A third of the radiotracer dose: two decades of progress in pediatric [18F]fluorodeoxyglucose PET/CT and PET/MR imaging

Stephan Waelti; Stephan Skawran; Thomas Sartoretti; Moritz Schwyzer; Antonio G Gennari; Cäcilia Mader; Valerie Treyer; Christian J Kellenberger; Irene A Burger; Thomas Hany; Alexander Maurer; Martin W Huellner; Michael Messerli

doi:10.1007/s00330-023-10319-6

A third of the radiotracer dose: two decades of progress in pediatric [¹⁸F]fluorodeoxyglucose PET/CT and PET/MR imaging

Eur Radiol. 2023 Oct 19. doi: 10.1007/s00330-023-10319-6. Online ahead of print.

Authors

Stephan Waelti^{1

2

3}, Stephan Skawran^{1

2}, Thomas Sartoretti^{1

2}, Moritz Schwyzer^{1

2}, Antonio G Gennari^{1

2}, Cäcilia Mader^{1

2}, Valerie Treyer^{1

2}, Christian J Kellenberger^{2

4}, Irene A Burger^{1

2

5}, Thomas Hany^{1

2

6}, Alexander Maurer^{1

2}, Martin W Huellner^{1

2}, Michael Messerli^{7

8}

Affiliations

¹ Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, CH-8091, Zurich, Switzerland.
² University of Zurich, Zurich, Switzerland.
³ Department of Radiology and Nuclear Medicine, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland.
⁴ Department of Diagnostic Imaging, University Children's Hospital Zurich, Zurich, Switzerland.
⁵ Department of Nuclear Medicine, Kantonsspital Baden, Baden, Switzerland.
⁶ MRI Bahnhofplatz, Zurich, Switzerland.
⁷ Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, CH-8091, Zurich, Switzerland. michael.messerli@usz.ch.
⁸ University of Zurich, Zurich, Switzerland. michael.messerli@usz.ch.

PMID: 37855853
DOI: 10.1007/s00330-023-10319-6

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 cm³ 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.

Keywords: Pediatrics; Positron emission tomography; Radiation dose; Radioactive tracers; [18F]fluorodeoxyglucose.