Baseline FDG PET/CT in free breathing versus deep inspiration breath-hold for pediatric patients with mediastinal lymphoma

Anni Young Lundgaard*, Danijela Dejanovic, Anne Kiil Berthelsen, Flemming Littrup Andersen, Laura Ann Rechner, Lise Borgwardt, Lisa Lyngsie Hjalgrim, Lena Specht, Maja Vestmø Maraldo

*Corresponding author for this work


INTRODUCTION: The prospective TEDDI protocol investigates the feasibility of radiotherapy delivery in deep inspiration breath-hold (DIBH) for pediatric patients. To secure optimal radiotherapy planning, a diagnostic baseline FDG PET/CT in free breathing (FB) and DIBH was acquired. The anatomical changes in the mediastinum and the effect on PET metrics between the two breathing conditions were assessed for pediatric patients with mediastinal lymphoma.

MATERIAL AND METHODS: Ten patients aged 5-17 were included and had a PET/CT in FB and DIBH. Metabolic active lymphoma volumes were manually delineated with a visually based segmentation method and the PET metrics were extracted. The anatomical lymphoma, lung and heart volumes were delineated on CT.

RESULTS: The lung volume increased while the heart was displaced caudally and separated from the lymphoma in DIBH compared to FB. Both the anatomical and the metabolically active lymphoma volumes appeared different regarding shape and configuration in the two breathing conditions. The image quality of the DIBH PET was equal to the FB PET regarding interpretation and delineation of lymphoma lesions. All PET metrics increased on the DIBH PET compared to the FB PET with the highest increase observed for the maximum standardized uptake value (33%, range 7-56%).

CONCLUSION: Diminished respiratory motion together with anatomical changes within the lymphoma increased all PET metrics in DIBH compared to FB. The anatomical changes observed in DIBH compared to FB are expected to reduce radiation doses to the heart and lungs in pediatric patients with mediastinal lymphoma referred for radiotherapy delivery in DIBH and, thereby, reduce their risk of late effects.

TRIAL REGISTRATION: The Danish Ethical Committee (H-16035870, approved November 24th 2016), the Danish Data Protection Agency (2012-58-0004, approved 1 January 2017). Registered retrospectively at (NCT03315546, 20 October 2017).

Original languageEnglish
JournalActa Oncologica
Issue number2
Pages (from-to)239-246
Number of pages8
Publication statusPublished - Feb 2022


  • Adolescent
  • Breath Holding
  • Child
  • Child, Preschool
  • Fluorodeoxyglucose F18
  • Heart
  • Humans
  • Lymphoma/diagnostic imaging
  • Organs at Risk/diagnostic imaging
  • Positron Emission Tomography Computed Tomography
  • Prospective Studies
  • Radiotherapy Dosage
  • Radiotherapy Planning, Computer-Assisted
  • Retrospective Studies


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