Physiological distribution characteristics and influencing factors of hepatic background and mediastinal blood pool on 18F-FDG PET/CT in children and adolescents of different ages

doi:10.3969/j.issn.1674-8115.2026.04.009

Abstract

Abstract:

Objective ·To investigate the physiological distribution characteristics of fluorine-18 fluorodeoxyglucose^{(¹⁸F-FDG) in the liver background and mediastinal blood pool on positron emission tomography/computed tomography (PET/CT) in children and adolescents, and to analyze the influencing factors. Methods ·A total of 271 pediatric patients (<18 years) with pathologically confirmed or suspected malignant tumors were retrospectively analyzed. Patients were divided into four age groups: ≤2 years, 3‒5 years, 6‒10 years, and ≥11 years. The maximum standardized uptake value and mean standardized uptake value (SUV_max and SUV_mean) of the liver and mediastinal blood pool were measured. Their associations with age, weight, height, body mass index (BMI), gender, liver function, and chemotherapy status were assessed. Results ·The SUV_max and SUV_mean of the liver were 1.89±0.62 and 1.36±0.44, respectively.The mediastinal blood pool SUV_max and SUV_mean were 1.11±0.37 and 0.98±0.32. Pearson correlation analysis showed that SUV_max and SUV_mean values of the liver and mediastinal blood pool were significantly positively correlated (r=0.78‒0.86, P<0.001). All SUV parameters were positively correlated with age, weight, height, and BMI (r=0.47‒0.73, P<0.05), but showed no significant correlation with gender (r=0.02‒0.04, P>0.05). ¹⁸F-FDG uptake in both the liver and mediastinal blood pool increased significantly with age. Hepatic SUV_max increased from 1.41±0.32 in the ≤2-year group to 2.57±0.60 in the ≥11-year group (P<0.001), while mediastinal SUV_max increased from 0.91±0.27 to 1.42±0.41 (P<0.001). Children with abnormal liver function had lower hepatic uptake compared to those with normal liver function (1.71±0.61 vs 1.93±0.61, P=0.034), while no significant difference was observed before and after chemotherapy. Multivariate regression analysis identified weight and age as independent influencing factors for hepatic SUV values (P<0.001), and body weight had the greatest impact on mediastinal blood pool SUV values (P<0.001). Conclusion ·Hepatic background and mediastinal blood pool ¹⁸F-FDG uptake increases with age and weight in children and adolescents, with SUV values typically below 2 in children under 5 years old. The SUV values of the liver and mediastinal blood pool show good consistency and reproducibility as non-target reference parameters for therapeutic response evaluation in pediatric PET/CT, which may improve the accuracy and standardization of image interpretation.}

Key words: children and adolescents, positron emission tomography, computed tomography, ¹⁸F-FDG, liver background, mediastinal blood pool, standardized uptake value (SUV)

CLC Number:

R445.6

Wang Shaoyan, Li Chao, Huang Shuo, Wu Shuqi, Chen Suyun. Physiological distribution characteristics and influencing factors of hepatic background and mediastinal blood pool on ¹⁸F-FDG PET/CT in children and adolescents of different ages[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026, 46(4): 496-501.

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SUV	≤2 years	3‒5 years	6‒10 years	≥11 years	F value	P value
Hepatic SUV_max	1.41±0.32	1.60±0.39	2.04±0.49	2.57±0.60	69.42	<0.001
Hepatic SUV_mean	1.06±0.25	1.17±0.31	1.45±0.39	1.80±0.46	46.78	<0.001
Mediastinal blood pool SUV_max	0.91±0.27	0.95±0.28	1.18±0.31	1.42±0.41	31.95	<0.001
Mediastinal blood pool SUV_mean	0.84±0.19	0.85±0.26	1.04±0.28	1.23±0.36	26.41	<0.001

SUV	≤2 years	3‒5 years	6‒10 years	≥11 years	F value	P value
Hepatic SUV_max	1.41±0.32	1.60±0.39	2.04±0.49	2.57±0.60	69.42	<0.001
Hepatic SUV_mean	1.06±0.25	1.17±0.31	1.45±0.39	1.80±0.46	46.78	<0.001
Mediastinal blood pool SUV_max	0.91±0.27	0.95±0.28	1.18±0.31	1.42±0.41	31.95	<0.001
Mediastinal blood pool SUV_mean	0.84±0.19	0.85±0.26	1.04±0.28	1.23±0.36	26.41	<0.001

Liver function	Hepatic SUV_max	Hepatic SUV_mean	Mediastinal blood pool SUV_max	Mediastinal blood pool SUV_mean
Normal (n=227)	1.93±0.61	1.39±0.45	1.12±0.36	0.99±0.32
Abnormal (n=44)	1.71±0.61	1.24±0.42	1.04±0.38	0.94±0.32
t	2.13	2.03	1.22	0.99
P value	0.034	0.043	0.226	0.325

Liver function	Hepatic SUV_max	Hepatic SUV_mean	Mediastinal blood pool SUV_max	Mediastinal blood pool SUV_mean
Normal (n=227)	1.93±0.61	1.39±0.45	1.12±0.36	0.99±0.32
Abnormal (n=44)	1.71±0.61	1.24±0.42	1.04±0.38	0.94±0.32
t	2.13	2.03	1.22	0.99
P value	0.034	0.043	0.226	0.325

SUV	Indicator	B value	β	t	P value	95% CI	F	Adjusted R²
Hepatic SUV_max	Weight	0.02	0.54	6.93	<0.001	0.014‒0.025	311.4	0.54
Hepatic SUV_max	Age	0.03	0.22	2.85	<0.001	0.010‒0.055	163.9	0.55
Hepatic SUV_mean	Weight	0.01	0.44	4.96	<0.001	0.007‒0.016	185.8	0.41
Hepatic SUV_mean	Age	0.03	0.23	2.64	0.010	0.006‒0.043	96.5	0.42
Mediastinal blood pool SUV_max	Weight	0.01	0.54	10.68	<0.001	0.010‒0.014	113.2	0.29
Mediastinal blood pool SUV_mean	Weight	0.01	0.51	9.70	<0.001	0.008‒0.011	95.9	0.26

Physiological distribution characteristics and influencing factors of hepatic background and mediastinal blood pool on ¹⁸F-FDG PET/CT in children and adolescents of different ages

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