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Święszkowska E, Broniszczak D, Kaliciński P, Szymczak M, Stefanowicz M, Grajkowska W, Dembowska-Bagińska B. Rhabdomyosarcoma of the Biliary Tract in Children: Analysis of Single Center Experience. Cancers (Basel) 2024; 16:3110. [PMID: 39272968 PMCID: PMC11394218 DOI: 10.3390/cancers16173110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 09/01/2024] [Accepted: 09/03/2024] [Indexed: 09/15/2024] Open
Abstract
Rhabdomyosarcoma (RMS) of the biliary tract is a rare tumor in children, constituting 0.5-0.8% of all pediatric RMS. Still, it is the most common malignancy in this location in children. Due to its rarity and location, it may cause diagnostic and treatment difficulties. Above all, there are no therapeutic guidelines specific for this tumor location. The aim of the study was to present an analysis of our experience with the treatment of children with biliary tract rhabdomyosarcoma (RMS) and discuss clinical recommendations for this specific location published in the literature. A retrospective analysis of medical records of eight children with biliary tree RMS treated in one center between 1996-2022 was performed. Records of eight children, five boys and three girls aged 2 yrs 6 mo to 16 yrs 9 mo (median-6 yrs) were analyzed. All patients presented with jaundice as the first symptom. In two patients, initial diagnosis of a tumor was established. For the remaining six, the primary diagnoses were as follows: choledochal cyst-one, malformation of the biliary ducts-one, choledocholithiasis-one, cholangitis-three. In four patients, the extrahepatic bile ducts were involved; in four patients, both the intrahepatic and extrahepatic bile ducts were involved. Embryonal RMS was diagnosed in seven patients (three botryoides type). Alveolar RMS was found in one patient. Biopsy (three surgical, four during endoscopic retrograde cholangiopancreatography (ERCP)) was performed in seven patients. One child underwent primary partial tumor resection (R2). Seven patients received neoadjuvant chemotherapy, followed by delayed resection in five, including liver transplantation in one (five were R0). Two patients did not undergo surgery. Radiotherapy was administered in four patients (two in first-line treatment, two at relapse/progression). Six patients (75%) are alive with no evidence of disease, with follow-up ranging from 1.2 yrs to 27 yrs (median 11 yrs. and 4 mo.). Two patients died from disease, 2 y 9 mo and 3 y 7 mo from diagnosis. Children presenting with obstructive jaundice should be evaluated for biliary tract RMS. The treatment strategy should include biopsy and preoperative chemotherapy, followed by tumor resection and radiotherapy for residual disease and in case of relapse.
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Affiliation(s)
- Ewa Święszkowska
- Department of Oncology, The Children's Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland
| | - Dorota Broniszczak
- Department of Pediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland
| | - Piotr Kaliciński
- Department of Pediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland
| | - Marek Szymczak
- Department of Pediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland
| | - Marek Stefanowicz
- Department of Pediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland
| | - Wiesława Grajkowska
- Department of Pathology, The Children's Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland
| | - Bożenna Dembowska-Bagińska
- Department of Oncology, The Children's Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland
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Broski SM. Positron Emission Tomography/Computed Tomography Transformation of Oncology: Musculoskeletal Cancers. PET Clin 2024; 19:217-229. [PMID: 38184453 DOI: 10.1016/j.cpet.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2024]
Abstract
The past 25 years have seen significant growth in the role of positron emission tomography/computed tomography (PET/CT) in musculoskeletal oncology. Substantiative advances in technical capability and image quality have been paralleled by increasingly widespread clinical adoption and implementation. It is now recognized that PET/CT is useful in diagnosis, staging, prognostication, response assessment, and surveillance of bone and soft tissue sarcomas, often providing critical information in addition to conventional imaging assessment. As individualized, precision medicine continues to evolve for patients with sarcoma, PET/CT is uniquely positioned to offer additional insight into the biology and management of these tumors.
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Affiliation(s)
- Stephen M Broski
- Department of Radiology, Mayo Clinic, Mayo Building, 2nd Floor, 200 First Street SW, Rochester, MN 55905, USA.
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Farina A, Gasperini C, Aparisi Gómez MP, Bazzocchi A, Fanti S, Nanni C. The Role of FDG-PET and Whole-Body MRI in High Grade Bone Sarcomas With Particular Focus on Osteosarcoma. Semin Nucl Med 2021; 52:635-646. [PMID: 34879906 DOI: 10.1053/j.semnuclmed.2021.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Sarcoma represents less than 2% of adult malignancies and about 15% to 20% of malignancies in children and adolescents/young adults. This neoplasm accounts for more than 80 different clinico-pathological entities with different clinical behavior; osteosarcoma and ewing sarcoma are the most frequent primary bone tumors. Because of the general poor prognosis, it is important to find out as many prognostic factors as possible to choose the best therapeutical approach and to correctly schedule the follow-up examinations. Third level imaging such as MRI and PET/CT are of utmost importance in the evaluation of sarcoma patients. The spine and bones in general are optimal sites to be evaluated with FDG PET/CT since the physiological background is low. The standardized uptake value (SUV max, a semiquantitave parameter) is used as a surrogate for proliferative cell rate, and the spatial heterogeneity of FDG distribution within the primary mass as a surrogate for malignancy. In several studies SUVmax was a predictive value for overall survival and progression-free survival. Whole-body MRI is a well-established technique for systemic, radiation-free evaluation, which is mostly applied in the oncological field. WB-MRI provides a combination of anatomical and functional sequences and is useful specifically in the evaluation of disease in organs with relatively high background activity such as the brain, liver, kidney, and spinal canal. These technologies provide accurate staging (also useful to drive the biopsy towards the most active foci in large heterogeneous masses), therapy assessment, relapse detection of local recurrence and distance metastasis but also prognostic indexes, in the context of whole body diagnostic procedures. This paper will provide an overview of the role and added value of PET/CT and WB-MRI in bone sarcomas particular focus on osteosarcoma. We also analyzed the role of the PET/CT and MRI for target delineation of radiation therapy and we and we will do an analysis of future prospects as new tracer non FDG.
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Affiliation(s)
- Arianna Farina
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | - Chiara Gasperini
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital,, Grafton, Auckland, New Zealand; Department of Radiology, Hospital Nueve de Octubre; Calle Valle de la Ballestera, Valencia, Spain
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Fanti
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | - Cristina Nanni
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Vaarwerk B, Breunis WB, Haveman LM, de Keizer B, Jehanno N, Borgwardt L, van Rijn RR, van den Berg H, Cohen JF, van Dalen EC, Merks JH. Fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography (PET) computed tomography (CT) for the detection of bone, lung, and lymph node metastases in rhabdomyosarcoma. Cochrane Database Syst Rev 2021; 11:CD012325. [PMID: 34753195 PMCID: PMC8577863 DOI: 10.1002/14651858.cd012325.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Rhabdomyosarcoma (RMS) is the most common paediatric soft-tissue sarcoma and can emerge throughout the whole body. For patients with newly diagnosed RMS, prognosis for survival depends on multiple factors such as histology, tumour site, and extent of the disease. Patients with metastatic disease at diagnosis have impaired prognosis compared to those with localised disease. Appropriate staging at diagnosis therefore plays an important role in choosing the right treatment regimen for an individual patient. Fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) is a functional molecular imaging technique that uses the increased glycolysis of cancer cells to visualise both structural information and metabolic activity. 18F-FDG-PET combined with computed tomography (CT) could help to accurately stage the extent of disease in patients with newly diagnosed RMS. In this review we aimed to evaluate whether 18F-FDG-PET could replace other imaging modalities for the staging of distant metastases in RMS. OBJECTIVES To determine the diagnostic accuracy of 18F-FDG-PET/CT imaging for the detection of bone, lung, and lymph node metastases in RMS patients at first diagnosis. SEARCH METHODS We searched MEDLINE in PubMed (from 1966 to 23 December 2020) and Embase in Ovid (from 1980 to 23 December 2020) for potentially relevant studies. We also checked the reference lists of relevant studies and review articles; scanned conference proceedings; and contacted the authors of included studies and other experts in the field of RMS for information about any ongoing or unpublished studies. We did not impose any language restrictions. SELECTION CRITERIA We included cross-sectional studies involving patients with newly diagnosed proven RMS, either prospective or retrospective, if they reported the diagnostic accuracy of 18F-FDG-PET/CT in diagnosing lymph node involvement or bone metastases or lung metastases or a combination of these metastases. We included studies that compared the results of the 18F-FDG-PET/CT imaging with those of histology or with evaluation by a multidisciplinary tumour board as reference standard. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, data extraction, and methodological quality assessement according to Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). We analysed data for the three outcomes (nodal involvement and lung and bone metastases) separately. We used data from the 2 × 2 tables (consisting of true positives, false positives, true negatives, and false negatives) to calculate sensitivity and specificity in each study and corresponding 95% confidence intervals. We did not consider a formal meta-analysis to be relevant because of the small number of studies and substantial heterogeneity between studies. MAIN RESULTS Two studies met our inclusion criteria. The diagnostic accuracy of 18F-FDG-PET/CT was reported in both studies, which included a total of 36 participants. We considered both studies to be at high risk of bias for the domain reference standard. We considered one study to be at high risk of bias for the domain index test and flow and timing. Sensitivity and specificity of 18F-FDG-PET/CT for the detection of bone metastases was 100% in both studies (95% confidence interval (CI) for sensitivity was 29% to 100% in study one and 40% to 100% in study two; 95% CI for specificity was 83% to 100% in study one and 66% to 100% in study two). The reported sensitivity of 18F-FDG-PET/CT for the detection of lung metastases was not calculated since only two participants in study two showed lung metastases, of which one was detected by 18F-FDG-PET/CT. Reported specificity was 96% in study one (95% CI 78% to 100%) and 100% (95% CI 72% to 100%) in study two. The reported sensitivity for the detection of nodal involvement was 100% (95% CI 63% to 100% in study one and 40% to 100% in study two); the reported specificity was 100% (95% CI 78% to 100%) in study one and 89% (95% CI 52% to 100%) in study two. AUTHORS' CONCLUSIONS The diagnostic accuracy of 18F-FDG-PET/CT for the detection of bone, lung, and lymph node metastases was reported in only two studies including a total of only 36 participants with newly diagnosed RMS. Because of the small number of studies (and participants), there is currently insufficient evidence to reliably determine the diagnostic accuracy of 18F-FDG-PET/CT in the detection of distant metastases. Larger series evaluating the diagnostic accuracy of 18F-FDG-PET/CT for the detection of metastases in patients with RMS are necessary.
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Affiliation(s)
- Bas Vaarwerk
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Department of Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Willemijn B Breunis
- Department of Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Oncology and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Lianne M Haveman
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Department of Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Bart de Keizer
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Nina Jehanno
- Department of Nuclear Medicine, Institut Curie, Paris, France
| | - Lise Borgwardt
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen , Denmark
| | - Rick R van Rijn
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Henk van den Berg
- Department of Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Jérémie F Cohen
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and Statistics (CRESS), UMR1153, Université de Paris, Paris, France
- Department of General Pediatrics and Pediatric Infectious Diseases, Necker - Enfants malades hospital, Assistance Publique - Hôpitaux de Paris, Paris Descartes University, Paris, France
| | | | - Johannes Hm Merks
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Department of Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Sobic Saranovic DP, Nikitovic M, Saponjski J, Grozdic Milojevic I, Paripovic L, Saranovic D, Beatovic S, Artiko VM. Post-treatment FDG PET/CT predicts progression-free survival in young patients with small round blue cell tumors: Ewing sarcoma and PNET. Eur J Radiol 2020; 129:109076. [PMID: 32446127 DOI: 10.1016/j.ejrad.2020.109076] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 04/30/2020] [Accepted: 05/12/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To determine if post-treatment F-18 FDG PET/CT results (overall positive findings, specific localizations) are independent predictors of disease progression in young patients with Ewing sarcoma and Primitive neuroectodermal tumor. METHOD A consecutive sample of 48 patients (age 14 ± 5 years, 32 male) was referred to F-18 FDG PET/CT for the suspected progression of Ewing sarcoma (39 patients) and Primitive neuroectodermal tumor (PNET) (9 patients) and followed-up clinically for 4.3 ± 2.3 years after F-18 FDG PET/CT (range 1-8 years). The diagnostic value of F-18 FDG PET/CT was determined in comparison to the biopsy. Kaplan-Meier analysis was used to compare progression-free survival between the groups with positive and negative F-18 FDG PET/CT findings. Variables included in the Cox regression for predicting the progression-free survival were sex, age, F-18 FDG PET/CT findings, MDCT findings, and MR ratio. RESULTS F-18 FDG PET/CT findings were positive in 32 (67 %) patients (sensitivity 93.7 %, specificity 87.5 %, accuracy 91.7 %) with an average SUVmax of 5.8 ± 3.2 (95 % CI 4.8-7.1). The progression-free survival was significantly lower (p = 0.001) in patients with positive F-18 FDG PET/CT findings (median 28 months) and when recurrence was located in bones, soft tissues, and muscles (p = 0.02, median 21 months). The significant predictors of the disease progression were the overall positive F-18 FDG PET/CT findings (HR 8.36, p = 0.004) and, specifically, the local recurrence in the bone with infiltration of soft tissue/muscles (HR 4.08, p = 0.003). CONCLUSION Post-treatment F-18 FDG PET/CT findings are useful for predicting the progression of Ewing sarcoma and PNET and should be included in the clinical monitoring of these patients.
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Affiliation(s)
- Dragana P Sobic Saranovic
- Faculty of Medicine, University of Belgrade, Visegradska 26 St., 11000, Belgrade, Serbia; Center for Nuclear Medicine, Clinical Center of Serbia, Visegradska 26 St., 11000, Belgrade, Serbia.
| | - Marina Nikitovic
- Faculty of Medicine, University of Belgrade, Visegradska 26 St., 11000, Belgrade, Serbia; National Cancer Research Center, Pasterova 14, 11000, Belgrade, Serbia.
| | - Jelena Saponjski
- Center for Nuclear Medicine, Clinical Center of Serbia, Visegradska 26 St., 11000, Belgrade, Serbia.
| | - Isidora Grozdic Milojevic
- Faculty of Medicine, University of Belgrade, Visegradska 26 St., 11000, Belgrade, Serbia; Center for Nuclear Medicine, Clinical Center of Serbia, Visegradska 26 St., 11000, Belgrade, Serbia.
| | - Lejla Paripovic
- National Cancer Research Center, Pasterova 14, 11000, Belgrade, Serbia.
| | - Djordjije Saranovic
- Faculty of Medicine, University of Belgrade, Visegradska 26 St., 11000, Belgrade, Serbia.
| | - Slobodanka Beatovic
- Faculty of Medicine, University of Belgrade, Visegradska 26 St., 11000, Belgrade, Serbia; Center for Nuclear Medicine, Clinical Center of Serbia, Visegradska 26 St., 11000, Belgrade, Serbia.
| | - Vera M Artiko
- Faculty of Medicine, University of Belgrade, Visegradska 26 St., 11000, Belgrade, Serbia; Center for Nuclear Medicine, Clinical Center of Serbia, Visegradska 26 St., 11000, Belgrade, Serbia.
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Albano D, Dondi F, Schumacher RF, D'Ippolito C, Porta F, Giubbini R, Bertagna F. Clinical and Prognostic Role of 18F-FDG PET/CT in Pediatric Ewing Sarcoma. J Pediatr Hematol Oncol 2020; 42:e79-e86. [PMID: 31135716 DOI: 10.1097/mph.0000000000001518] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Ewing sarcoma (ES) is one of the most common pediatric solid tumors with aggressive behavior and unfavorable survival. In this study, we evaluated the diagnostic accuracy of baseline and restaging fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) scans and their possible prognostic role in pediatric ES. We evaluated 17 patients who underwent a total of 27 18F-FDG-PET/CT scans (10 for staging and 17 for restaging). The PET images were analyzed visually and semiquantitatively by measuring SUVmean, SUVmax, SUVlbm, SUVbsa, MTV, and TLG. Moreover, PET/CT results were compared with other conventional imaging (CI) results. Among 10 baseline PET/CT scan results, 9 were positive and 1 not valuable by interference; baseline PET/CT and CI were concordant in 7 cases and discordant in 2, with pulmonary micrometastases not detected by PET/CT. Among 17 restaging PET/CT scan results, 9 were positive and 8 negative; CI and restaging PET/CT were concordant in 9 cases and discordant in 8. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of restaging 18F-FDG-PET/CT were 73%, 83%, 89%, 62.5%, and 76%, respectively. After a median follow-up of 20 months, relapse/progression occurred in 8 patients and death in 5. A positive 18F-FDG-PET/CT at restaging was significantly associated with shorter overall survival compared with unremarkable PET/CT at the same timepoint, but not with progression-free survival. Instead, metabolic PET/CT features were not correlated with outcome. 18F-FDG-PET/CT showed a good diagnostic performance in pediatric ES; except for pulmonary micrometastases, PET/CT was better than CI at restaging. Only restaging PET/CT result was significantly correlated with overall survival.
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Affiliation(s)
- Domenico Albano
- Department of Nuclear Medicine, University of Brescia and Spedali Civili Brescia
| | - Francesco Dondi
- Department of Nuclear Medicine, University of Brescia and Spedali Civili Brescia
| | - Richard Fabian Schumacher
- Department of Pediatric Hematology Oncology, University Children's Hospital "Ospedale dei Bambini", ASST Spedali Civili Brescia, Brescia, Italy
| | - Carmelita D'Ippolito
- Department of Pediatric Hematology Oncology, University Children's Hospital "Ospedale dei Bambini", ASST Spedali Civili Brescia, Brescia, Italy
| | - Fulvio Porta
- Department of Pediatric Hematology Oncology, University Children's Hospital "Ospedale dei Bambini", ASST Spedali Civili Brescia, Brescia, Italy
| | - Raffaele Giubbini
- Department of Nuclear Medicine, University of Brescia and Spedali Civili Brescia
| | - Francesco Bertagna
- Department of Nuclear Medicine, University of Brescia and Spedali Civili Brescia
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Kogan F, Broski SM, Yoon D, Gold GE. Applications of PET-MRI in musculoskeletal disease. J Magn Reson Imaging 2019; 48:27-47. [PMID: 29969193 DOI: 10.1002/jmri.26183] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 04/19/2018] [Indexed: 12/26/2022] Open
Abstract
New integrated PET-MRI systems potentially provide a complete imaging modality for diagnosis and evaluation of musculoskeletal disease. MRI is able to provide excellent high-resolution morphologic information with multiple contrast mechanisms that has made it the imaging modality of choice in evaluation of many musculoskeletal disorders. PET offers incomparable abilities to provide quantitative information about molecular and physiologic changes that often precede structural and biochemical changes. In combination, hybrid PET-MRI can enhance imaging of musculoskeletal disorders through early detection of disease as well as improved diagnostic sensitivity and specificity. The purpose of this article is to review emerging applications of PET-MRI in musculoskeletal disease. Both clinical applications of malignant musculoskeletal disease as well as new opportunities to incorporate the molecular capabilities of nuclear imaging into studies of nononcologic musculoskeletal disease are discussed. Lastly, we discuss some of the technical considerations and challenges of PET-MRI as they specifically relate to musculoskeletal disease. LEVEL OF EVIDENCE 5 TECHNICAL EFFICACY: Stage 3 J. Magn. Reson. Imaging 2018;48:27-47.
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Affiliation(s)
- Feliks Kogan
- Department of Radiology, Stanford University, Stanford, California, USA
| | | | - Daehyun Yoon
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Garry E Gold
- Department of Radiology, Stanford University, Stanford, California, USA.,Department of Bioengineering, Stanford University, Stanford, California, USA.,Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
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Revannagowda S, Gangadhar K, Akaike G, Dighe M. Primary Intra-abdominal Ewing's Sarcoma in Adults: A Multimodality Imaging Spectrum. Curr Probl Diagn Radiol 2019; 49:133-139. [PMID: 30642618 DOI: 10.1067/j.cpradiol.2018.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/18/2018] [Accepted: 12/31/2018] [Indexed: 11/22/2022]
Abstract
Ewing sarcoma (ES) and peripheral primitive neuroectodermal tumor are part of a spectrum of neoplastic diseases known as the ES family of tumors, which also includes extraosseous ES, peripheral primitive neuroectodermal tumor, malignant small-cell tumor of the thoracopulmonary region (Askin's tumor), and atypical ES. Although imaging features of these tumors have been previously described, extensive discussion about intra-abdominal manifestations is scarce in the literature. We present an imaging spectrum of these tumors in the abdomen and pelvis with particular attention to multimodality approach for staging and restaging.
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10
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Angelini A, Castellucci P, Ceci F. Future Perspective of the Application of Positron Emission Tomography-Computed Tomography-MR Imaging in Musculoskeletal Disorders. PET Clin 2018; 14:183-191. [PMID: 30420219 DOI: 10.1016/j.cpet.2018.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) is the imaging method of choice in sarcoma patients. PET may help in diagnosis, grading, staging, biopsy guidance, monitoring response to therapy, restaging for recurrence, and prognosis. 18F-FDG-PET/MRI combines the higher tissue contrast of MRI in the study of soft-tissue lesions and the peculiarities of PET imaging that allow the characterization of tissues. The use of 18F-FDG-PET/MRI in these patients has reduces the radiation dose, which is of great importance, particularly in children. Data support the routine use of 18F-FDG-PET either using CT or MRI in patients with sarcoma.
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Affiliation(s)
- Andrea Angelini
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Via 8 Febbraio 1848, 2, 35122 Padova, Italy
| | - Paolo Castellucci
- Nuclear Medicine, Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Via massarenti 9, 40138, Bologna, Italy
| | - Francesco Ceci
- Department of Molecular and Medical Pharmacology, Ahmanson Translational Imaging Division, University of California at Los Angeles (UCLA), 200 Medical Plaza, Suite B114, Los Angeles CA 90095, USA; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
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11
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Huang T, Li F, Yan Z, Ma Y, Xiong F, Cai X, Zhang Q, Liu F, Dong J. Effectiveness of 18F-FDG PET/CT in the diagnosis, staging and recurrence monitoring of Ewing sarcoma family of tumors: A meta-analysis of 23 studies. Medicine (Baltimore) 2018; 97:e13457. [PMID: 30508968 PMCID: PMC6283220 DOI: 10.1097/md.0000000000013457] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To investigate the value of positron emission tomography (PET) and PET/computed tomography (CT) using fluorine-18-fluorodeoxyglucose (F-FDG) in the diagnosis, staging, restaging and recurrence monitoring of Ewing sarcoma family of tumors (ESFTs), a meta-analysis was performed through systematically searching PubMed, Embase, and Cochrane Central library to retrieve articles. METHODS After screening and diluting out the articles that met inclusion criteria to be used for statistical analysis the pooled evaluation indexes including sensitivity, specificity, and diagnostic odd ratio (DOR) as well as the summary receiver operating characteristic curve (SROC) were calculated involving diagnostic data (true positive, false positive, false negative, and true negative) extracted from original studies. RESULTS Screening determined that out of 2007, 23 studies involving a total of 524 patients were deemed viable for inclusion in the meta-analysis. The results of the analysis showed that the sensitivity and specificity were at 86% and 80%, respectively. Additionally, a satisfactory accuracy of F-FDG PET and PET/CT was observed in detecting ESFT recurrence, lung metastasis, and osseous metastasis. CONCLUSION This meta-analysis suggests that F-FDG PET and PET/CT with an extremely high accuracy could be considered a valuable method for detecting distant metastasis and post-operational recurrence of ESFT, which might have a profound impact on the development of treatment protocols for ESFT.
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Affiliation(s)
- Tao Huang
- Department of Orthopaedics, Yantai Shan Hospital, Yantai
| | - Feng Li
- Department of Orthopaedics, Zhangqiu District People's Hospital of Jinan City, Zhangqiu District, Jinan City, Shandong Province, China
| | - Zexing Yan
- Department of Trauma Surgery, University of Regensburg, Regensburg
| | - Yupeng Ma
- Department of Orthopaedics, Yantai Shan Hospital, Yantai
| | - Fei Xiong
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Großhadern, Munich, Germany
| | - Xia Cai
- Department of Orthopaedics, Zhangqiu District People's Hospital of Jinan City, Zhangqiu District, Jinan City, Shandong Province, China
| | - Qingyu Zhang
- Department of Orthopaedics, Qilu Hospital, Shandong University
| | - Fanxiao Liu
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Großhadern, Munich, Germany
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Jinlei Dong
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
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Khalatbari H, Parisi MT, Kwatra N, Harrison DJ, Shulkin BL. Pediatric Musculoskeletal Imaging: The Indications for and Applications of PET/Computed Tomography. PET Clin 2018; 14:145-174. [PMID: 30420216 DOI: 10.1016/j.cpet.2018.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The use of PET/computed tomography (CT) for the evaluation and management of children, adolescents, and young adults continues to expand. The principal tracer used is 18F-fluorodeoxyglucose and the principal indication is oncology, particularly musculoskeletal neoplasms. The purpose of this article is to review the common applications of PET/CT for imaging of musculoskeletal issues in pediatrics and to introduce the use of PET/CT for nononcologic issues, such as infectious/inflammatory disorders, and review the use of 18F-sodium fluoride in trauma and sports-related injuries.
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Affiliation(s)
- Hedieh Khalatbari
- Department of Radiology, University of Washington School of Medicine, Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA 98105, USA.
| | - Marguerite T Parisi
- Department of Radiology, University of Washington School of Medicine, Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA 98105, USA; Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA 98105, USA
| | - Neha Kwatra
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Douglas J Harrison
- Department of Pediatrics, MD Anderson Cancer Center, 7600 Beechnut Street, Houston, TX 77074, USA
| | - Barry L Shulkin
- Department of Diagnostic Imaging, St Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
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14
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Behzadi AH, Raza SI, Carrino JA, Kosmas C, Gholamrezanezhad A, Basques K, Matcuk GR, Patel J, Jadvar H. Applications of PET/CT and PET/MR Imaging in Primary Bone Malignancies. PET Clin 2018; 13:623-634. [PMID: 30219192 DOI: 10.1016/j.cpet.2018.05.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Primary bone malignancies are characterized with anatomic imaging. However, in recent years, there has been an increased interest in PET/computed tomography scanning and PET/MRI with fludeoxyglucose F 18 for evaluating and staging musculoskeletal neoplasms. These hybrid imaging modalities have shown promise largely owing to their high sensitivity, ability to perform more thorough staging, and ability to monitor treatment response. This article reviews the current role of PET/computed tomography scanning and PET/MRI in primary malignancies of bone, with an emphasis on imaging characteristics, clinical usefulness, and current limitations.
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Affiliation(s)
| | - Syed Imran Raza
- Department of Radiology, Weill Cornell Medical Center, 525 East 68th Street, New York, NY 10065, USA
| | - John A Carrino
- Department of Radiology and Imaging, 535 East 70th Street, Hospital for Special Surgery, New York, NY 10021, USA
| | - Christos Kosmas
- Department of Radiology and Imaging, University Hospitals of Cleveland, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Ali Gholamrezanezhad
- Division of Musculoskeletal Radiology, Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA 90007, USA
| | - Kyle Basques
- Department of Radiology and Imaging, University Hospitals of Cleveland, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - George R Matcuk
- Division of Musculoskeletal Radiology, Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA 90007, USA
| | - Jay Patel
- Department of Radiology, Weill Cornell Medical Center, 525 East 68th Street, New York, NY 10065, USA
| | - Hossein Jadvar
- Division of Nuclear Medicine, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90007, USA
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Heinemann M, Ranft A, Langer T, Jürgens H, Kreyer J, Vieth V, Schäfers M, Weckesser M, Simon T, Hassenpflug W, Corbacioglu S, Bielack S, Mayer-Steinacker R, Kühne T, van den Berg H, Gelderblom H, Bauer S, Stegger L, Dirksen U. Recurrence of Ewing sarcoma: Is detection by imaging follow-up protocol associated with survival advantage? Pediatr Blood Cancer 2018; 65:e27011. [PMID: 29480574 DOI: 10.1002/pbc.27011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 01/24/2018] [Accepted: 01/24/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND The Cooperative Ewing Sarcoma Study and the Late Effects Surveillance System of the Society for Paediatric Oncology and Haematology recommend a structured follow-up imaging protocol (FUIP) for patients with Ewing sarcoma (EwS) with decreasing frequency of imaging over the first 5 years. The present study aims to assess the effectiveness of the FUIP for EwS patients regarding survival after relapse. PATIENTS AND METHODS A retrospective multicenter analysis on 160 eligible patients with EwS recurrence was performed. Potential survival differences following recurrence diagnosis between patients with protocol-detected and symptomatic relapse were investigated using the Kaplan-Meier method. Additional subgroup analyses were performed on the relapse type. Overall survival (OS) was calculated from diagnosis of relapse to last follow-up or death. RESULTS In the multicenter analysis, recurrence was detected by FUIP in 77 of 160 patients (48%) and due to symptoms in 83 patients (52%). Regarding the entire study population, OS was significantly superior in patients with protocol-detected relapse compared to patients with symptomatic relapse (median, 2.4 vs. 1.2 years; P < 0.001). In the subgroup analyses, patients whose lung recurrences were detected by the FUIP experienced longer survival after recurrence than those whose recurrences were detected symptomatically (P = 0.023). In the 83 symptomatic patients, pain was the most prevalent symptom of relapse (72%). CONCLUSION FUIP may benefit survival in EwS relapse, especially in lung recurrence. Pain was the leading symptom of relapse.
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Affiliation(s)
- Melina Heinemann
- University Hospital Muenster, Westphalian-Wilhelms University, Muenster, Germany.,Department of Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Ranft
- University Hospital Muenster, Westphalian-Wilhelms University, Muenster, Germany.,Paediatrics III, West German Cancer Centre, University Hospital of Essen, Essen, Germany
| | - Thorsten Langer
- Paediatric Oncology and Haematology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Herbert Jürgens
- Paediatric Haematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Justus Kreyer
- Department of Orthopaedic and Trauma Surgery, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Volker Vieth
- Department of Clinical Radiology, University Hospital Muenster, Muenster, Germany
| | - Michael Schäfers
- Department of Nuclear Medicine, University Hospital Muenster, Muenster, Germany
| | - Matthias Weckesser
- Department of Nuclear Medicine, University Hospital Muenster, Muenster, Germany
| | - Thorsten Simon
- Department of Paediatric Oncology and Haematology, University Children's Hospital of Cologne, Cologne, Germany
| | - Wolf Hassenpflug
- Department of Paediatric Haematology and Oncology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Selim Corbacioglu
- Department of Paediatric Haematology, Oncology, and Stem Cell Transplantation, Children's Hospital Regensburg, University of Regensburg, Regensburg, Germany
| | - Stefan Bielack
- Paediatrics 5 (Oncology, Haematology, and Immunology), Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | | | - Thomas Kühne
- Department of Oncology and Haematology, University Children's Hospital Basel, Basel, Switzerland
| | - Henk van den Berg
- Paediatric Oncology, Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Hans Gelderblom
- Clinical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Sebastian Bauer
- Sarcoma Centre, West German Cancer Centre, University Hospital of Essen, Essen, Germany.,German Cancer Research Centre, Essen, Germany
| | - Lars Stegger
- Department of Nuclear Medicine, University Hospital Muenster, Muenster, Germany
| | - Uta Dirksen
- University Hospital Muenster, Westphalian-Wilhelms University, Muenster, Germany.,Paediatrics III, West German Cancer Centre, University Hospital of Essen, Essen, Germany.,Sarcoma Centre, West German Cancer Centre, University Hospital of Essen, Essen, Germany.,German Cancer Research Centre, Essen, Germany
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18F-FDG PET/CT in Diagnostic and Prognostic Evaluation of Patients With Suspected Recurrence of Chondrosarcoma. Clin Nucl Med 2018; 43:87-93. [DOI: 10.1097/rlu.0000000000001947] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Heinemann M, Ranft A, Jürgens H, Langer T, Vieth V, Timmermann B, Weckesser M, Dirksen U, Stegger L. Ewing sarcoma during follow-up. Nuklearmedizin 2018. [PMID: 29533418 DOI: 10.3413/nukmed-0909-17-07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIM To evaluate the performance of a prospectively defined follow-up imaging protocol that includes FDG-PET(/CT) to detect tumour recurrence in Ewing sarcoma (EwS) before becoming symptomatic. METHODS Imaging results and clinical data during follow-up were retrospectively analysed from all patients treated successfully within the EURO E.W.I.N.G. 99 trial at the University Hospital Münster, Germany. All patients received follow-up imaging according to a comprehensive protocol that included regular X-ray, CT, MRI, bone scan and PET(/CT), albeit not all on the same day and with varying intervals for the different modalities. RESULTS 80 of 105 patients underwent follow-up at our institution after complete remission. 30 patients had recurrent tumour during the follow-up period of 3.6 years on average. 19 recurrences (63%) were detected by scheduled imaging before the advent of clinical symptoms. The majority of these recurrences (8 out of 19; 42%) was detected first by PET/ CT (and confirmed with additional imaging thereafter), even though the total number of PET/CTs was comparatively low (138) and PET/CT was not systematically scheduled before other imaging techniques. Recurrences detected by bone scan were also detectable by PET. CONCLUSIONS The implemented follow-up protocol was effective in the detection of EwS recurrence before the advent of symptoms. Most cases of those detected before onset of symptoms were detected by PET/CT first. This hybrid imaging modality should therefore be considered in the routine follow-up of EwS patients, as is standard in our hospital. In combination with PET, low-dose chest CT seems to be sufficient in the detection of small pulmonary nodules.
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18
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Sharp SE, Shulkin BL, Gelfand MJ, McCarville MB. FDG PET/CT appearance of local osteosarcoma recurrences in pediatric patients. Pediatr Radiol 2017; 47:1800-1808. [PMID: 28887617 DOI: 10.1007/s00247-017-3963-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 06/15/2017] [Accepted: 08/09/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Osteosarcoma is the most common pediatric malignant bone tumor, frequently surgically managed with limb salvage rather than amputation. Local recurrences are seen in up to 9% of osteosarcoma patients, with CT and MRI imaging often limited by metal artifacts. OBJECTIVE To describe the [F-18]2-fluoro-2-deoxyglucose (FDG) PET/CT appearance of local osteosarcoma recurrences with correlation to findings on other imaging modalities. MATERIALS AND METHODS A retrospective review of pediatric osteosarcoma patients imaged with FDG PET/CT was performed in patients with pathologically proven local recurrences. FDG PET/CT findings were reviewed and correlated with available comparison imaging studies. RESULTS Ten local osteosarcoma recurrences in eight pediatric osteosarcoma patients were imaged with FDG PET/CT. All eight patients had a local recurrence after limb salvage; two patients had a second local recurrence after amputation. All local recurrences were seen with FDG PET/CT, demonstrating solid (n=5) or peripheral/nodular (n=5) FDG uptake patterns. Maximum standard uptake values (SUVs) ranged from 3.0 to 15.7. In five recurrences imaged with FDG PET/CT and MRI, MRI was limited or nondiagnostic in three. In four recurrences imaged with FDG PET/CT and bone scan, the bone scan was negative in three. CONCLUSION Local osteosarcoma recurrences are well visualized by FDG PET/CT, demonstrating either solid or peripheral/nodular FDG uptake with a wide range of maximum SUVs. FDG PET/CT demonstrates the full extent of local recurrences, while MRI can be limited by artifact from metallic hardware. PET/CT appears to be more sensitive than bone scan in detecting local osteosarcoma recurrences.
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Affiliation(s)
- Susan E Sharp
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, OH, 45229, USA.
| | - Barry L Shulkin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Michael J Gelfand
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, OH, 45229, USA
| | - M Beth McCarville
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA
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21
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Diagnostic value of 18F-FDG-PET/CT for the follow-up and restaging of soft tissue sarcomas in adults. Diagn Interv Imaging 2017; 98:693-698. [DOI: 10.1016/j.diii.2017.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/20/2017] [Accepted: 06/12/2017] [Indexed: 12/29/2022]
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22
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Biassoni L, Easty M. Paediatric nuclear medicine imaging. Br Med Bull 2017; 123:127-148. [PMID: 28910997 DOI: 10.1093/bmb/ldx025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 08/05/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Nuclear medicine imaging explores tissue viability and function by using radiotracers that are taken up at cellular level with different mechanism. This imaging technique can also be used to assess blood flow and transit through tubular organs. Nuclear medicine imaging has been used in paediatrics for decades and this field is continuously evolving. SOURCES OF DATA The data presented comes from clinical experience and some milestone papers on the subject. AREAS OF AGREEMENT Nuclear medicine imaging is well-established in paediatric nephro-urology in the context of urinary tract infection, ante-natally diagnosed hydronephrosis and other congenital renal anomalies. Also, in paediatric oncology, I-123-meta-iodobenzyl-guanidine has a key role in the management of children with neuroblastic tumours. Bone scintigraphy is still highly valuable to localize the source of symptoms in children and adolescents with bone pain when other imaging techniques have failed. Thyroid scintigraphy in neonates with congenital hypothyroidism is the most accurate imaging technique to confirm the presence of ectopic functioning thyroid tissue. AREAS OF CONTROVERSY Radionuclide transit studies of the gastro-intestinal tract are potentially useful in suspected gastroparesis or small bowel or colonic dysmotility. However, until now a standardized protocol and a validated normal range have not been agreed, and more work is necessary. Research is ongoing on whether magnetic resonance imaging (MRI), with its great advantage of great anatomical detail and no ionizing radiations, can replace nuclear medicine imaging in some clinical context. On the other hand, access to MRI is often difficult in many district general hospitals and general anaesthesia is frequently required, thus adding to the complexity of the examination. GROWING POINTS Patients with bone pain and no cause for it demonstrated on MRI can benefit from bone scintigraphy with single photon emission tomography and low-dose computed tomography. This technique can identify areas of mechanical stress at cortical bone level, difficult to demonstrate on MRI, which can act as pain generators. Positron emission tomography (PET) is being tested in the staging, response assessment and at the end of treatment of several paediatric malignancies. PET is becoming more widely utilized in neurology in the pre-surgical assessment of some children with drug resistant epilepsy. AREAS TIMELY FOR DEVELOPING RESEARCH The use of PET/MRI scanners is very attractive as it combines benefits of MR imaging with the assessment of cellular viability and metabolism with PET in one examination. This imaging technique will allow important research on tumour in-vivo metabolism (possible applications include lymphomas, neuroblastomas, malignant germ cell tumours andbrain tumours), with the aim of offering a personalized biological profile of the tumour in a particular patient. Ground-breaking research is also envisaged in neurosciences, especially in epilepsy, using PET tracers that would enable a better identification of the epileptogenic focus, and in psychiatry, with the use of radiolabeled neurotransmitters. In paediatric nephro-urology, the identification of the asymptomatic child with ante-natally diagnosed hydronephrosis at risk of losing renal parenchymal function if left untreated is another area of active research involving radionuclide renography.
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Affiliation(s)
- Lorenzo Biassoni
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Marina Easty
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
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Garg G, Benchekroun MT, Abraham T. FDG-PET/CT in the Postoperative Period: Utility, Expected Findings, Complications, and Pitfalls. Semin Nucl Med 2017; 47:579-594. [PMID: 28969758 DOI: 10.1053/j.semnuclmed.2017.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
FDG-PET/CT as a modality is increasingly used for detection of recurrence and for restaging in patients with clinical suspicion of malignancy, as well as in patients with elevated tumor markers. However, there are many pitfalls in the interpretation of these scans when the studies are performed after some treatment. Some of these are attributed to normal physiological distribution and are compounded when there are inflammatory changes occurring after surgery. The body's inherent response to the surgical insult results in this inflammation. In addition, there are also complications that can happen following surgery, causing increased FDG uptake. Despite various fallacies, FDG-PET/CT provides valuable information in evaluation of residual and recurrent malignant disease. In this article, we aim to describe some of these postsurgical changes secondary to inflammation, common surgical complications, and finally, the utility of FDG-PET/CT in these patients to detect recurrent disease, even in the background of postsurgical changes.
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Affiliation(s)
- Gunjan Garg
- Division of Nuclear Medicine, Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Mohammed Taoudi Benchekroun
- Division of Nuclear Medicine, Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Tony Abraham
- Division of Nuclear Medicine, Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY.
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Iwanowska B, Brągoszewska H, Mądzik J, Szkudlińska-Pawlak S, Kopyś-Wiszniewska I, Jastrzębska M, Kowalska B, Uliasz M, Bekiesińska-Figatowska M. Imaging of Complications After Limb Prostheses Implantation in Children with Bone Tumors. Pol J Radiol 2017; 82:227-232. [PMID: 28507643 PMCID: PMC5411374 DOI: 10.12659/pjr.900644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 08/12/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Tumors of the developmental age are an important problem in clinical practice. Primary bone tumors constitute 1-1.5% of all tumors, and 7% of all tumors diagnosed in the developmental age. The aim of the study was to assess the capabilities of imaging methods in diagnosing complications of limb endoprostheses in children with osteoarticular tumors. MATERIAL/METHODS We included 155 patients with limb endoprostheses, aged 7-26 years. There were 113 patients with knee prostheses, 1 patient with bilateral knee prostheses, 16 patients with shoulder prostheses, 14 patients with hip prostheses, 11 patients with hip and knee prostheses, and 1 patient with a femoral prosthesis. All patients underwent plain radiography and an ultrasound study. RESULTS Complications were found in 50 patients (32% of all patients). The following complications were seen - inflammatory changes in soft tissues and bones (12 patients, 7.7%), stump fractures (11 patients, 7%), lack of elongation effect or shortening of the prosthesis (7 patients, 4.5%), prosthesis fractures (4 patients, 2.5%), crural fractures (4 patients, 2.5%), loosening of the prosthesis (3 patients, 1.9%), joint dislocation (2 patients, 1.3%), stump and prosthesis fracture (1 patient, 0.6%) and local recurrence (6 patients, 3.9%). Prostheses were exchanged for the following reasons - fractures (5 patients, 3.2%), inflammation (2 patients with 3 exchanges, 1.9%). Local recurrence and inflammation were confirmed by a biopsy. CONCLUSIONS Radiography and ultrasonography are of crucial importance in monitoring patients after implantation of limb endoprostheses. The findings did not require confirmation in additional studies: CT and MRI. Suspicion of local recurrence and inflammation required a biopsy confirmation.
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Affiliation(s)
- Beata Iwanowska
- Department of Diagnostic Imaging, Institute of Mother and Child, Warsaw, Poland
| | - Hanna Brągoszewska
- Department of Diagnostic Imaging, Institute of Mother and Child, Warsaw, Poland
| | - Jarosław Mądzik
- Department of Diagnostic Imaging, Institute of Mother and Child, Warsaw, Poland
| | | | | | | | - Barbara Kowalska
- Department of Diagnostic Imaging, Institute of Mother and Child, Warsaw, Poland
| | - Maria Uliasz
- Department of Diagnostic Imaging, Institute of Mother and Child, Warsaw, Poland
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Hurley C, McCarville MB, Shulkin BL, Mao S, Wu J, Navid F, Daw NC, Pappo AS, Bishop MW. Comparison of (18) F-FDG-PET-CT and Bone Scintigraphy for Evaluation of Osseous Metastases in Newly Diagnosed and Recurrent Osteosarcoma. Pediatr Blood Cancer 2016; 63:1381-6. [PMID: 27082077 PMCID: PMC5082741 DOI: 10.1002/pbc.26014] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 03/17/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Bone scintigraphy (BS) is used to detect osseous metastases in osteosarcoma. (18) F-fluorodeoxyglucose-positron emission tomography-computed tomography ((18) F-FDG-PET-CT) is being increasingly used for staging. We compared the sensitivity, specificity, and diagnostic accuracy of (18) F-FDG-PET-CT and BS for detecting osseous metastases in osteosarcoma. METHODS We retrospectively reviewed 39 patients with osteosarcoma who had paired PET-CT and BS at diagnosis and/or first recurrence from 2003 to 2012. Imaging studies were reviewed by two pediatric imaging specialists who were blinded to results of the opposing modality and reference standard. Reviewers categorized lesions as benign, malignant, or indeterminate. Reference standard for lesion histology was biopsy or clinical follow-up. Diagnostic performance of PET-CT, BS, and combined modalities were determined. RESULTS There were 40 examinations from 39 patients and 65 distant lesions were evaluated. Median age was 12 years (range 5-19 years). Four patients had 15 osseous metastases at diagnosis (two biopsied and 13 clinically), and two had five osseous metastases at recurrence (one biopsied and five clinically). For distant sites, sensitivity, specificity, and diagnostic accuracy were 79%, 89% and 86% for PET-CT, 32%, 96%, and 77% for BS, and 95%, 85%, and 88% for PET-CT/BS combined. Sensitivity of PET-CT was superior to BS (P = 0.035); combined imaging modalities were superior to BS (P < 0.001) but not better than PET-CT alone (P = 0.25). Specificity for BS approached significance compared to combined imaging (P = 0.063). Examination-based analysis yielded similar results between individual and combined imaging modalities. CONCLUSIONS (18) F-FDG-PET-CT demonstrated superior sensitivity over BS for detecting osseous metastases, supporting the use of (18) F-FDG-PET-CT for staging of osteosarcoma.
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Affiliation(s)
- Caitlin Hurley
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - M. Beth McCarville
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN
| | - Barry L. Shulkin
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN
| | - Shenghua Mao
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jianrong Wu
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
| | - Fariba Navid
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Najat C. Daw
- Department of Pediatrics, M.D. Anderson Cancer Center, Houston, TX
| | - Alberto S. Pappo
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Michael W. Bishop
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN,Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
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Tabacchi E, Fanti S, Nanni C. The Possible Role of PET Imaging Toward Individualized Management of Bone and Soft Tissue Malignancies. PET Clin 2016; 11:285-96. [PMID: 27321032 DOI: 10.1016/j.cpet.2016.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This article presents fluorodeoxyglucose PET/computed tomography for the evaluation of soft tissue sarcomas. Its clinical impact is discussed analyzing all the clinical information provided when applied in different phases of the disease. A special paragraph is dedicated to the use of functional imaging for driving the biopsy.
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Affiliation(s)
- Elena Tabacchi
- Nuclear Medicine, AOU di Bologna Policlinico S. Orsola-Malpighi, Via Massarenti 9, Bologna 40138, Italy
| | - Stefano Fanti
- Nuclear Medicine, AOU di Bologna Policlinico S. Orsola-Malpighi, Via Massarenti 9, Bologna 40138, Italy
| | - Cristina Nanni
- Nuclear Medicine, AOU di Bologna Policlinico S. Orsola-Malpighi, Via Massarenti 9, Bologna 40138, Italy.
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Quartuccio N, Byun BH, Alongi P, Caobelli F, Kong CB, Lim SM, Cistaro A. Assessment of response to treatment in paediatric bone sarcomas by means of PET imaging. Clin Transl Imaging 2016. [DOI: 10.1007/s40336-015-0160-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Qualitative FDG PET Image Assessment Using Automated Three-Segment MR Attenuation Correction Versus CT Attenuation Correction in a Tertiary Pediatric Hospital: A Prospective Study. AJR Am J Roentgenol 2015; 205:652-8. [PMID: 26295654 DOI: 10.2214/ajr.14.14231] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The purpose of this study was to systematically evaluate the diagnostic quality of (18)F-FDG PET images generated using MR attenuation correction (MRAC) compared with those images generated using CT attenuation correction (CTAC) in a pediatric population. SUBJECTS AND METHODS Forty-two patients (mean age, 12.8 years; percentage who were male, 57%) who were referred for 62 indicated whole-body PET/CT studies were prospectively recruited to undergo PET/MRI examinations during the same clinic visit in which PET/CT was performed. MRAC was performed using an automatic three-segment model. Three nuclear radiologists scored the diagnostic quality of the PET images generated by MRAC and CTAC using a Likert scale (range of scores, 1-5). Images graded with a score of 1-3 were considered clinically unacceptable, whereas images with a score of 4-5 were considered clinically acceptable. A Wilcoxon signed-rank test was used to compare differences in the grading of PET/MRI and PET/CT images. The Fisher exact test was used to evaluate potential differences in clinically acceptable image quality and the presence of artifact. Fleiss kappa statistics were used to examine interobserver agreement. RESULTS There was no statistically significant difference in the proportion of PET images generated with MRAC and CTAC for which image quality was considered clinically acceptable. A total of 3.9% of PET assessments generated with MRAC were of unacceptable image quality, compared with 2.2% of PET images generated with CTAC. Two of the three radiologists who reviewed the PET images reported the presence of artifacts more often on MRAC-derived images, and they graded the mean quality of these images 0.48 and 0.29 points lower on the 5-point Likert scale than they graded the mean quality of CTAC-derived images (p < 0.0001). Interobserver agreement was fair (κ = 0.39). CONCLUSION The diagnostic quality of PET images obtained from a pediatric population with the use of an automatic three-segmentation MRAC method was comparable to that of PET images obtained with the use of CTAC.
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Comparison of Standardized Uptake Values in Normal Structures Between PET/CT and PET/MRI in a Tertiary Pediatric Hospital: A Prospective Study. AJR Am J Roentgenol 2015; 205:1094-101. [DOI: 10.2214/ajr.15.14304] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Liu F, Zhang Q, Zhu D, Liu F, Li Z, Li J, Wang B, Zhou D, Dong J. Performance of Positron Emission Tomography and Positron Emission Tomography/Computed Tomography Using Fluorine-18-Fluorodeoxyglucose for the Diagnosis, Staging, and Recurrence Assessment of Bone Sarcoma: A Systematic Review and Meta-Analysis. Medicine (Baltimore) 2015; 94:e1462. [PMID: 26356700 PMCID: PMC4616630 DOI: 10.1097/md.0000000000001462] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
To investigate the performance of fluorine-18-fluorodeoxyglucose (F-FDG) positron emission tomography (PET) and PET/computed tomography (CT) in the diagnosis, staging, restaging, and recurrence surveillance of bone sarcoma by systematically reviewing and meta-analyzing the published literature.To retrieve eligible studies, we searched the MEDLINE, Embase, and the Cochrane Central library databases using combinations of following Keywords: "positron emission tomography" or "PET," and "bone tumor" or "bone sarcoma" or "sarcoma." Bibliographies from relevant articles were also screened manually. Data were extracted and the pooled sensitivity, specificity, and diagnostic odds ratio (DOR), on an examination-based or lesion-based level, were calculated to appraise the diagnostic accuracy of F-FDG PET and PET/CT. All statistical analyses were performed using Meta-Disc 1.4.Forty-two trials were eligible. The pooled sensitivity and specificity of PET/CT to differentiate primary bone sarcomas from benign lesions were 96% (95% confidence interval [CI], 93-98) and 79% (95% CI, 63-90), respectively. For detecting recurrence, the pooled results on an examination-based level were sensitivity 92% (95% CI, 85-97), specificity 93% (95% CI, 88-96), positive likelihood ratio (PLR) 10.26 (95% CI, 5.99-17.60), and negative likelihood ratio (NLR) 0.11 (95% CI, 0.05-0.22). For detecting distant metastasis, the pooled results on a lesion-based level were sensitivity 90% (95% CI, 86-93), specificity 85% (95% CI, 81-87), PLR 5.16 (95% CI, 2.37-11.25), and NLR 0.15 (95% CI, 0.11-0.20). The accuracies of PET/CT for detecting local recurrence, lung metastasis, and bone metastasis were satisfactory. Pooled outcome estimates of F-FDG PET were less complete compared with those of PET/CT.F-FDG PET and PET/CT showed a high sensitivity for diagnosing primary bone sarcoma. Moreover, PET/CT demonstrated excellent accuracy for the staging, restaging, and recurrence surveillance of bone sarcoma. However, to avoid misdiagnosis, pathological examination or long-term follow-up should be carried out for F-FDG-avid lesions in patients with suspected bone sarcoma.
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Affiliation(s)
- Fanxiao Liu
- From the Department of Orthopedics, Shandong Hospital Affiliated to Shandong University, Jinan, Shandong, China (FL, BW, DZ); Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (QZ, ZL, JL); and Department of Orthopedics, Heze Peony People's Hospital, Heze, Shandong, China (DZ, FL)
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Is dedicated chest CT needed in addition to PET/CT for evaluation of pediatric oncology patients? Clin Imaging 2015; 39:794-8. [DOI: 10.1016/j.clinimag.2015.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 04/26/2015] [Accepted: 05/08/2015] [Indexed: 11/23/2022]
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Sheikhbahaei S, Marcus C, Hafezi-Nejad N, Taghipour M, Subramaniam RM. Value of FDG PET/CT in Patient Management and Outcome of Skeletal and Soft Tissue Sarcomas. PET Clin 2015; 10:375-93. [PMID: 26099673 DOI: 10.1016/j.cpet.2015.03.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Fluorodeoxyglucose (FDG)-PET/computed tomography (CT) has been increasingly used in bone and soft tissue sarcomas and provides advantages in the initial tumor staging, tumor grading, therapy assessment, and recurrence detection. FDG-PET/CT metabolic parameters are reliable predictors of survival in sarcomas and could be implemented in risk stratification models along with other prognostic factors in these patients.
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Affiliation(s)
- Sara Sheikhbahaei
- Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, JHOC 3230, 601 North Caroline Street, Baltimore, MD 21287, USA
| | - Charles Marcus
- Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, JHOC 3230, 601 North Caroline Street, Baltimore, MD 21287, USA
| | - Nima Hafezi-Nejad
- Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, JHOC 3230, 601 North Caroline Street, Baltimore, MD 21287, USA
| | - Mehdi Taghipour
- Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, JHOC 3230, 601 North Caroline Street, Baltimore, MD 21287, USA
| | - Rathan M Subramaniam
- Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, JHOC 3230, 601 North Caroline Street, Baltimore, MD 21287, USA; Department of Oncology, Johns Hopkins School of Medicine, 401 North Broadway, Baltimore, MD 21231, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA.
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Kornerup JS, Brodin P, Birk Christensen C, Björk-Eriksson T, Kiil-Berthelsen A, Borgwardt L, Munck Af Rosenschöld P. Use of PET/CT instead of CT-only when planning for radiation therapy does not notably increase life years lost in children being treated for cancer. Pediatr Radiol 2015; 45:570-81. [PMID: 25378209 DOI: 10.1007/s00247-014-3197-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 07/03/2014] [Accepted: 08/13/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND PET/CT may be more helpful than CT alone for radiation therapy planning, but the added risk due to higher doses of ionizing radiation is unknown. OBJECTIVE To estimate the risk of cancer induction and mortality attributable to the [F-18]2-fluoro-2-deoxyglucose (FDG) PET and CT scans used for radiation therapy planning in children with cancer, and compare to the risks attributable to the cancer treatment. MATERIALS AND METHODS Organ doses and effective doses were estimated for 40 children (2-18 years old) who had been scanned using PET/CT as part of radiation therapy planning. The risk of inducing secondary cancer was estimated using the models in BEIR VII. The prognosis of an induced cancer was taken into account and the reduction in life expectancy, in terms of life years lost, was estimated for the diagnostics and compared to the life years lost attributable to the therapy. Multivariate linear regression was performed to find predictors for a high contribution to life years lost from the radiation therapy planning diagnostics. RESULTS The mean contribution from PET to the effective dose from one PET/CT scan was 24% (range: 7-64%). The average proportion of life years lost attributable to the nuclear medicine dose component from one PET/CT scan was 15% (range: 3-41%). The ratio of life years lost from the radiation therapy planning PET/CT scans and that of the cancer treatment was on average 0.02 (range: 0.01-0.09). Female gender was associated with increased life years lost from the scans (P < 0.001). CONCLUSION Using FDG-PET/CT instead of CT only when defining the target volumes for radiation therapy of children with cancer does not notably increase the number of life years lost attributable to diagnostic examinations.
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Affiliation(s)
- Josefine S Kornerup
- Section of Radiotherapy, Department of Oncology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark,
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Zbojniewicz AM, Sorger JI. Posttreatment imaging of pediatric musculoskeletal tumors. Radiographics 2015; 34:724-40. [PMID: 24819791 DOI: 10.1148/rg.342135069] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pediatric patients who are diagnosed with musculoskeletal tumors often require serial imaging both during and after treatment. Although many of the treatments used in adults overlap with those used in children and adolescents, the growing skeleton presents specific challenges that require a unique approach. Surgical treatment of benign osseous lesions typically requires only curettage and bone grafting, whereas that of osseous malignancies generally consists of wide excision and limb salvage, with either endoprosthetic or biologic reconstruction. Current conventional endoprostheses consist of modular components that allow intraoperative customization; however, if there is great potential for future growth, an expandable endoprosthesis may be required. Biologic reconstruction may consist of an allograft and/or autograft and, in some circumstances, can spare the growth plates in a child, thereby allowing normal growth. Expected posttreatment imaging findings in soft-tissue tumors may include muscle flaps and postoperative fluid collections. Medical treatment, including radiation therapy and chemotherapy, can have predictable imaging manifestations, including signal alterations in bone marrow, muscle, and subcutaneous fat. Finally, treatment complications may manifest with clinical symptoms and include infection or mechanical failure, although other complications such as local tumor recurrence may go clinically undetected until surveillance imaging. Familiarity with the expected posttreatment imaging findings in pediatric patients with musculoskeletal tumors can aid in the detection of complications.
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Affiliation(s)
- Andrew M Zbojniewicz
- From the Division of Pediatric Radiology (A.M.Z.) and Department of Orthopedic Surgery (J.I.S.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229
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Uslu L, Donig J, Link M, Rosenberg J, Quon A, Daldrup-Link HE. Value of 18F-FDG PET and PET/CT for evaluation of pediatric malignancies. J Nucl Med 2015; 56:274-86. [PMID: 25572088 DOI: 10.2967/jnumed.114.146290] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Successful management of solid tumors in children requires imaging tests for accurate disease detection, characterization, and treatment monitoring. Technologic developments aim toward the creation of integrated imaging approaches that provide a comprehensive diagnosis with a single visit. These integrated diagnostic tests not only are convenient for young patients but also save direct and indirect health-care costs by streamlining procedures, minimizing hospitalizations, and minimizing lost school or work time for children and their parents. (18)F-FDG PET/CT is a highly sensitive and specific imaging modality for whole-body evaluation of pediatric malignancies. However, recent concerns about ionizing radiation exposure have led to a search for alternative imaging methods, such as whole-body MR imaging and PET/MR. As we develop new approaches for tumor staging, it is important to understand current benchmarks. This review article will synthesize the current literature on (18)F-FDG PET/CT for tumor staging in children, summarizing questions that have been solved and providing an outlook on unsolved avenues.
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Affiliation(s)
- Lebriz Uslu
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, California; and
| | - Jessica Donig
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, California; and
| | - Michael Link
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Jarrett Rosenberg
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, California; and
| | - Andrew Quon
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, California; and
| | - Heike E Daldrup-Link
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, California; and
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Quartuccio N, Fox J, Kuk D, Wexler LH, Baldari S, Cistaro A, Schöder H. Pediatric bone sarcoma: diagnostic performance of ¹⁸F-FDG PET/CT versus conventional imaging for initial staging and follow-up. AJR Am J Roentgenol 2015; 204:153-60. [PMID: 25539251 DOI: 10.2214/ajr.14.12932] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purpose of this study was to compare the diagnostic performance of (18)F-FDG PET/CT and conventional imaging for staging and follow-up of pediatric osteosarcoma and skeletal Ewing sarcoma. MATERIALS AND METHODS We calculated sensitivity, specificity, and accuracy of PET/CT and conventional imaging (CT, MRI, bone scanning) for sites of disease and number of lesions. Diagnostic benefit, defined as better characterization of lesions, was evaluated on a per-scan basis, comparing PET/CT and conventional imaging. RESULTS A total of 412 lesions were characterized by imaging in 64 patients (20, osteosarcoma; 44, Ewing sarcoma). For osteosarcoma patients PET/CT was available only at follow-up, where it proved more accurate than conventional imaging for the detection of bone lesions (accuracy, 95% vs 67% for CT and 86% for MRI) and complementary to CT in evaluating lung nodules (sensitivity, 84% vs 94%; specificity, 79% vs 71%) with diagnostic benefit in 18% of examinations. In patients with Ewing sarcoma, PET/CT tended to perform better during follow-up than at initial staging (accuracy, 85% vs 69%). For lung findings, PET/CT was more specific than CT but was less sensitive. The diagnostic benefit of PET/CT was greater at staging (28%) than during followup (9%). On a per-patient basis, PET/CT provided diagnostic benefit in 21 of 44 patients with Ewing sarcoma and nine of 20 patients with osteosarcoma at least once during clinical management. CONCLUSION FDG PET/CT provides diagnostic benefit in Ewing sarcoma and osteosarcoma, with the exception of small lung nodules. Prospective studies are needed to define the best imaging algorithm and combination of tests in the staging and follow-up of patients with pediatric bone sarcoma.
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Affiliation(s)
- Natale Quartuccio
- 1 Nuclear Medicine Unit, Department of Biomedical Sciences and of Morphologic and Functional Images, University of Messina, Messina, Italy
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Kornerup JS, Brodin NP, Björk-Eriksson T, Birk Christensen C, Kiil-Berthelsen A, Aznar MC, Hollensen C, Markova E, Munck Af Rosenschöld P. PET/CT-guided treatment planning for paediatric cancer patients: a simulation study of proton and conventional photon therapy. Br J Radiol 2014; 88:20140586. [PMID: 25494657 DOI: 10.1259/bjr.20140586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the impact of including fluorine-18 fludeoxyglucose ((18)F-FDG) positron emission tomography (PET) scanning in the planning of paediatric radiotherapy (RT). METHODS Target volumes were first delineated without and subsequently re-delineated with access to (18)F-FDG PET scan information, on duplicate CT sets. RT plans were generated for three-dimensional conformal photon RT (3DCRT) and intensity-modulated proton therapy (IMPT). The results were evaluated by comparison of target volumes, target dose coverage parameters, normal tissue complication probability (NTCP) and estimated risk of secondary cancer (SC). RESULTS Considerable deviations between CT- and PET/CT-guided target volumes were seen in 3 out of the 11 patients studied. However, averaging over the whole cohort, CT or PET/CT guidance introduced no significant difference in the shape or size of the target volumes, target dose coverage, irradiated volumes, estimated NTCP or SC risk, neither for IMPT nor 3DCRT. CONCLUSION Our results imply that the inclusion of PET/CT scans in the RT planning process could have considerable impact for individual patients. There were no general trends of increasing or decreasing irradiated volumes, suggesting that the long-term morbidity of RT in childhood would on average remain largely unaffected. ADVANCES IN KNOWLEDGE (18)F-FDG PET-based RT planning does not systematically change NTCP or SC risk for paediatric cancer patients compared with CT only. 3 out of 11 patients had a distinct change of target volumes when PET-guided planning was introduced. Dice and mismatch metrics are not sufficient to assess the consequences of target volume differences in the context of RT.
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Affiliation(s)
- J S Kornerup
- 1 Section of Radiotherapy, Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Paganelli M, Beaunoyer M, Samson Y, Dal Soglio D, Dubois J, Lallier M, Alvarez F. A child with unresectable biliary rhabdomyosarcoma: 48-month disease-free survival after liver transplantation. Pediatr Transplant 2014; 18:E146-51. [PMID: 24815678 DOI: 10.1111/petr.12279] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2014] [Indexed: 01/27/2023]
Abstract
We describe here a two-yr-old boy with biliary RMS successfully treated by chemotherapy and LT. The child presented with obstructive jaundice at 20 months of age. A mildly vascularized, non-calcified, partially cystic lesion was visualized in the left hepatic lobe. Solid infiltration of the common bile duct and of both left and right hepatic ducts was suspected. Liver biopsy suggested a botryoid-type embryonal RMS originating from the biliary tract. After extrahepatic spread of the tumor was excluded, a biliary drain was applied and neoadjuvant chemotherapy was started. After the treatment, although reduced in volume, the mass was still unresectable without aggressive surgery and gross residual disease. LT with a reduced segment II/III graft was performed four months after diagnosis. The patient received six cycles of adjuvant chemotherapy, and he is alive and recurrence-free 48 months post-transplantation. A posteriori, the transplant might have possibly been avoided with an aggressive resection with biliary reconstruction. Nevertheless, although the risk of the transplant has to be balanced against the chemoresponsiveness of the tumor, the four-yr disease-free survival of this patient suggests that, when coupled with effective chemotherapy, transplantation might be considered a potential treatment for unresectable biliary RMS.
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Affiliation(s)
- M Paganelli
- Department of Gastroenterology, Hepatology and Nutrition, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
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Hoshi M, Oebisu N, Takada J, Ieguchi M, Wakasa K, Nakamura H. Role of FDG-PET/CT for monitoring soft tissue tumors. Oncol Lett 2014; 7:1243-1248. [PMID: 24660036 PMCID: PMC3961202 DOI: 10.3892/ol.2014.1876] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 01/23/2014] [Indexed: 12/16/2022] Open
Abstract
The aim of the current study was to evaluate the limitations of 2-deoxy-2-F18-fluoro-D-glucose positron emission tomography combined with computed tomography (FDG-PET/CT) when monitoring soft tissue tumors. The diagnostic criteria of malignancy was defined as the tumor having a maximum standardized uptake value (SUVmax) ≥2.0 and a maximum diameter ≥5 cm as measured using FDG-PET/CT. One-hundred-and-thirteen patients, that were either included in the criteria or not, were compared. In addition, the values of SUVmax of the primary tumor and relapse in 12 patients were evaluated. The Kaplan-Meier analysis demonstrated that patients with tumors measuring ≥5 cm size and ≥2.0 SUVmax were associated with a worse survival rate. Among the 12 patients with relapse, statistical significances were detected in the tumor diameters, however, not in the SUVmax values. Thus, the criteria identified patients that were associated with a poor prognosis, and the SUVmax of distant metastases and local recurrences were identified to be significantly affected by tumor size.
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Affiliation(s)
- Manabu Hoshi
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Naoto Oebisu
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Jun Takada
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Makoto Ieguchi
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Kenichi Wakasa
- Department of Diagnostic Pathology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Hiroaki Nakamura
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
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Rodríguez-Alfonso B, Mucientes Rasilla J, Mitjavila Casanovas M, Cardona Arboniés J, Cubedo R. [18F-FDG-PET-CT in soft tissue sarcomas: when to image?]. Rev Esp Med Nucl Imagen Mol 2013; 33:43-9. [PMID: 24094372 DOI: 10.1016/j.remn.2013.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 07/25/2013] [Accepted: 07/26/2013] [Indexed: 12/24/2022]
Affiliation(s)
- B Rodríguez-Alfonso
- Servicio de Medicina Nuclear, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España.
| | - J Mucientes Rasilla
- Servicio de Medicina Nuclear, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - M Mitjavila Casanovas
- Servicio de Medicina Nuclear, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - J Cardona Arboniés
- Servicio de Medicina Nuclear, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - R Cubedo
- Servicio de Oncología Médica, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
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PET/MRI Imaging in High-Risk Sarcoma: First Findings and Solving Clinical Problems. Case Rep Oncol Med 2013; 2013:793927. [PMID: 23936700 PMCID: PMC3713328 DOI: 10.1155/2013/793927] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 06/12/2013] [Indexed: 12/23/2022] Open
Abstract
Simultaneous positron emission tomography (PET) and magnetic resonance imaging (MRI) is a new whole-body hybrid PET/MR imaging technique that combines metabolic and cross-sectional diagnostic imaging. Since the use of MRI in imaging of soft-tissue sarcoma is extremely beneficial, investigation of the combined PET/MRI is of great interest. In this paper, we present three cases and first data. Combined PET/MRI technique can support the process of clinical decision-making and give answers to some meaningful questions when treating patients with STS. Therefore, the combined modality of simultaneous PET/MRI offers new pieces to the puzzle of sarcoma treatment.
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Abstract
BACKGROUND Desmoplastic small round cell tumors (DSRCT) typically have a large stromal component and often are extensively disseminated in the peritoneal cavity at diagnosis. These factors contribute to difficulty in quantifying response to chemotherapy using RECIST or WHO criteria. This study compares the overall disease response to chemotherapy by fluorodeoxyglucose-positron emission tomography (FDG-PET) and computed tomography (CT) in patients with DSRCT. METHODS We conducted a retrospective chart review of 7 patients with DSRCT who were imaged by FDG-PET and CT at diagnosis and after 3 cycles of chemotherapy. Response to chemotherapy was graded according to EORTC metabolic response guidelines and RECIST. RESULTS All tumors demonstrated some decrease in SUVmax (51%±21%) and longest diameter (23%±8%) with chemotherapy. The best response achieved by FDG-PET was a partial response in 6 patients and by CT was a partial response in 1 patient. Measured response was concordant between the 2 modalities in 2 patients. CONCLUSIONS In this small series response measurement by FDG-PET did not always correlate with response measurement by CT. A greater decrease in metabolic activity as compared with size was seen in all patients. Further studies are needed to define the role of FDG-PET in assessing early response of DSRCT to chemotherapy.
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Federico SM, Spunt SL, Krasin MJ, Billups CA, Wu J, Shulkin B, Mandell G, McCarville MB. Comparison of PET-CT and conventional imaging in staging pediatric rhabdomyosarcoma. Pediatr Blood Cancer 2013; 60:1128-34. [PMID: 23255260 PMCID: PMC4266929 DOI: 10.1002/pbc.24430] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 11/09/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Over the past decade, PET-CT has been used to assess rhabdomyosarcoma (RMS) in children. However, the role of PET-CT in staging RMS is unknown. PROCEDURE Thirty subjects with RMS, median age 7.3 years, underwent PET-CT before therapy. PET-CTs and conventional imaging (CI) were independently reviewed by two radiologists and two nuclear medicine physicians to determine the presence of metastases. Accuracy, sensitivity, and specificity of PET-CT for detecting metastases were compared to CI using biopsy and clinical follow-up as reference standards. Maximum standardized uptake values (SUV(max)) of primary tumors, lymph nodes, and pulmonary nodules were measured. RESULTS Primary tumors had an average SUV(max) of 7.2 (range, 2.5-19.2). Accuracy rates for 17 subjects with nodal disease were 95% for PET-CT and 49% for CI. PET-CT had 94% sensitivity and 100% specificity for nodal disease. Of seven pulmonary nodules detected by CI, three were not identified by PET-CT, two were indeterminate, and one was malignant with a SUV(max) (3.4) > twice that of benign nodules. Two subjects had bone disease; both were identified by PET-CT but only one by CI. Four subjects had bone marrow disease, two had positive PET-CTs but none had positive CI. Two subjects had soft tissue metastases detected by PET-CT but not CI. CONCLUSIONS PET-CT performed better than CI in identifying nodal, bone, bone marrow, and soft tissue disease in children with RMS. CI remains essential for detection of pulmonary nodules. We recommend PET-CT for staging of children with RMS. CI with Tc(99m) bone scan can be eliminated.
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Affiliation(s)
- Sara M. Federico
- Department of Oncology, St. Jude Children's Research Hospital, Memphis TN
| | - Sheri L. Spunt
- Department of Oncology, St. Jude Children's Research Hospital, Memphis TN,Department of Pediatrics, The University of Tennessee, College of Medicine, Memphis, TN
| | - Matthew J. Krasin
- Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis TN
| | | | - Jianrong Wu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis TN
| | - Barry Shulkin
- Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis TN
| | - Gerald Mandell
- Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis TN
| | - M. Beth McCarville
- Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis TN,Department of Radiology, The University of Tennessee, College of Medicine, Memphis, TN
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Murphey MD, Senchak LT, Mambalam PK, Logie CI, Klassen-Fischer MK, Kransdorf MJ. From the Radiologic Pathology Archives: Ewing Sarcoma Family of Tumors: Radiologic-Pathologic Correlation. Radiographics 2013; 33:803-31. [DOI: 10.1148/rg.333135005] [Citation(s) in RCA: 170] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Diagnostic accuracy of 18F-FDG PET/CT for detecting recurrence in patients with primary skeletal Ewing sarcoma. Eur J Nucl Med Mol Imaging 2013; 40:1036-43. [DOI: 10.1007/s00259-013-2388-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 03/04/2013] [Indexed: 11/25/2022]
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Al-Ibraheem A, Buck AK, Benz MR, Rudert M, Beer AJ, Mansour A, Pomykala KL, Haller B, Juenger H, Scheidhauer K, Schwaiger M, Herrmann K. (18) F-fluorodeoxyglucose positron emission tomography/computed tomography for the detection of recurrent bone and soft tissue sarcoma. Cancer 2012; 119:1227-34. [PMID: 23233156 DOI: 10.1002/cncr.27866] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 09/18/2012] [Indexed: 11/11/2022]
Abstract
BACKGROUND The clinical utility of modern hybrid imaging modalities for detecting recurrent bone or soft tissue sarcoma remains to be determined. In this report, the authors present a clinical study on the diagnostic accuracy and incremental value of integrated (18) F-fluorodeoxyglucose positron emission tomography/computed tomography ((18) F-FDG PET/CT) in patients with a history of sarcoma who have clinically suspected disease recurrence. METHODS Forty-three patients who had a history of bone or soft tissue sarcoma and had documented complete remission underwent (18) F-FDG PET/CT. Image analysis was performed independently for (18) F-FDG PET (n = 43) and for contrast-enhanced spiral CT (CE-CT) (n = 30) by 2 separate readers, whereas combined (18) F-FDG PET/CT (n = 43) images were analyzed in consensus by both readers. Imaging findings were rated on a 5-point scale and finally were reported as malignant, benign, or equivocal. Imaging findings were validated either by histopathology (n = 24) or by clinical follow-up (n = 19). RESULTS (18) F-FDG PET/CT had greater sensitivity and specificity compared with CE-CT alone (94% and 92% vs 78% and 67%, respectively), resulting in significantly greater accuracy (93% vs 73%; P = .03). (18) F-FDG PET/CT was particularly superior regarding detection of local recurrence or soft tissue lesions (sensitivity and specificity: 83% and 100% vs 50% and 100%, respectively) or bone metastases (100% and 100% vs 85% and 88%, respectively). CONCLUSIONS (18) F-FDG PET/CT had greater diagnostic accuracy in the detection of recurrent bone or soft tissue sarcoma compared with CE-CT alone. The detection of local recurrence was the most evident advantage of (18) F-FDG PET/CT over CE-CT. Cancer 2013. © 2012 American Cancer Society.
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Affiliation(s)
- Akram Al-Ibraheem
- Department of Nuclear Medicine, Technische Universität München, Munich, Germany
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48
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Is there a need for dedicated bone imaging in addition to 18F-FDG PET/CT imaging in pediatric sarcoma patients? J Pediatr Hematol Oncol 2012; 34:131-6. [PMID: 22134608 DOI: 10.1097/mph.0b013e3182282825] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Many children with sarcomas undergo whole body 2-deoxy-2-((18)F)fluoro-D-glucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) and technetium methylene diphosphonate ((99)Tc-MDP) studies. It is unknown whether the combination of both tests results in more accurate detection of bone lesions than (18)F-FDG- PET/CT alone. METHODS (99)Tc-MDP bone and (18)F-FDG PET/CT scans were each read by 2 "blinded" observers and then reviewed side-by-side by 3 readers. Bone lesions were graded qualitatively on a 5-point scale (from benign to malignant). Clinical and imaging follow-up (n = 21) and bone biopsy results (n = 8) served as reference standard. RESULTS A total of 39 paired (99)Tc-MDP and (18)F-FDG-PET/CT studies (cases) performed at a mean interval 4 ± 7 days, were performed on 29 patients (mean age 12 ± 5 y). Of these, 21 patients (72%) had bone sarcoma, whereas 8 patients (28%) had soft tissue sarcoma. By patient and case-based analysis, (18)F-FDG PET/CT had an accuracy of 100%. Tc-MDP had accuracies of 90% and 82% by patient and case-based analysis. The combined interpretation had an accuracy of 97%. CONCLUSIONS In this study, (99)Tc-MDP bone imaging does not provide an added diagnostic value for bone involvement over (18)F-FDG-PET/CT.
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Abstract
The commonest urogenital tumours in childhood are Wilms tumour of the kidney and rhabdomyosarcoma in the pelvis. We review these tumours along with other primary renal tumours and less common ovarian and testicular tumours in childhood. Current clinical concepts, relevant staging investigations and imaging features are described.
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Affiliation(s)
- S Swinson
- Department of Radiology, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK
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Walter F, Federman N, Apichairuk W, Nelson S, Phelps ME, Allen-Auerbach M, Walter MA, Czernin J. 18F-fluorodeoxyglucose uptake of bone and soft tissue sarcomas in pediatric patients. Pediatr Hematol Oncol 2011; 28:579-87. [PMID: 21936620 DOI: 10.3109/08880018.2011.602180] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A high (18)F-fluorodeoxyglucose (FDG) uptake by positron emission tomography/computed tomography (PET/CT) imaging in sarcomas of adults has been reported. The current study aimed at defining the degree of (18)F-FDG uptake of pediatric sarcomas. This retrospective study included 29 patients (23 males, 6 females; mean age 14 ± 5 years) with soft tissue (n = 9) or bone (n = 20) sarcomas. Twenty-two patients (76%) underwent (18)F-FDG PET/CT and 7 (24%) had dedicated (18)F-FDG PET studies. Tumor (18)F-FDG uptake was quantified by standard uptake value (SUV)(max) and tumor-to-liver ratios (SUV ratios; tumor SUV(max)/liver SUV(mean)). Tumor SUV(max) and SUV ratios were correlated with tumor Ki-67 expression. SUV(max) ranged from 1.4 to 24 g/mL (median 2.5 g/mL) in soft tissue sarcomas and 1.6 to 20.4 g/mL (median 6.9 g/mL) in bone sarcomas (P = .03), and from 1.6 to 9.2 g/mL (median 3.9 g/mL) and 3.5 to 20.4 g/mL (median 12 g/mL) in Ewing sarcoma and osteosarcoma, respectively (P = .009). Tumor SUV ratios ranged from 0.8 to 8.7 (median 1.9) in soft tissue sarcomas and 1.4 to 8.9 (median 3.8) in bone sarcomas (P = .08). Ewing sarcoma had a significantly lower tumor SUV ratio than osteosarcoma (P = .01). Ki-67 expression correlated significantly with the (18)F-FDG uptake in bone but not in soft tissue sarcomas. All sarcomas were visualized by (18)F-FDG PET/CT imaging. A higher (18)F-FDG uptake was observed in osteosarcoma than in Ewing and soft tissue sarcomas. The results of this study suggest that the degree of tumor (18)F-FDG uptake is sufficient to allow for monitoring of therapeutic responses in pediatric sarcomas.
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Affiliation(s)
- Franziska Walter
- Ahmanson Translational Imaging Division and Department of Molecular and Medical Pharmacology, University of California-Los Angeles, CA, USA
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