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

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript



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.


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.


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.


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.


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Authors and Affiliations



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).

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