Poli GL, Torres L, Coca M, Veselinovic M, Lassmann M, Delis H, et al. Paediatric nuclear medicine practice: an international survey by the IAEA. Eur J Nucl Med Mol Imaging. 2020;47:1552–63. https://doi.org/10.1007/s00259-019-04624-w.

    Article  CAS  PubMed  Google Scholar 

  11. Treves ST, Gelfand MJ, Fahey FH, Parisi MT. 2016 Update of the North American Consensus Guidelines for Pediatric Administered Radiopharmaceutical Activities. J Nucl Med. 2016;57:15n-n18.

    PubMed  Google Scholar 

  12. Lassmann M, Biassoni L, Monsieurs M, Franzius C. The new EANM paediatric dosage card: additional notes with respect to F-18. Eur J Nucl Med Mol Imaging. 2008;35:1666–8. https://doi.org/10.1007/s00259-008-0799-9.

    Article  CAS  PubMed  Google Scholar 

  13. Cherry SR, Jones T, Karp JS, Qi J, Moses WW, Badawi RD. Total-body PET: maximizing sensitivity to create new opportunities for clinical research and patient care. J Nucl Med. 2018;59:3–12. https://doi.org/10.2967/jnumed.116.184028.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Badawi RD, Shi H, Hu P, Chen S, Xu T, Price PM, et al. First human imaging studies with the EXPLORER total-body PET scanner. J Nucl Med. 2019;60:299–303. https://doi.org/10.2967/jnumed.119.226498.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Schmall JP, Surti S, Otero HJ, Servaes S, Karp JS, States LJ. Investigating low-dose image quality in whole-body pediatric (18)F-FDG scans using time-of-flight PET/MRI. J Nucl Med. 2021;62:123–30. https://doi.org/10.2967/jnumed.119.240127.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Gatidis S, Schmidt H, la Fougère C, Nikolaou K, Schwenzer NF, Schäfer JF. Defining optimal tracer activities in pediatric oncologic whole-body (18)F-FDG-PET/MRI. Eur J Nucl Med Mol Imaging. 2016;43:2283–9. https://doi.org/10.1007/s00259-016-3503-5.

    Article  CAS  PubMed  Google Scholar 

  17. Kertész H, Beyer T, London K, Saleh H, Chung D, Rausch I, Cal-Gonzalez J, Kitsos T, Kench PL. Reducing radiation exposure to paediatric patients undergoing [18F]FDG-PET/CT imaging. Mol Imaging Biol. 2021 ;23(5):775–86. https://doi.org/10.1007/s11307-021-01601-4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Zhao YM, Li YH, Chen T, Zhang WG, Wang LH, Feng J, et al. Image quality and lesion detectability in low-dose pediatric (18)F-FDG scans using total-body PET/CT. Eur J Nucl Med Mol Imaging. 2021;48:3378–85. https://doi.org/10.1007/s00259-021-05304-4.

    Article  CAS  PubMed  Google Scholar 

  19. Liu G, Hu P, Yu H, Tan H, Zhang Y, Yin H, et al. Ultra-low-activity total-body dynamic PET imaging allows equal performance to full-activity PET imaging for investigating kinetic metrics of (18)F-FDG in healthy volunteers. Eur J Nucl Med Mol Imaging. 2021;48:2373–83. https://doi.org/10.1007/s00259-020-05173-3.

    Article  PubMed  Google Scholar 

  20. Tan H, Sui X, Yin H, Yu H, Gu Y, Chen S, et al. Total-body PET/CT using half-dose FDG and compared with conventional PET/CT using full-dose FDG in lung cancer. Eur J Nucl Med Mol Imaging. 2021;48:1966–75. https://doi.org/10.1007/s00259-020-05091-4.

    Article  CAS  PubMed  Google Scholar 

  21. Spinelli A, Buoncristiano M, Nardone P, Starc G, Hejgaard T, Júlíusson PB, et al. Thinness, overweight, and obesity in 6- to 9-year-old children from 36 countries: The World Health Organization European Childhood Obesity Surveillance Initiative-COSI 2015–2017. Obesity Rev. 2021;22(Suppl 6):e13214. https://doi.org/10.1111/obr.13214.

    Article  Google Scholar 

  22. Daniels SR, Arnett DK, Eckel RH, Gidding SS, Hayman LL, Kumanyika S, et al. Overweight in children and adolescents: pathophysiology, consequences, prevention, and treatment. Circulation. 2005;111:1999–2012. https://doi.org/10.1161/01.Cir.0000161369.71722.10.

    Article  PubMed  Google Scholar 

  23. de Groot EH, Post N, Boellaard R, Wagenaar NR, Willemsen AT, van Dalen JA. Optimized dose regimen for whole-body FDG-PET imaging. EJNMMI Res. 2013;3:63. https://doi.org/10.1186/2191-219x-3-63.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Cox CPW, van Assema DME, Verburg FA, Brabander T, Konijnenberg M, Segbers M. A dedicated paediatric [(18)F]FDG PET/CT dosage regimen. EJNMMI Res. 2021;11:65. https://doi.org/10.1186/s13550-021-00812-8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Meier JM, Alavi A, Iruvuri S, Alzeair S, Parker R, Houseni M, et al. Assessment of age-related changes in abdominal organ structure and function with computed tomography and positron emission tomography. Semin Nucl Med. 2007;37:154–72. https://doi.org/10.1053/j.semnuclmed.2007.02.001.

    Article  PubMed  Google Scholar 

  26. Yeung HW, Sanches A, Squire OD, Macapinlac HA, Larson SM, Erdi YE. Standardized uptake value in pediatric patients: an investigation to determine the optimum measurement parameter. Eur J Nucl Med Mol Imaging. 2002;29:61–6. https://doi.org/10.1007/s00259-001-0662-8.

    Article  CAS  PubMed  Google Scholar 

  27. Wegner EA, Barrington SF, Kingston JE, Robinson RO, Ferner RE, Taj M, et al. The impact of PET scanning on management of paediatric oncology patients. Eur J Nucl Med Mol Imaging. 2005;32:23–30. https://doi.org/10.1007/s00259-004-1645-3.

    Article  CAS  PubMed  Google Scholar 

  28. Montravers F, McNamara D, Landman-Parker J, Grahek D, Kerrou K, Younsi N, et al. [(18)F]FDG in childhood lymphoma: clinical utility and impact on management. Eur J Nucl Med Mol Imaging. 2002;29:1155–65. https://doi.org/10.1007/s00259-002-0861-y.

    Article  CAS  PubMed  Google Scholar 

  29. Sgouros G, Frey EC, Bolch WE, Wayson MB, Abadia AF, Treves ST. An approach for balancing diagnostic image quality with cancer risk: application to pediatric diagnostic imaging of 99mTc-dimercaptosuccinic acid. J Nucl Med. 2011;52:1923–9. https://doi.org/10.2967/jnumed.111.092221.

    Article  PubMed  Google Scholar 

  30. Alessio AM, Sammer M, Phillips GS, Manchanda V, Mohr BC, Parisi MT. Evaluation of optimal acquisition duration or injected activity for pediatric 18F-FDG PET/CT. J Nucl Med. 2011;52:1028–34. https://doi.org/10.2967/jnumed.110.086579.

    Article  PubMed  Google Scholar 

  31. Tatsumi M, Miller JH, Wahl RL. 18F-FDG PET/CT in evaluating non-CNS pediatric malignancies. J Nucl Med. 2007;48:1923–31. https://doi.org/10.2967/jnumed.107.044628.

    Article  PubMed  Google Scholar 

  32. Uslu L, Donig J, Link M, Rosenberg J, Quon A, Daldrup-Link HE. Value of 18F-FDG PET and PET/CT for evaluation of pediatric malignancies. J Nucl Med. 2015;56:274–86. https://doi.org/10.2967/jnumed.114.146290.

    Article  CAS  PubMed  Google Scholar 

  33. Büsing KA, Schönberg SO, Brade J, Wasser K. Impact of blood glucose, diabetes, insulin, and obesity on standardized uptake values in tumors and healthy organs on 18F-FDG PET/CT. Nucl Med Biol. 2013;40:206–13. https://doi.org/10.1016/j.nucmedbio.2012.10.014.

    Article  CAS  PubMed  Google Scholar 

  34. Sastre J, Pallardó FV, Plá R, Pellín A, Juan G, O’Connor JE, et al. Aging of the liver: age-associated mitochondrial damage in intact hepatocytes. Hepatology (Baltimore, MD). 1996;24:1199–205. https://doi.org/10.1002/hep.510240536.

    Article  CAS  Google Scholar 

  35. Schmidkonz C, Krumbholz M, Atzinger A, Cordes M, Goetz TI, Prante O, et al. Assessment of treatment responses in children and adolescents with Ewing sarcoma with metabolic tumor parameters derived from (18)F-FDG-PET/CT and circulating tumor DNA. Eur J Nucl Med Mol Imaging. 2020;47:1564–75. https://doi.org/10.1007/s00259-019-04649-1.

    Article  CAS  PubMed  Google Scholar 

  36. Pijl JP, Kwee TC, Slart R, Yakar D, Wouthuyzen-Bakker M, Glaudemans A. Clinical implications of increased uptake in bone marrow and spleen on FDG-PET in patients with bacteremia. Eur J Nucl Med Mol Imaging. 2021;48:1467–77. https://doi.org/10.1007/s00259-020-05071-8.

    Article  CAS  PubMed  Google Scholar 

  37. Patel NH, Osborne MT, Teague H, Parel P, Svirydava M, Sorokin AV, et al. Heightened splenic and bone marrow uptake of (18)F-FDG PET/CT is associated with systemic inflammation and subclinical atherosclerosis by CCTA in psoriasis: An observational study. Atherosclerosis. 2021;339:20–6. https://doi.org/10.1016/j.atherosclerosis.2021.11.008.

    Article  CAS  PubMed  Google Scholar 

  38. Akamatsu G, Ishikawa K, Mitsumoto K, Taniguchi T, Ohya N, Baba S, et al. Improvement in PET/CT image quality with a combination of point-spread function and time-of-flight in relation to reconstruction parameters. J Nucl Med. 2012;53:1716–22. https://doi.org/10.2967/jnumed.112.103861.

    Article  PubMed  Google Scholar 

  39. Zhang YQ, Hu PC, Wu RZ, Gu YS, Chen SG, Yu HJ, et al. The image quality, lesion detectability, and acquisition time of (18)F-FDG total-body PET/CT in oncological patients. Eur J Nucl Med Mol Imaging. 2020;47:2507–15. https://doi.org/10.1007/s00259-020-04823-w.

    Article  CAS  PubMed  Google Scholar 

  40. Shammas A, Lim R, Charron M. Pediatric FDG PET/CT: physiologic uptake, normal variants, and benign conditions. Radiographics. 2009;29:1467–86. https://doi.org/10.1148/rg.295085247.

    Article  Google Scholar 

  41. Halpern BS, Dahlbom M, Quon A, Schiepers C, Waldherr C, Silverman DH, et al. Impact of patient weight and emission scan duration on PET/CT image quality and lesion detectability. J Nucl Med. 2004;45:797–801.

    PubMed  Google Scholar 

  42. Accorsi R, Karp JS, Surti S. Improved dose regimen in pediatric PET. J Nucl Med. 2010;51:293–300. https://doi.org/10.2967/jnumed.109.066332.

    Article  PubMed  Google Scholar 

  43. de Langen AJ, Vincent A, Velasquez LM, van Tinteren H, Boellaard R, Shankar LK, et al. Repeatability of 18F-FDG uptake measurements in tumors: a metaanalysis. J Nucl Med. 2012;53:701–8. https://doi.org/10.2967/jnumed.111.095299.

    Article  CAS  PubMed  Google Scholar 

  44. Wahl RL, Jacene H, Kasamon Y, Lodge MA. From RECIST to PERCIST: evolving considerations for PET response criteria in solid tumors. J Nucl Med. 2009;50(Suppl 1):122s-s150. https://doi.org/10.2967/jnumed.108.057307.

    Article  CAS  PubMed  Google Scholar 

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Author notes

  1. Wanqi Chen and Lei Liu contributed equally to this work

Authors and Affiliations

  1. State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfengdong Road, Guangzhou, 510060, Guangdong, China

    Wanqi Chen, Lei Liu, Yinghe Li, Shatong Li, Zhijian Li, Weiguang Zhang, Xu Zhang, Wei Fan, Yumo Zhao, Yizhuo Zhang & Yingying Hu

  2. Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China

    Wanqi Chen, Lei Liu, Yinghe Li, Shatong Li, Zhijian Li, Weiguang Zhang, Xu Zhang, Wei Fan, Yumo Zhao & Yingying Hu

  3. Central Research Institute, United Imaging Healthcare Group Co., Ltd, Shanghai, China

    Runze Wu, Debin Hu, Hongyan Sun & Yun Zhou

  4. Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China

    Yizhuo Zhang

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  1. Wanqi Chen
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Contributions

Conceptualization: Yingying Hu, Yizhuo Zhang, and Yumo Zhao; methodology: Wanqi Chen, Lei Liu, Yumo Zhao, and Zhijian Li; formal analysis and investigation: Yingying Hu, Wanqi Chen, Lei Liu, Zhijian Li, and Weiguang Zhang; writing—original draft preparation: Wanqi Chen, Lei Liu, and Yingying Hu; writing—review and editing: Yingying Hu, Yizhuo Zhang, Yumo Zhao, Runze Wu, Yinghe Li, Shatong Li, and Xu Zhang; technical support: Hongyan Sun, Debin Hu, Runze Wu and Yun Zhou; resources: Yingying Hu; and supervision: Yumo Zhao, Yizhuo Zhang, and Yingying Hu. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Yumo Zhao, Yizhuo Zhang or Yingying Hu.

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All procedures performed in studies involving human participants were conducted in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Conflict of interest

Authors Runze Wu, Hongyan Sun, Debin Hu, and Yun Zhou are employees of United Imaging Research. The other authors working at Sun Yat-sen University Cancer Center have full control of the data and declare that they have no conflicts of interest.

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Chen, W., Liu, L., Li, Y. et al. Evaluation of pediatric malignancies using total-body PET/CT with half-dose [18F]-FDG. Eur J Nucl Med Mol Imaging 49, 4145–4155 (2022). https://doi.org/10.1007/s00259-022-05893-8

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