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Image quality and lesion detectability in low-dose pediatric 18F-FDG scans using total-body PET/CT

European Journal of Nuclear Medicine and Molecular Imaging volume 48, pages 3378–3385 (2021)Cite this article

Abstract

Purpose

To investigate the effects of dose reduction on image quality and lesion detectability of oncological 18F-FDG total-body PET/CT in pediatric oncological patients and explore the minimum threshold of administered tracer activity.

Methods

A total of 33 pediatric patients (weight 8.5–58.5 kg; age 0.8–17.6 years) underwent total-body PET/CT using uEXPLORER scanner with an 18F-FDG administered dose of 3.7 MBq/kg and an acquisition time of 600 s were retrospectively enrolled. Low-dose images (0.12–1.85 MBq/kg) were simulated by truncating the list-mode PET data to reducing count density. Subjective image quality was rated on a 5-point scale. Semi-quantitative uptake metrics for low-dose images were assessed using region-of-interest (ROI) analysis of healthy liver and suspected lesions and were compared with full-dose images. The micro-lesion detectability was compared among the dose-dependent PET images.

Results

Our analysis shows that sufficient subjective image quality and lesion conspicuity could be maintained down to 1/30th (0.12 MBq/kg) of the administered dose of 18F-FDG, where good image quality scores were given to 1/2- and 1/10- dose groups. The image noise was significantly more deranged than the overall quality and lesion conspicuity in 1/30- to 1/10-dose groups (all p < 0.05). With reduced doses, quantitative analysis of ROIs showed that SUVmax and SD in the liver increased gradually (p < 0.05), but SUVmax in the lesions and lesion-to-background ratio (LBR) showed no significant deviation down to 1/30-dose. One hundred percent of the 18F-FDG-avid micro-lesions identified in full-dose images were localized down to 1/15-dose images, while 97% of the lesion were localized in 1/30-dose images.

Conclusion

The total-body PET/CT might significantly decrease the administered dose upon maintaining the image quality and diagnostic performance of micro-lesions in pediatric patients. Data suggests that using total-body PET/CT, optimal image quality could be achieved with an administered dose-reduction down to 1/10-dose (0.37 MBq/kg).

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Data availability

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

References

  1. Boellaard R, Delgado-Bolton R, Oyen WJ, Giammarile F, Tatsch K, Eschner W, et al. FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging. 2015;42:328–54. https://doi.org/10.1007/s00259-014-2961-x.

    Article  CAS  PubMed  Google Scholar 

  2. Townsend DW. Dual-modality imaging: combining anatomy and function. J Nucl Med. 2008;49:938–55. https://doi.org/10.2967/jnumed.108.051276.

    Article  PubMed  Google Scholar 

  3. Fletcher JW, Djulbegovic B, Soares HP, Siegel BA, Lowe VJ, Lyman GH, et al. Recommendations on the use of 18F-FDG PET in oncology. J Nucl Med. 2008;49:480–508. https://doi.org/10.2967/jnumed.107.047787.

    Article  PubMed  Google Scholar 

  4. Chambers G, Frood R, Patel C, Scarsbrook A. (18)F-FDG PET-CT in paediatric oncology: established and emerging applications. Br J Radiol. 2019;92:20180584. https://doi.org/10.1259/bjr.20180584.

    Article  PubMed  Google Scholar 

  5. Stauss J, Franzius C, Pfluger T, Juergens KU, Biassoni L, Begent J, et al. Guidelines for 18F-FDG PET and PET-CT imaging in paediatric oncology. Eur J Nucl Med Mol Imaging. 2008;35:1581–8. https://doi.org/10.1007/s00259-008-0826-x.

    Article  CAS  PubMed  Google Scholar 

  6. 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 

  7. Fahey FH, Treves ST, 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 

  8. 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 

  9. Treves TS, Gelfand M, Parisi M, Lassmann M, Goske M, Sexton-Stallone B, et al. Update: image gently and nuclear medicine at 10 years. J Nucl Med. 2019;60:7N–9N.

    Article  PubMed  Google Scholar 

  10. Parisi MT, Bermo MS, Alessio AM, Sharp SE, Gelfand MJ, Shulkin BL. Optimization of pediatric PET/CT. Semin Nucl Med. 2017;47:258–74. https://doi.org/10.1053/j.semnuclmed.2017.01.002.

    Article  PubMed  Google Scholar 

  11. 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 

  12. 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 

  13. Fahey FH, Goodkind AB, Plyku D, Khamwan K, O'Reilly SE, Cao X, et al. Dose estimation in pediatric nuclear medicine. Semin Nucl Med. 2017;47:118–25. https://doi.org/10.1053/j.semnuclmed.2016.10.006.

    Article  PubMed  Google Scholar 

  14. 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 

  15. Treves ST, Falone AE, Fahey FH. Pediatric nuclear medicine and radiation dose. Semin Nucl Med. 2014;44:202–9. https://doi.org/10.1053/j.semnuclmed.2014.03.009.

    Article  PubMed  Google Scholar 

  16. Treves ST, Gelfand MJ, Fahey FH, Parisi MT. Update of the north American consensus guidelines for pediatric administered radiopharmaceutical activities. J Nucl Med. 2016;57:15n-8n.

    Google Scholar 

  17. 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 

  18. Koizumi K, Masaki H, Matsuda H, Uchiyama M, Okuno M, Oguma E, et al. Japanese consensus guidelines for pediatric nuclear medicine. Part 1: pediatric radiopharmaceutical administered doses (JSNM pediatric dosage card). Part 2: technical considerations for pediatric nuclear medicine imaging procedures. Ann Nucl Med. 2014;28:498–503. https://doi.org/10.1007/s12149-014-0826-9.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Vali R, Alessio A, Balza R, Borgwardt L, Bar-Sever Z, Czachowski M, et al. SNMMI procedure standard/EANM practice guideline on pediatric (18)F-FDG PET/CT for oncology 1.0. J Nucl Med. 2021;62:99–110. https://doi.org/10.2967/jnumed.120.254110.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Schmall JP, Surti S, Otero H, Servaes S, Karp JS, States LJ. Investigating low-dose image quality in whole-body pediatric 18F-FDG scans using TOF-PET/MRI. J Nucl Med. 2021;62(1):123–30. https://doi.org/10.2967/jnumed.119.240127.

    Article  PubMed  Google Scholar 

  21. 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 

  22. 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 

  23. 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 

  24. Zhang X, Cherry SR, Xie Z, Shi H, Badawi RD, Qi J. Subsecond total-body imaging using ultrasensitive positron emission tomography. Proc Natl Acad Sci U S A. 2020;117:2265–7. https://doi.org/10.1073/pnas.1917379117.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. 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 

  26. 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. https://doi.org/10.1007/s00259-020-05173-3.

  27. Sekine T, Delso G, Zeimpekis KG, de Galiza Barbosa F, Ter Voert E, Huellner M, et al. Reduction of (18)F-FDG dose in clinical PET/MR imaging by using silicon photomultiplier detectors. Radiology. 2018;286:249–59. https://doi.org/10.1148/radiol.2017162305.

    Article  PubMed  Google Scholar 

  28. Seith F, Schmidt H, Kunz J, Küstner T, Gatidis S, Nikolaou K, et al. Simulation of tracer dose reduction in (18)F-FDG PET/MRI: effects on oncologic Reading, image quality, and artifacts. J Nucl Med. 2017;58:1699–705. https://doi.org/10.2967/jnumed.116.184440.

    Article  CAS  PubMed  Google Scholar 

  29. Alessio AM, Kinahan PE, Manchanda V, Ghioni V, Aldape L, Parisi MT. Weight-based, low-dose pediatric whole-body PET/CT protocols. J Nucl Med. 2009;50:1570–7. https://doi.org/10.2967/jnumed.109.065912.

    Article  PubMed  Google Scholar 

  30. 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 

  31. 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 

  32. Masuda Y, Kondo C, Matsuo Y, Uetani M, Kusakabe K. Comparison of imaging protocols for 18F-FDG PET/CT in overweight patients: optimizing scan duration versus administered dose. J Nucl Med. 2009;50:844–8. https://doi.org/10.2967/jnumed.108.060590.

    Article  PubMed  Google Scholar 

  33. Nagaki A, Onoguchi M, Matsutomo N. Patient weight-based acquisition protocols to optimize (18)F-FDG PET/CT image quality. J Nucl Med Technol. 2011;39:72–6. https://doi.org/10.2967/jnmt.110.081661.

    Article  PubMed  Google Scholar 

  34. Citrin DE. Recent developments in radiotherapy. N Engl J Med. 2017;377:1065–75. https://doi.org/10.1056/NEJMra1608986.

    Article  CAS  PubMed  Google Scholar 

  35. Matheoud R, Leva L, Secco C, Sacchetti G, Monica PD, Brambilla M, et al. Small lesions detectability with the biograph 16 hi-Rez PET/CT scanner and fast imaging protocols: performance evaluation using an anthropomorphic thoracic phantom and ROC analyses. Ann Nucl Med. 2011;25:179–88. https://doi.org/10.1007/s12149-010-0437-z.

    Article  PubMed  Google Scholar 

  36. Xie T, Bolch WE, Lee C, Zaidi H. Pediatric radiation dosimetry for positron-emitting radionuclides using anthropomorphic phantoms. Med Phys. 2013;40:102502. https://doi.org/10.1118/1.4819939.

    Article  CAS  PubMed  Google Scholar 

  37. Khamwan K, O'Reilly SE, Plyku D, Goodkind A, Josefsson A, Cao X, et al. Re-evaluation of pediatric (18)F-FDG dosimetry: Cristy-Eckerman versus UF/NCI hybrid computational phantoms. Phys Med Biol. 2018;63:165012. https://doi.org/10.1088/1361-6560/aad47a.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Code availability

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

Funding

The authors did not receive financial support from any organization for the submitted work.

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Author notes

  1. Yu-Mo Zhao and Ying-He Li contributed equally to this work.

Authors and Affiliations

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

    Yu-Mo Zhao, Ying-He Li, Tao Chen, Wei-Guang Zhang, Lin-Hao Wang, Xu Zhang, Wei Fan & Ying-Ying Hu

  2. Department of Nuclear Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfengdong Road, Guangzhou, 510060, Guangdong, China

    Yu-Mo Zhao, Ying-He Li, Tao Chen, Wei-Guang Zhang, Lin-Hao Wang, Xu Zhang, Wei Fan & Ying-Ying Hu

  3. Central research institute, United Imaging Healthcare, Shanghai, China

    Jiatai Feng & Chenwei Li

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  1. Yu-Mo Zhao
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Contributions

Conceptualization: Xu Zhang, Wei Fan, Yu-Mo Zhao, Ying-Ying Hu; Methodology: Yu-Mo Zhao, Ying-Ying Hu, Wei-Guang Zhang; Formal analysis and investigation: Ying-Ying Hu, Yu-Mo Zhao, Tao Chen, Wei-Guang Zhang, Lin-Hao Wang; Writing - original draft preparation: Yu-Mo Zhao, Ying-Ying Hu, Tao Chen; Writing - review and editing: Ying-He Li, Yu-Mo Zhao, Jiatai Feng; Technical support: Jiatai Feng, Chenwei Li; Resources: Wei Fan; Supervision: Xu Zhang, Wei Fan, Ying-Ying Hu. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Xu Zhang, Wei Fan or Ying-Ying Hu.

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

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Additional informed consent was obtained from all legal guardians for whom identifying information is included in this article.

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Author JT.F. and CW.L. 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 conflict of interest.

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Zhao, YM., Li, YH., Chen, T. et al. Image quality and lesion detectability in low-dose pediatric 18F-FDG scans using total-body PET/CT. Eur J Nucl Med Mol Imaging 48, 3378–3385 (2021). https://doi.org/10.1007/s00259-021-05304-4

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