PET/CT In paediatric lymphoma: Current role and advances.

Abstract

Fluorine-18 fluorodeoxyglucose ([¹⁸F] FDG) PET/CT has become central to the management of paediatric lymphoma, providing critical information for staging, response assessment, and treatment adaptation. Its integration into international clinical trials and treatment protocols has enabled response-adapted strategies that improve outcomes while reducing long-term toxicity, particularly through the selective omission of radiotherapy in early responders. Beyond its established clinical role, recent advances are expanding the capabilities of PET/CT. Quantitative biomarkers such as metabolic tumour volume (MTV) and total lesion glycolysis (TLG) offer more comprehensive assessment of disease burden than conventional metrics like SUVmax. Emerging applications in immunotherapy, including checkpoint inhibitors and CAR-T cell therapy, highlight the evolving role of PET in response prediction and treatment monitoring, although paediatric-specific data remain limited. Artificial intelligence and radiomics are introducing novel approaches for automated image analysis and risk stratification, while dose reduction strategies and hybrid imaging modalities such as PET/MRI aim to minimize radiation exposure in children. Additionally, the development of novel radiotracers, including proliferation and immune-targeted agents, may further refine disease characterization in the future. Despite these advances, significant challenges remain, particularly regarding standardization, validation, and translation into paediatric clinical practice. Continued collaborative research and harmonization efforts will be essential to ensure that technological innovations translate into meaningful improvements in outcomes for children with lymphoma.