PET/CT imaging experience in pediatric oncology: A feasible and non-invasive procedure

Objectives Few PET units perform imaging for children probably due to the supposed constraints of organizational procedures and especially sedation of children. The aim of this study is to share our experience in the management of PET in pediatric oncology.

Methods Hundred and fifty-one consecutive PET/CT scans were performed in 89 different children (44F/45M), median age 10 years (range 3-18 years). Thirty-five PET/CT scans were performed in children aged 3 to 5 years; 70 in children aged 6 to 12 years, and 46 in children aged 13 to 18 years. All PET examinations were performed without any sedation or drug preparation, even for the youngest children. Children would fast for 4 to 6 hours prior to FDG administration and were installed in a warm quiet room with blankets to avoid brown fat activation. Injected FDG activities were calculated according to the EANM-Guidelines 2008. When required, i.v. contrast agent was used to avoid additional diagnostic CT exposure. Parents were allowed to stay with their child during the whole procedure, wearing an external operational dosimeter. Dose delivered to the parent was registered at the end of procedure.

Results PET/CT indications were staging and response assessment of lymphoma (n=92), staging of soft tissue sarcoma (n=14), bone sarcoma (n=13), response assessment of glioma (n=8), suspected malignant peripheral nerve sheath tumor (n= 8), head and neck cancer (n=8), neuroblastoma (n=2), and miscellaneous (n=6). Median effective dose delivered to the parent was 12 µSv ± 10 SD (range 4-50) for the whole procedure.

Conclusions PET/CT imaging in pediatric oncology is a feasible procedure. Skilled and trained technologists, implication of both parents and children and a reassuring environment allow avoiding sedation. The effective dose to the parent is low with regard to the diagnostic and prognostic benefit of PET/CT imaging in patients’ care.