Is dedicated chest CT needed in addition to PET/CT for evaluation of pediatric oncology patients?



      To assess the computed tomography (CT) portion of a positron emission tomography (PET)/CT, at lower dose without breath holding, as compared to diagnostic chest CT (dCTC), performed at regular dose with breath holding, and question the necessity of both for patient care in pediatric oncology.

      Materials and Methods

      This retrospective study included 46 pediatric patients with histologically proven malignant tumors that had a total of 119 scans.


      A total of 29 discrepancies were found between dCTC and PET/CT reports.


      In the evaluation of metastatic thoracic disease in pediatric oncology patients, the non-breath holding CT portion of PET/CT has sensitivity and specificity that approaches dCTC.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Imaging
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • De Wever W
        • Ceyssens S
        • Mortelmans L
        • Stroobants S
        • Marchal G
        • Bogaert J
        • et al.
        Additional value of PET-CT in the staging of lung cancer: comparison with CT alone, PET alone and visual correlation of PET and CT.
        Eur Radiol. 2007; 17: 23-32
        • Bar-Shalom R
        • Guralnik L
        • Tsalic M
        • Leiderman M
        • Frenkel A
        • Gaitini D
        • Ben-Nun A
        • Keidar Z
        • Israel O
        The additional value of PET/CT over PET in FDG imaging of oesophageal cancer.
        Eur J Nucl Med Mol Imaging. 2005; 32: 918-924
        • Som P
        • Atkins HL
        • Bandoypadhyay D
        • Fowler JS
        • MacGregor RR
        • Matsui K
        • et al.
        A fluorinated glucose analog, 2-fluoro-2-deoxy-d-glucose (F-18): nontoxic tracer for rapid tumor detection.
        J Nucl Med. 1980; 21: 670-675
        • Antoch G
        • Saoudi N
        • Kuehl H
        • Dahmen G
        • Mueller SP
        • Beyer T
        • et al.
        Accuracy of whole-body dual-modality fluorine-18-2-fluoro-2-deoxy-d-glucose positron emission tomography and computed tomography (FDG-PET/CT) for tumor staging in solid tumors: comparison with CT and PET.
        J Clin Oncol. 2004; 22: 4357-4368
        • Lardinois D
        • Weder W
        • Hany TF
        • Kamel EM
        • Korom S
        • Seifert B
        • et al.
        Staging of non-small-cell lung cancer with integrated positron-emission tomography and computed tomography.
        N Engl J Med. 2003; 348: 2500-2507
        • Shah NB
        • Platt SL
        ALARA: is there a cause for alarm? Reducing radiation risks from computed tomography scanning in children.
        Curr Opin Pediatr. 2008; 20: 243-247
        • Brenner DJ
        • Hall EJ
        Computed tomography—an increasing source of radiation exposure.
        N Engl J Med. 2007; 357: 2277-2284
        • Pearce MS
        • Salotti JA
        • Little MP
        • McHugh K
        • Lee C
        • Kim KP
        • et al.
        Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study.
        Lancet. 2012; 380: 499-505
        • Friedman DL
        • Whitton J
        • Leisenring W
        • Mertens AC
        • Hammond S
        • Stovall M
        • et al.
        Subsequent neoplasms in 5-year survivors of childhood cancer: the Childhood Cancer Survivor Study.
        J Natl Cancer Inst. 2010; 102: 1083-1095
        • Slovis TL
        Children, computed tomography radiation dose, and the As Low As Reasonably Achievable (ALARA) concept.
        Pediatrics. 2003; 112: 971-972
        • Osman MM
        • Cohade C
        • Fishman EK
        • Wahl RL
        Clinically significant incidental findings on the unenhanced CT portion of PET/CT studies: frequency in 250 patients.
        J Nucl Med. 2005; 46: 1352-1355
        • Allen-Auerbach M
        • Yeom K
        • Park J
        • Phelps M
        • Czernin J
        Standard PET/CT of the chest during shallow breathing is inadequate for comprehensive staging of lung cancer.
        J Nucl Med. 2006; 47: 298-301
        • Kuehl H
        • Veit P
        • Rosenbaum SJ
        • Bockisch A
        • Antoch G
        Can PET/CT replace separate diagnostic CT for cancer imaging? Optimizing CT protocols for imaging cancers of the chest and abdomen.
        J Nucl Med. 2007; 48: 45s-57s
        • Shrimpton PC
        • Hillier MC
        • Lewis MA
        • Dunn M
        National survey of doses from CT in the UK: 2003.
        Br J Radiol. 2006; 79: 968-980
        • Shrimpton PC
        • Wall BF
        Effective dose and dose-length product in CT.
        Radiology. 2009; 250: 604-605
        • Thomas KE
        • Wang B
        Age-specific effective doses for pediatric MSCT examinations at a large children’s hospital using DLP conversion coefficients: a simple estimation method.
        Pediatr Radiol. 2008; 38: 645-656
        • Chen CJ
        • Ma SY
        Prevalence of clinically significant extraosseous findings on unenhanced CT portions of (1)(8)F-fluoride PET/CT bone scans.
        ScientificWorldJournal. 2012; 2012: 979867
        • Arush MW
        • Israel O
        • Postovsky S
        • Militianu D
        • Meller I
        • Zaidman I
        • et al.
        Positron emission tomography/computed tomography with 18fluoro-deoxyglucose in the detection of local recurrence and distant metastases of pediatric sarcoma.
        Pediatr Blood Cancer. 2007; 49: 901-905
        • Nakamoto Y
        • Chin BB
        • Kraitchman DL
        • Lawler LP
        • Marshall LT
        • Wahl RL
        Effects of nonionic intravenous contrast agents at PET/CT imaging: phantom and canine studies.
        Radiology. 2003; 227: 817-824
        • Antoch G
        • Freudenberg LS
        • Beyer T
        • Bockisch A
        • Debatin JF
        Focal tracer uptake: a potential artifact in contrast-enhanced dual-modality PET/CT scans.
        J Nucl Med. 2002; 43: 1339-1342
        • Berthelsen AK
        • Holm S
        • Loft A
        • Klausen TL
        • Andersen F
        • Højgaard L
        PET/CT with intravenous contrast can be used for PET attenuation correction in cancer patients.
        Eur J Nucl Med Mol Imaging. 2005; 32: 1167-1175
        • Antoch G
        • Freudenberg LS
        • Beyer T
        • Bockisch A
        • Debatin JF
        To enhance or not to enhance? 18F-FDG and CT contrast agents in dual-modality 18F-FDG PET/CT.
        J Nucl Med. 2004; 45: 56s-65s
        • Sun T
        • Mok GS
        Techniques for respiration-induced artifacts reductions in thoracic PET/CT.
        Quant Imaging Med Surg. 2012; 2: 46-52
        • Bogdanich W
        • McGinty JC
        Medicare claims show overuse for CT scanning.
        The New York Times. The New York Times, 2011: A1