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



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.


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.


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.


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.


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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.


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

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Authors and Affiliations



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.

Conflict of interest

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).

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