FDG-PET/CT in children with malignant diseases - comparison of a long axial field of view scanner with a standard scanner.
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AIM: [18F]FDG positron-emission-tomography/computed tomography (PET/CT) is a crucial tool in paediatric oncology for staging, treatment response assessment, and follow-up imaging. Long axial field of view (LAFOV) PET/CT is more sensitive for the detection of annihilation events than short axial field of view (SAFOV) instrumentation, thus enabling lower radiation dose and/or briefer acquisition time. In consideration of the radiation sensitivity of children, we compared the performance of LAFOV and SAFOV PET/CT in paediatric oncology. METHODS: Twenty-six paediatric oncology patients (mean age 13.7 ± 4.8 y), of whom half had diagnosis of lymphoma, underwent 37 [18F]FDG PET/CT scans (12 SAFOV, 25 LAFOV). The LAFOV acquisitions (1-3 MBq/kg) were numerically rescaled to simulate 0.5-3 MBq/kg, yielding 75 LAFOV studies. Four blinded readers rated image quality on a 5-point Likert scale, and recorded various imaging metrics, statistical comparison, and power calculations. RESULTS: LAFOV at 2 and 3 MBq/kg achieved significantly higher Likert ratings than SAFOV. LAFOV at 1 MBq/kg yielded comparable ratings to SAFOV (p=0.13), while 0.5 MBq/kg was inferior to SAFOV (p=0.012). Hepatic background SD decreased and SNR increased dose-dependently with LAFOV (p<0.001), whereas lesion SUVmax and SUVmean remained stable across scanners. TBR was lower for LAFOV at higher doses, despite unchanged image quality. Inter-rater agreement was fair to moderate. CONCLUSION: LAFOV PET/CT supports [18F]FDG dose reduction without impairing image quality for lesion detection. 1 MBq/kg yielded diagnostic quality comparable to SAFOV, while 2-3 MBq/kg provided superior performance. These results support LAFOV PET/CT as a strategy to minimize radiation exposure in children.