PET and PET/CT in children and young adults

Abstract

The introduction of PET, and especially 18F-FDG PET, has transformed pediatric nuclear medicine. In particular, hybrid imaging with 18F-FDG PET/CT has transformed pediatric nuclear oncology. However, PET and PET/CT have a wide variety of pediatric indications including neurology, sports medicine and orthopedics, pediatric cardiology, and infection imaging, as well as pediatric oncology. Most PET and PET/CT studies utilize the glucose analogue, 18F-fluorodeoxyglucose (18F-FDG). Infants and children provide special challenges to acquiring a technically adequate and diagnostically satisfactory PET or PET/CT scan. Adequate pre-study preparation of the patient and family is critical. Imaging protocols must pay particular attention to the pediatric spectrum of disease, the developmental needs of pediatric patients, and the goal of minimizing radiation exposure. Interpretation of pediatric 18F-FDG PET and PET/CT requires knowledge of pediatric diseases and an appreciation for the patterns of tracer biodistribution that can be seen in infants and children. Issues such as sedation or anesthesia, rarely a concern in adult nuclear medicine, are a normal part of routine pediatric PET and PET/CT. Protocols and departmental procedures must balance the developmental needs of children with the goal of acquiring a diagnostic imaging study that answers the clinical question.