Physiological FDG uptake in growth plate on pediatric PET

Document Type : Original Article


Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Japan


Objective(s):18F-Fluorodeoxyglucose (FDG) uptake in children is different from that in adults. Physiological accumulation is known to occur in growth plates, but the pattern of distribution has not been fully investigated. Our aim was to evaluate the metabolic activity of growth plates according to age and location.
Methods:We retrospectively evaluated 89 PET/CT scans in 63 pediatric patients (male : female=25 : 38, range, 0–18 years). Patients were classified into four age groups (Group A: 0–2 years, Group B: 3–9 years, Group C: 10–14 years and Group D: 15-18 years). The maximum standardized uptake value (SUVmax) of the proximal and distal growth plates of the humerus, the forearm bones and the femur were measured. The SUVmax of each site and each age group were compared and statistically analyzed. We also examined the correlations between age and SUVmax.
Results:As for the comparison of SUVmax in each location, the SUVmax was significantly higher in the distal femur than those in the other sites (p< 0.01). SUVmax in the distal humerus and the proximal forearm bones were significantly lower than those in the other sites (p< 0.01). In the distal femur, there was large variation in SUVmax, while in the distal humerus and the proximal forearm bones, there was small variation. As for the comparison of SUVmax in each age group, the SUVmax in group D tended to be lower than those in the other groups, but in the distal femur, there was no significant difference among each age group.
Conclusion:Our data indicate that FDG uptake in growth plates varies depending on the site and age with remarkable uptake especially in the distal femur.


1. Biermann M, Schwarzlmuller T, Fasmer KE, Reitan BC, Johnsen B, Rosendahl K. Is there a role for PET-CT and SPECT-CT in pediatric oncology? Acta Radiol. 2013; 54(9):1037-45 .
2. Harrison DJ, Parisi MT, Shulkin BL. The Role of (18) F-FDG-PET/CT in Pediatric Sarcoma. Semin Nucl Med. 2017; 47(3):229-41 .
3. Nakamoto Y, Tatsumi M, Hammoud D, Cohade C, Osman MM, Wahl RL. Normal FDG distribution patterns in the head and neck: PET/CT evaluation. Radiology. 2005;234(3): 879-85.
4. Brink I, Reinhardt MJ, Hoegerle S, Altehoefer C, Moser E, Nitzsche EU. Increased metabolic activity in the thymus gland studied with 18FFDG PET: age dependency and frequency after chemotherapy. J Nucl Med. 2001; 42(4):591-5.
5. Taralli S, Leccisotti L, Mattoli MV, Castaldi P, de Waure C, Mancuso A, et al. Physiological Activity of Spinal Cord in Children: An 18F-FDG PET-CT Study. Spine (Phila Pa 1976). 2015; 40(11):E647-52 .
6. Jadvar H, Connolly LP, Fahey FH, Shulkin BL. PET and PET/CT in pediatric oncology. Semin Nucl Med. 2007; 37(5):316-31 .
7. Nilsson O, Marino R, De Luca F, Phillip M, Baron J. Endocrine regulation of the growth plate. Horm Res. 2005; 64(4):157-65 .
8. Harcke HT, Mandell GA. Scintigraphic evaluation of the growth plate. Semin Nucl Med. 1993; 23(4):266-73 .
9. Zionts LE, Harcke HT, Brooks KM, MacEwen GD. Posttraumatic tibia valga: a case demonstrating asymmetric activity at the proximal growth plate on technetium bone scan. J Pediatr Orthop. 1987; 7(4):458-62.
10. Celen Z, Zincirkeser S, Ozkilic S, Nacar F. Evaluation of growth in children using quantitative bone scintigraphy. J Int Med Res. 1999; 27(6):286-91 .
11. Yamane T, Kuji I, Sato A, Matsunari I. Quantification of osteoblastic activity in epiphyseal growth plates by quantitative bone SPECT/CT. Skeletal Radiol. 2018; 47(6):805-810.
12. Bestic JM, Peterson JJ, Bancroft LW. Pediatric FDG PET/CT: Physiologic uptake, normal variants, and benign conditions. Radiographics. 2009; 29(5):1487-500.
13. Spoudeas HA. Growth and endocrine function after chemotherapy and radiotherapy in childhood. Eur J Cancer. 2002; 38(13):1748- 1759.
14. Koizumi K, Masaki H, Matsuda H, Uchiyama M, Okuno M, Oguma E, et al. Japanese consensus guidelines for pediatric nuclear medicine. Part 1: Pediatric radio-pharmaceutical administered doses (JSNM pediatric dosage card). Part 2: Technical considerations for pediatric nuclear medicine imaging procedures. Ann Nucl Med. 2014; 28(5):498-503 .
15. Karlberg J. On the construction of the infancychildhood-puberty growth standard. Acta Paediatr Scand Suppl. 1989; 356:26-37.
16. Tanaka T. Bone age atlas for Japanese children. Tokyo: Medical View; 2011.