Pediatric FDG PET/CT: physiologic uptake, normal variants, and benign conditions

Area of Science:

• Nuclear Medicine
• Pediatric Oncology
• Medical Imaging

Background:

• 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG) Positron Emission Tomography (PET) is vital for pediatric oncology evaluations.
• Normal FDG uptake in children differs significantly from adults, presenting unique interpretation challenges.

Purpose of the Study:

• To highlight the unique normal distribution of FDG uptake in pediatric patients.
• To identify common physiologic variants and benign lesions that mimic malignancy on FDG PET/CT.
• To discuss pitfalls and artifacts associated with combined PET/CT imaging in children.

Main Methods:

• Review of pediatric FDG PET/CT imaging findings.
• Analysis of common physiologic variants and benign conditions.
• Identification of technical artifacts in PET/CT.

Main Results:

• Common sites of normal FDG uptake in children include head and neck, heart, breast, thymus, liver, spleen, GI tract, genitourinary system, bone marrow, muscles, and brown adipose tissue.
• Benign lesions and physiologic variants can be mistaken for malignancies.
• PET/CT artifacts like attenuation correction errors and misregistration can occur.

Conclusions:

• Accurate interpretation of pediatric FDG PET/CT necessitates comprehensive knowledge of normal pediatric uptake patterns, variants, benign mimics, and technical artifacts.
• Understanding these factors enhances diagnostic accuracy, reduces unnecessary procedures, and optimizes treatment strategies for pediatric cancer patients.