Investigating Low-Dose Image Quality in Whole-Body Pediatric 18F-FDG Scans Using Time-of-Flight PET/MRI

In this study, we investigated the diagnostic performance of whole-body F-18-FDG imaging using a PET/MRI scanner with time-of-flight capability for low-dose clinical imaging of pediatric patients. In addition to clinically acquired image data using a dosing regimen of 3.7 MBq/kg, images from simulated low-dose regimens (1.9-0.41 MBq/kg) were evaluated using several metrics: SUV quantitation, qualitative image quality, and lesion detectability. Methods: Low-dose images were generated by truncating the list-mode PET data to reduce the count statistics. Changes in PET quantitation for low-dose images were assessed using volume-of-interest analysis of healthy tissue and suspected lesions. Three pediatric radiologists reviewed the image volumes without knowing the dose level. Qualitative image quality was assessed on the basis of Likert scoring. Radiologists were also asked to identify suspected lesions within the liver for PET-only and PET/MR images. Lesion detectability was measured using a receiver-operating-characteristic study and quantified using a free-response receiving-operating-characteristic (FROG) methodology to assess changes in performance for low-dose images. Results: Our analysis of volume-of-interest quantitation showed that SUVs remain stable down to 'A dose (1.2 MBq/kg). Likert scoring of PET/MR images showed no noticeable trend with dose level; however, scores of PET-only images were lower for low-dose scans, with a 12% reduction for 1/3-dose images compared with full-dose images. There was minimal change in total lesion count for different dose levels; however, all 3 readers had an increase in false-negatives for 1/3-dose images compared with full-dose images. Using the FROG methodology to quantify lesion-detection performance for human observers, no significant differences were observed for the 3 dosing levels when using the averaged reader data (all P values > 0.103). For all readers, the FROG performance was higher for PET/MRI than for PET alone. Conclusion: Reductions to the lowest recommended pediatric dosing regimens are possible when using PET/MRI. The data suggest that the administered dose can be decreased to 2.46 MBq/kg, a 33% reduction in PET activity, with no degradation in image quality, leading to a corresponding reduction in absorbed dose.