1
|
Tsuchiya K, Akisue T, Ehara S, Kawai A, Kawano H, Hiraga H, Hosono A, Hutani H, Morii T, Morioka H, Nishida Y, Oda Y, Ogose A, Shimose S, Yamaguchi T, Yamamoto T, Yoshida M. Japanese orthopaedic association (JOA) clinical practice guidelines on the management of malignant bone tumors - Secondary publication. J Orthop Sci 2024:S0949-2658(23)00321-4. [PMID: 39003183 DOI: 10.1016/j.jos.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/13/2023] [Indexed: 07/15/2024]
Abstract
BACKGROUND In Japan, there are currently no general guidelines for the treatment of primary malignant bone tumors. Therefore, the Japanese Orthopaedic Association established a committee to develop guidelines for the appropriate diagnosis and treatment of primary malignant bone tumors for medical professionals in clinical practice. METHODS The guidelines were developed in accordance with "Minds Clinical Practice Guideline Development Handbook 2014″ and "Minds Clinical Practice Guideline Development Manual 2017". The Japanese Orthopaedic Association's Bone and Soft Tissue Tumor Committee established guideline development and systematic review committees, drawing members from orthopedic specialists leading the diagnosis and treatment of bone and soft tissue tumors. Pediatricians, radiologists, and diagnostic pathologists were added to both committees because of the importance of multidisciplinary treatment. Based on the diagnosis and treatment algorithm for primary malignant bone tumors, important decision-making points were selected, and clinical questions (CQ) were determined. The strength of recommendation was rated on two levels and the strength of evidence was rated on four levels. The recommendations published were selected based on agreement by 70% or more of the voters. RESULTS The guideline development committee examined the important clinical issues in the clinical algorithm and selected 22 CQs. The systematic review committee reviewed the evidence concerning each CQ and a clinical value judgment was added by experts. Eventually, 25 questions were published and the text of each recommendation was determined. CONCLUSION Since primary malignant bone tumors are rare, there is a dearth of strong evidence based on randomized controlled trials, and recommendations cannot be applied to all the patients. In clinical practice, appropriate treatment of patients with primary malignant bone tumors should be based on the histopathological diagnosis and degree of progression of each case, using these guidelines as a reference.
Collapse
Affiliation(s)
- Kazuaki Tsuchiya
- Department of Orthopaedic Surgery, Toho University of Medicine, Japan.
| | - Toshihiro Akisue
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Japan
| | - Shigeru Ehara
- Department of Radiology, Japan Community Healthcare Organization (JCHO) Sendai Hospital, Japan
| | - Akira Kawai
- Department of Musculoskeletal Oncology and Rehabilitation Medicine, Japan
| | - Hirotaka Kawano
- Department of Orthopaedic Surgery, Teikyo University of Medicine, Japan
| | - Hiroaki Hiraga
- Department of Musculoskeletal Oncology, National Hospital Organization Hokkaido Cancer Center, Japan
| | - Ako Hosono
- Department of Pediatric Oncology, National Cancer Center Hospital East, Japan
| | - Hiroyuki Hutani
- Department of Orthopaedic Surgery, Hyogo Medical University, Japan
| | - Takeshi Morii
- Department of Orthopaedic Surgery, Kyorin University Faculty of Medicine, Japan
| | - Hideo Morioka
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Japan
| | - Yoshihiro Nishida
- Department of Rehabilitation Medicine, Nagoya University Hospital, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Akira Ogose
- Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Japan
| | - Shoji Shimose
- National Hospital Organization Kure Medical Center, Japan
| | - Takehiko Yamaguchi
- Department of Pathology, Dokkyo Medical University, Nikko Medical Center, Japan
| | - Tetsuji Yamamoto
- Department of Orthopaedic Surgery, Kagawa University Hospital, Japan
| | - Masahiro Yoshida
- International University of Health and Welfare, Japan Council for Quality Health Care, Japan
| |
Collapse
|
2
|
Halalsheh H, Amer S, Omari Z, Shawagfeh M, Boheisi M, Sultan I. Comparative Analysis of Skip Metastasis in Pediatric Osteosarcoma: Clinical Features and Outcomes. J Pediatr Hematol Oncol 2024; 46:154-158. [PMID: 38408127 PMCID: PMC10956669 DOI: 10.1097/mph.0000000000002831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/19/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Skip metastasis (SM) is a synchronous regional bone metastasis. Using new imaging modalities, the detection of SM is easier and possibly more common. We reviewed patients with SM and compared their characteristics and outcomes to other patients with osteosarcoma treated at our center. METHODS We reviewed retrospectively children (<18 years) with newly diagnosed osteosarcoma who presented from June 2006 to March 2022. Patients' characteristics, treatment modalities, and outcomes were analyzed. All cases were discussed in a multidisciplinary clinic that included 2 experienced radiologists. RESULTS We identified 155 patients with osteosarcoma, among which 13 (8.3%) patients had SM detected by MRI. Patients with SM had a median age at diagnosis of 11.2 years (range 7 to 17). Three patients had lung metastasis at diagnosis. Bone scan was positive for the SM in 8 patients (62%). All patients underwent primary tumor resection after neoadjuvant chemotherapy (amputation in 5, limb salvage surgery in 8). Five had postchemotherapy necrosis ≥90% in primary tumor. Seven patients relapsed/progressed (1 local and 6 in the lung), all relapsed patients died of disease. Compared to the rest of the patients, those with SM had similar clinical features to patients without SM; outcomes were similar with no significant differences in event-free survival and overall survival ( P =0.7 and 0.3, respectively). CONCLUSION In this study, we observed a percentage of patients with SM comparable to previous reports. Patients with SM exhibited clinical features akin to the rest of our patients. Thorough evaluation of imaging studies and multidisciplinary care, coupled with meticulous surgical planning, are crucial for achieving a cure, which remained unjeopardized in our patients with SM.
Collapse
Affiliation(s)
- Hadeel Halalsheh
- Departments of Pediatric
- Department of Pediatric, The University of Jordan, Amman, Jordan
| | | | | | | | | | | |
Collapse
|
3
|
Puranik AD, Choudhury S, Ghosh S, Dev ID, Ramchandani V, Uppal A, Bhosale V, Palsapure A, Rungta R, Pandey R, Khatri S, George G, Satamwar Y, Maske R, Agrawal A, Shah S, Purandare NC, Rangarajan V. Tata Memorial Centre Evidence Based Use of Nuclear medicine diagnostic and treatment modalities in cancer. Indian J Cancer 2024; 61:S1-S28. [PMID: 38424680 DOI: 10.4103/ijc.ijc_52_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 01/31/2024] [Indexed: 03/02/2024]
Abstract
ABSTRACT PET/CT and radioisotope therapy are diagnostic and therapeutic arms of Nuclear Medicine, respectively. With the emergence of better technology, PET/CT has become an accessible modality. Diagnostic tracers exploring disease-specific targets has led the clinicians to look beyond FDG PET. Moreover, with the emergence of theranostic pairs of radiopharmaceuticals, radioisotope therapy is gradually making it's way into treatment algorithm of common cancers in India. We therefore would like to discuss in detail the updates in PET/CT imaging and radionuclide therapy and generate a consensus-driven evidence based document which would guide the practitioners of Oncology.
Collapse
Affiliation(s)
- Ameya D Puranik
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital and Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Cederberg KB, Iyer RS, Chaturvedi A, McCarville MB, McDaniel JD, Sandberg JK, Shammas A, Sharp SE, Nadel HR. Imaging of pediatric bone tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper. Pediatr Blood Cancer 2023; 70 Suppl 4:e30000. [PMID: 36250990 PMCID: PMC10661611 DOI: 10.1002/pbc.30000] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 11/08/2022]
Abstract
Malignant primary bone tumors are uncommon in the pediatric population, accounting for 3%-5% of all pediatric malignancies. Osteosarcoma and Ewing sarcoma comprise 90% of malignant primary bone tumors in children and adolescents. This paper provides consensus-based recommendations for imaging in children with osteosarcoma and Ewing sarcoma at diagnosis, during therapy, and after therapy.
Collapse
Affiliation(s)
- Kevin B. Cederberg
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ramesh S. Iyer
- Department of Radiology, Seattle Children’s Hospital, Seattle, WA
| | - Apeksha Chaturvedi
- Division of Pediatric Radiology, Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY
| | - MB McCarville
- Department of Diagnostic Imaging, St Jude Children’s Research Hospital, Memphis, TN
| | - Janice D. McDaniel
- Department of Pediatric Interventional Radiology, Akron Children’s Hospital, Akron, OH and Department of Radiology, Northeast Ohio Medical University, Rootstown, OH
| | - Jesse K. Sandberg
- Department of Pediatric Radiology, Lucile Packard Children’s Hospital, Stanford University, Stanford, CA
| | - Amer Shammas
- Division of Nuclear Medicine, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, OH, Canada
| | - Susan E. Sharp
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Helen R. Nadel
- Department of Pediatric Radiology, Lucile Packard Children’s Hospital, Stanford University, Stanford, CA
| |
Collapse
|
5
|
Oh C, Bishop MW, Cho SY, Im HJ, Shulkin BL. 18F-FDG PET/CT in the Management of Osteosarcoma. J Nucl Med 2023:jnumed.123.265592. [PMID: 37201958 DOI: 10.2967/jnumed.123.265592] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/26/2023] [Indexed: 05/20/2023] Open
Abstract
Osteosarcoma is the most common type of primary malignant bone tumor. 18F-FDG PET/CT is useful for staging, detecting recurrence, monitoring response to neoadjuvant chemotherapy, and predicting prognosis. Here, we review the clinical aspects of osteosarcoma management and assess the role of 18F-FDG PET/CT, in particular with regard to pediatric and young adult patients.
Collapse
Affiliation(s)
- Chiwoo Oh
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea
| | - Michael W Bishop
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Steve Y Cho
- Nuclear Medicine and Molecular Imaging Section, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Hyung-Jun Im
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea;
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University, Seoul, Republic of Korea; and
| | - Barry L Shulkin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee
| |
Collapse
|
6
|
Karaarslan E, Alis D, Basar Y, Kumbasar B, Kalayci CB, Alpan B, Ozger H. The Role of Whole-Body Magnetic Resonance Imaging in Assessing Extrapulmonary Metastases in Osteosarcoma Staging and Restaging: A Pilot Study. J Comput Assist Tomogr 2023:00004728-990000000-00148. [PMID: 36944103 DOI: 10.1097/rct.0000000000001455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
OBJECTIVE The aim of the study is to investigate the role of whole-body magnetic resonance imaging (MRI) in assessing extrapulmonary metastases in primary osteosarcoma staging. METHODS We retrospectively reviewed medical data to identify primary osteosarcoma patients with available preoperative whole-body MRI obtained in the staging or restaging. Histopathology was the reference test for assessing the diagnostic performance, if available. Otherwise, oncology board decisions were used as the reference. In addition, the benefits of whole-body MRI to F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) and bone scintigraphy were investigated. RESULTS In all, 36 patients with osteosarcoma (24 staging, 12 restaging) with a mean age of 16.36 ± 5.63 years (range, 9-29 years) were included in the study. The median follow-up duration was 26.61 months (interquartile range, 33.3 months). Of 36 patients, 8 had skeletal, 1 had a lymph node, and 1 had a subcutaneous metastasis. Whole-body MRI correctly identified all patients with metastatic disease but incorrectly classified a bone infarct in one patient as a skeletal metastasis, equating a scan-level sensitivity, specificity, accuracy, negative predictive value, and positive predictive value of 100%, 96.3%, 97.3%, 100%, and 90.91%. Whole-body MRI contributed to bone scintigraphy by identifying a skeletal metastasis in one patient and positron emission tomography-computed tomography by ruling out a skeletal metastasis in another. CONCLUSIONS Whole-body MRI could accurately identify extrapulmonary metastases in primary osteosarcoma patients for staging or restaging. In addition, it might contribute to the standard whole-body imaging methods.
Collapse
Affiliation(s)
- Ercan Karaarslan
- From the Department of Radiology, Acibadem Mehmet Ali Aydinlar University, School of Medicine
| | - Deniz Alis
- From the Department of Radiology, Acibadem Mehmet Ali Aydinlar University, School of Medicine
| | - Yeliz Basar
- Department of Radiology, Acibadem Healthcare Group
| | | | | | - Bugra Alpan
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | - Harzem Ozger
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| |
Collapse
|
7
|
Gherghe M, Mutuleanu MD, Stanciu AE, Irimescu I, Lazar AM, Toma RV, Trifanescu OG, Anghel RM. Quantitative Assessment of Treatment Response in Metastatic Breast Cancer Patients by SPECT-CT Bone Imaging-Getting Closer to PET-CT. Cancers (Basel) 2023; 15:696. [PMID: 36765651 PMCID: PMC9913230 DOI: 10.3390/cancers15030696] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/15/2023] [Accepted: 01/21/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Cancer represents the major cause of death mainly through its ability to spread to other organs, highlighting the importance of metastatic disease diagnosis and accurate follow up for treatment management purposes. Although until recently the main method for imaging interpretation was represented by qualitative methods, quantitative analysis of SPECT-CT data represents a viable, objective option. METHODS Seventy-five breast cancer patients presenting metastatic bone disease underwent at least two Bone SPECT-CT studies using [99mTc]-HDP between November 2019 to October 2022. RESULTS Our findings show a good positive relationship between the qualitative methods of imaging interpretation and quantitative analysis, with a correlation coefficient of 0.608 between qualitative whole body scintigraphy and quantitative SPECT-CT, and a correlation coefficient of 0.711 between the qualitative and quantitative interpretation of SPECT-CT data; nevertheless, there is a need for accurate, objective and reproducible methods for imaging interpretation, especially for research purposes. CONCLUSIONS Quantitative evaluation of the SPECT-CT data has the potential to be the first choice of imaging interpretation for patient follow up and treatment response evaluation, especially for research purposes, because of its objectivity and expression of uptake changes in absolute units.
Collapse
Affiliation(s)
- Mirela Gherghe
- Nuclear Medicine Department, University of Medicine and Pharmacy Carol Davila Bucharest, 050474 București, Romania
- Nuclear Medicine Department, Institute of Oncology “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Mario-Demian Mutuleanu
- Nuclear Medicine Department, University of Medicine and Pharmacy Carol Davila Bucharest, 050474 București, Romania
- Nuclear Medicine Department, Institute of Oncology “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Adina Elena Stanciu
- Carcinogenesis and Molecular Biology Department, Institute of Oncology “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Ionela Irimescu
- Nuclear Medicine Department, Institute of Oncology “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Alexandra Maria Lazar
- Nuclear Medicine Department, Institute of Oncology “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Radu Valeriu Toma
- Oncology Department, University of Medicine and Pharmacy Carol Davila Bucharest, 050474 Bucharest, Romania
- Radiotherapy I Department, Institute of Oncology “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Oana Gabriela Trifanescu
- Oncology Department, University of Medicine and Pharmacy Carol Davila Bucharest, 050474 Bucharest, Romania
- Radiotherapy II Department, Institute of Oncology “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Rodica Maricela Anghel
- Oncology Department, University of Medicine and Pharmacy Carol Davila Bucharest, 050474 Bucharest, Romania
- Radiotherapy II Department, Institute of Oncology “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| |
Collapse
|
8
|
Zheng K, Hou Y, Zhang Y, Wang F, Sun A, Yang D. Molecular features and predictive models identify the most lethal subtype and a therapeutic target for osteosarcoma. Front Oncol 2023; 13:1111570. [PMID: 36874110 PMCID: PMC9980341 DOI: 10.3389/fonc.2023.1111570] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/23/2023] [Indexed: 02/18/2023] Open
Abstract
Background Osteosarcoma is the most common primary malignant bone tumor. The existing treatment regimens remained essentially unchanged over the past 30 years; hence the prognosis has plateaued at a poor level. Precise and personalized therapy is yet to be exploited. Methods One discovery cohort (n=98) and two validation cohorts (n=53 & n=48) were collected from public data sources. We performed a non-negative matrix factorization (NMF) method on the discovery cohort to stratify osteosarcoma. Survival analysis and transcriptomic profiling characterized each subtype. Then, a drug target was screened based on subtypes' features and hazard ratios. We also used specific siRNAs and added a cholesterol pathway inhibitor to osteosarcoma cell lines (U2OS and Saos-2) to verify the target. Moreover, PermFIT and ProMS, two support vector machine (SVM) tools, and the least absolute shrinkage and selection operator (LASSO) method, were employed to establish predictive models. Results We herein divided osteosarcoma patients into four subtypes (S-I ~ S-IV). Patients of S- I were found probable to live longer. S-II was characterized by the highest immune infiltration. Cancer cells proliferated most in S-III. Notably, S-IV held the most unfavorable outcome and active cholesterol metabolism. SQLE, a rate-limiting enzyme for cholesterol biosynthesis, was identified as a potential drug target for S-IV patients. This finding was further validated in two external independent osteosarcoma cohorts. The function of SQLE to promote proliferation and migration was confirmed by cell phenotypic assays after the specific gene knockdown or addition of terbinafine, an inhibitor of SQLE. We further employed two machine learning tools based on SVM algorithms to develop a subtype diagnostic model and used the LASSO method to establish a 4-gene model for predicting prognosis. These two models were also verified in a validation cohort. Conclusion The molecular classification enhanced our understanding of osteosarcoma; the novel predicting models served as robust prognostic biomarkers; the therapeutic target SQLE opened a new way for treatment. Our results served as valuable hints for future biological studies and clinical trials of osteosarcoma.
Collapse
Affiliation(s)
- Kun Zheng
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences (Beijing), Beijing Institute of Lifeomics, Beijing, China.,Department of Orthopedics, General Hospital of Southern Theater Command, Guangzhou, China
| | - Yushan Hou
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences (Beijing), Beijing Institute of Lifeomics, Beijing, China.,Research Unit of Proteomics Driven Cancer Precision Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yiming Zhang
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences (Beijing), Beijing Institute of Lifeomics, Beijing, China.,Research Unit of Proteomics Driven Cancer Precision Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Fei Wang
- Department of Orthopedics, General Hospital of Southern Theater Command, Guangzhou, China
| | - Aihua Sun
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences (Beijing), Beijing Institute of Lifeomics, Beijing, China.,Research Unit of Proteomics Driven Cancer Precision Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Dong Yang
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences (Beijing), Beijing Institute of Lifeomics, Beijing, China
| |
Collapse
|
9
|
Noriega-Álvarez E, Orduña Díez M, Sanz Viedma S, Peiró Valgañón V, Velasco Nuño M, Orcajo Rincón J, Rodríguez Alfonso B, Domínguez Gadea L. Aportaciones de la medicina nuclear en la enfermedad musculoesquelética tumoral maligna en niños. Rev Esp Med Nucl Imagen Mol 2022. [DOI: 10.1016/j.remn.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
10
|
Contributions of nuclear medicine to malignant musculoskeletal tumor disease in children. Rev Esp Med Nucl Imagen Mol 2022; 41:395-407. [DOI: 10.1016/j.remnie.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/05/2022] [Indexed: 11/06/2022]
|
11
|
Aydos U, Sever T, Vural Ö, Topuz Türkcan B, Okur A, Akdemir ÜÖ, Poyraz A, Pinarli FG, Atay LÖ, Karadeniz C. Prognostic value of fluorodeoxyglucose positron emission tomography derived metabolic parameters and textural features in pediatric sarcoma. Nucl Med Commun 2022; 43:778-786. [PMID: 35506271 DOI: 10.1097/mnm.0000000000001577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate the prognostic value of PET-derived metabolic features and textural parameters of primary tumors in pediatric sarcoma patients. METHODS The imaging findings of 43 patients (14 girls and 29 boys; age 11.4 ± 4.4 years) who underwent 18-fluorodeoxyglucose positron emission tomography (PET)/computed tomography for primary staging prior to therapy between 2005 and 2020 were retrospectively evaluated. The diagnoses were osteosarcoma in 10, rhabdomyosarcoma in 10, and Ewing sarcoma in 23 patients. PET metabolic data and textural features of primary tumors were obtained. Cox proportional hazards regression models were used to identify predictors for progression-free survival and overall survival. Survival curves were estimated by using the Kaplan-Meier method. RESULTS Distant metastases were detected in primary staging in 13 patients (30.2%). The median follow-up duration after diagnosis was 28 months (range: 10-171 months). In multivariate Cox regression analysis, the presence of distant metastasis and neighborhood grey-level difference matrix_Contrast (ngldm_Contrast) were found as independent predictors for both progression-free survival and overall survival. Grey-level zone length matrix_Zone-length nonuniformity (glzlm_ZLNU) was also found as an independent predictor for overall survival. The Kaplan-Meier survival analysis showed that higher ngldm_Contrast and glzlm_ZLNU values of primary tumors were significantly associated with shorter progression-free survival and overall survival. CONCLUSION In addition to the presence of distant metastasis at initial diagnosis, textural features of primary tumors may be used as prognostic biomarkers to identify patients with worse prognosis in pediatric sarcoma. Higher tumor heterogeneity is significantly associated with shorter progression-free survival and OS.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Aylar Poyraz
- Department of Medical Pathology, Gazi University, Faculty of Medicine, Beşevler/Ankara, Turkey
| | | | | | | |
Collapse
|
12
|
Nguyen JC, Baghdadi S, Pogoriler J, Guariento A, Rajapakse CS, Arkader A. Pediatric Osteosarcoma: Correlation of Imaging Findings with Histopathologic Features, Treatment, and Outcome. Radiographics 2022; 42:1196-1213. [PMID: 35594197 DOI: 10.1148/rg.210171] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Osteosarcoma is the most common primary bone sarcoma in children. Imaging plays a pivotal role in diagnostic workup, surgical planning, and follow-up monitoring for possible disease relapse. Survival depends on multiple factors, including presence or absence of metastatic disease, chemotherapy response, and surgical margins. At diagnosis, radiography and anatomic MRI are used to characterize the primary site of disease, whereas chest CT and whole-body bone scintigraphy and/or PET are used to identify additional sites of disease. Treatment starts with neoadjuvant chemotherapy, followed by en bloc tumor resection and limb reconstruction, and finally, adjuvant chemotherapy. Preoperative planning requires precise tumor delineation, which traditionally has been based on high-spatial-resolution anatomic MRI to identify tumor margins (medullary and extraosseous), skip lesions, neurovascular involvement, and joint invasion. These findings direct the surgical approach and affect the options for reconstruction. For skeletally immature children, the risk of cumulative limb-length discrepancy and need for superior longevity of the reconstruction have led to the advent and preferential use of several pediatric-specific surgical techniques, including rotationplasty, joint preservation surgery, autograft or allograft reconstruction, and extendible endoprostheses. A better understanding of the clinically impactful imaging features can directly and positively influence patient care. Online supplemental material is available for this article. ©RSNA, 2022.
Collapse
Affiliation(s)
- Jie C Nguyen
- From the Department of Radiology (J.C.N., A.G.), Division of Orthopaedic Surgery (S.B., A.A.), and Department of Pathology and Laboratory Medicine (J.P.), Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104; and Department of Radiology (C.S.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (J.C.N., J.P., A.A.)
| | - Soroush Baghdadi
- From the Department of Radiology (J.C.N., A.G.), Division of Orthopaedic Surgery (S.B., A.A.), and Department of Pathology and Laboratory Medicine (J.P.), Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104; and Department of Radiology (C.S.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (J.C.N., J.P., A.A.)
| | - Jennifer Pogoriler
- From the Department of Radiology (J.C.N., A.G.), Division of Orthopaedic Surgery (S.B., A.A.), and Department of Pathology and Laboratory Medicine (J.P.), Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104; and Department of Radiology (C.S.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (J.C.N., J.P., A.A.)
| | - Andressa Guariento
- From the Department of Radiology (J.C.N., A.G.), Division of Orthopaedic Surgery (S.B., A.A.), and Department of Pathology and Laboratory Medicine (J.P.), Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104; and Department of Radiology (C.S.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (J.C.N., J.P., A.A.)
| | - Chamith S Rajapakse
- From the Department of Radiology (J.C.N., A.G.), Division of Orthopaedic Surgery (S.B., A.A.), and Department of Pathology and Laboratory Medicine (J.P.), Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104; and Department of Radiology (C.S.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (J.C.N., J.P., A.A.)
| | - Alexandre Arkader
- From the Department of Radiology (J.C.N., A.G.), Division of Orthopaedic Surgery (S.B., A.A.), and Department of Pathology and Laboratory Medicine (J.P.), Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104; and Department of Radiology (C.S.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (J.C.N., J.P., A.A.)
| |
Collapse
|
13
|
Martin JR, Auran RL, Duran MD, de Comas AM, Jacofsky DJ. Management of Primary Aggressive Tumors of the Knee. J Knee Surg 2022; 35:585-596. [PMID: 35181876 DOI: 10.1055/s-0042-1743221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Primary bone sarcomas and aggressive benign bone tumors are relatively rare. It is essential to recognize features that are concerning for these aggressive tumors based on a patient's history, physical exam, and radiographs. Physicians and other health care providers should have a high suspicion for these tumors and promptly refer these patients to orthopaedic oncologists. A multidisciplinary, team-based approach is required to obtain an accurate diagnosis and provide comprehensive care. This review discussed the appropriate work-up, biopsy principles, relevant peri-operative medical management, and surgical treatment options for patients with aggressive primary bone tumors around the knee. Primary bone sarcomas (osteosarcoma and chondrosarcoma) and aggressive benign bone tumors (giant cell tumor, chondroblastoma, and chondromyxoid fibroma) that have a predilection to the distal femur and proximal tibia are the focus of this review.
Collapse
Affiliation(s)
- John R Martin
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona
| | - Richard L Auran
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona
| | - Michael D Duran
- The Center for Orthopedic Research and Eduction (CORE) Institute, Phoenix, Arizona
| | - Amalia M de Comas
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona.,The Center for Orthopedic Research and Eduction (CORE) Institute, Phoenix, Arizona
| | - David J Jacofsky
- The Center for Orthopedic Research and Eduction (CORE) Institute, Phoenix, Arizona
| |
Collapse
|
14
|
Sittiju P, Chaiyawat P, Pruksakorn D, Klangjorhor J, Wongrin W, Phinyo P, Kamolphiwong R, Phanphaisarn A, Teeyakasem P, Kongtawelert P, Pothacharoen P. Osteosarcoma-Specific Genes as a Diagnostic Tool and Clinical Predictor of Tumor Progression. BIOLOGY 2022; 11:biology11050698. [PMID: 35625426 PMCID: PMC9138411 DOI: 10.3390/biology11050698] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/12/2022] [Accepted: 04/28/2022] [Indexed: 01/15/2023]
Abstract
Simple Summary The standard method for the diagnosis and monitoring of osteosarcoma is biopsy and tumor imaging, which causes discomfort to patients and is difficult to repeat. A blood sample can be used as a non-invasive method for monitoring tumor material. Vimentin and ezrin show clinical significance in samples obtained from OS patients but need circulating tumor cell purification, since they are expressed in leukocytes. Due to the low-temperature storage of the samples, it proved impossible to perform purification to remove the contamination. We propose that novel or OS-specific biomarkers using differential gene expression from the Gene Expression Omnibus (GEO) database is a promising approach for developing diagnostic and tumor progression strategies. Seven genes from the database showed significant expression in OS cell lines/primary cells compared to a normal blood donor, together with ezrin and VIM. The expression of the five candidate genes together with ezrin and vimentin were quantified by qRT-PCR and analyzed using a mathematical model with high efficiency to discriminate between OS patients and normal samples, resulting in the selection of three candidate genes: COL5A2 (one of the five from the database) as well as ezrin and VIM. Our study demonstrates that these genes in retrospective samples could serve as tools of OS detection and predictors of disease progression. Abstract A liquid biopsy is currently an interesting tool for measuring tumor material with the advantage of being non-invasive. The overexpression of vimentin and ezrin genes was associated with epithelial-mesenchymal transition (EMT), a key process in metastasis and progression in osteosarcoma (OS). In this study, we identified other OS-specific genes by calculating differential gene expression using the Gene Expression Omnibus (GEO) database, confirmed by using quantitative reverse transcription-PCR (qRT-PCR) to detect OS-specific genes, including VIM and ezrin in the buffy coat, which were obtained from the whole blood of OS patients and healthy donors. Furthermore, the diagnostic model for OS detection was generated by utilizing binary logistic regression with a multivariable fractional polynomial (MFP) algorithm. The model incorporating VIM, ezrin, and COL5A2 genes exhibited outstanding discriminative ability, as determined by the receiver operating characteristic curve (AUC = 0.9805, 95% CI 0.9603, 1.000). At the probability cut-off value of 0.3366, the sensitivity and the specificity of the model for detecting OS were 98.63% (95% CI 90.5, 99.7) and 94.94% (95% CI 87.5, 98.6), respectively. Bioinformatic analysis and qRT-PCR, in our study, identified three candidate genes that are potential diagnostic and prognostic genes for OS.
Collapse
Affiliation(s)
- Pattaralawan Sittiju
- Thailand Excellence Center for Tissue Engineering and Stem Cells, Department of Biochemistry, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.S.); (P.K.)
| | - Parunya Chaiyawat
- Musculoskeletal Science and Translational Research Center, Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.C.); (D.P.); (J.K.); (P.P.); (A.P.); (P.T.)
- Center of Multidisciplinary Technology for Advanced Medicine (CMUTEAM), Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Dumnoensun Pruksakorn
- Musculoskeletal Science and Translational Research Center, Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.C.); (D.P.); (J.K.); (P.P.); (A.P.); (P.T.)
- Center of Multidisciplinary Technology for Advanced Medicine (CMUTEAM), Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Jeerawan Klangjorhor
- Musculoskeletal Science and Translational Research Center, Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.C.); (D.P.); (J.K.); (P.P.); (A.P.); (P.T.)
| | - Weerinrada Wongrin
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Phichayut Phinyo
- Musculoskeletal Science and Translational Research Center, Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.C.); (D.P.); (J.K.); (P.P.); (A.P.); (P.T.)
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Rawikant Kamolphiwong
- Department of Biomedical Sciences and Biomedical Engineering, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand;
| | - Areerak Phanphaisarn
- Musculoskeletal Science and Translational Research Center, Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.C.); (D.P.); (J.K.); (P.P.); (A.P.); (P.T.)
| | - Pimpisa Teeyakasem
- Musculoskeletal Science and Translational Research Center, Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.C.); (D.P.); (J.K.); (P.P.); (A.P.); (P.T.)
| | - Prachya Kongtawelert
- Thailand Excellence Center for Tissue Engineering and Stem Cells, Department of Biochemistry, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.S.); (P.K.)
| | - Peraphan Pothacharoen
- Thailand Excellence Center for Tissue Engineering and Stem Cells, Department of Biochemistry, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.S.); (P.K.)
- Correspondence: ; Tel.: +66-53-94-5325 (ext. 206)
| |
Collapse
|
15
|
Blay JY, Palmerini E, Bollard J, Aguiar S, Angel M, Araya B, Badilla R, Bernabeu D, Campos F, Chs CS, Carvajal Montoya A, Casavilca-Zambrano S, Castro-Oliden, Chacón M, Clara-Altamirano MA, Collini P, Correa Genoroso R, Costa FD, Cuellar M, Dei Tos AP, Dominguez Malagon HR, Donati DM, Dufresne A, Eriksson M, Farias-Loza M, Frezza AM, Frisoni T, Garcia-Ortega DY, Gerderblom H, Gouin F, Gómez-Mateo MC, Gronchi A, Haro J, Hindi N, Huanca L, Jimenez N, Karanian M, Kasper B, Lopes A, Lopes David BB, Lopez-Pousa A, Lutter G, Maki RG, Martinez-Said H, Martinez-Tlahuel JL, Mello CA, Morales Pérez JM, Moura DS, Nakagawa SA, Nascimento AG, Ortiz-Cruz EJ, Patel S, Pfluger Y, Provenzano S, Righi A, Rodriguez A, Santos TG, Scotlandi K, Mlg S, Soulé T, Stacchiotti S, Valverde CM, Waisberg F, Zamora Estrada E, Martin-Broto J. SELNET clinical practice guidelines for bone sarcoma. Crit Rev Oncol Hematol 2022; 174:103685. [PMID: 35460913 DOI: 10.1016/j.critrevonc.2022.103685] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/14/2022] [Accepted: 04/14/2022] [Indexed: 11/29/2022] Open
Abstract
Bone sarcoma are infrequent diseases, representing < 0.2% of all adult neoplasms. A multidisciplinary management within reference centers for sarcoma, with discussion of the diagnostic and therapeutic strategies within an expert multidisciplinary tumour board, is essential for these patients, given its heterogeneity and low frequency. This approach leads to an improvement in patient's outcome, as demonstrated in several studies. The Sarcoma European Latin-American Network (SELNET), aims to improve clinical outcome in sarcoma care, with a special focus in Latin-American countries. These Clinical Practice Guidelines (CPG) have been developed and agreed by a multidisciplinary expert group (including medical and radiation oncologist, surgical oncologist, orthopaedic surgeons, radiologist, pathologist, molecular biologist and representatives of patients advocacy groups) of the SELNET consortium, and are conceived to provide the standard approach to diagnosis, treatment and follow-up of bone sarcoma patients in the Latin-American context.
Collapse
Affiliation(s)
- J Y Blay
- Léon Bérard Center, 28 rue Laennec 69373 Lyon Cedex 08, France.
| | - E Palmerini
- IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Pupilli, 1, 40136, Bologna, Italy
| | - J Bollard
- Léon Bérard Center, 28 rue Laennec 69373 Lyon Cedex 08, France
| | - S Aguiar
- A.C.Camargo Cancer Center, Rua prof Antonio Prudente, 211 - Liberdade, São Paulo 01509-010, Brazil
| | - M Angel
- Instituto Alexander Fleming, Av. Cramer 1180. CP, C1426ANZ Buenos Aires, Argentina
| | - B Araya
- Hospital Dr. R. A. Calderón Guardia, 7-9 Av, 15-17 St, Aranjuez, San José, Costa Rica
| | - R Badilla
- Hospital Dr. R. A. Calderón Guardia, 7-9 Av, 15-17 St, Aranjuez, San José, Costa Rica
| | - D Bernabeu
- Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - F Campos
- A.C.Camargo Cancer Center, Rua prof Antonio Prudente, 211 - Liberdade, São Paulo 01509-010, Brazil
| | - Caro-Sánchez Chs
- Instituto Nacional de Cancerologia, Torre Nueva de Hospitalización, primer piso. Av. San Fernando 86, Colonia Niño Jesus. CP, 14080 Tlalpan Mexico
| | - A Carvajal Montoya
- Hospital Dr. R. A. Calderón Guardia, 7-9 Av, 15-17 St, Aranjuez, San José, Costa Rica
| | - S Casavilca-Zambrano
- Instituto Nacional de Enfermedades Neoplásicas, Av. Angamos Este 2520, Lima, Peru
| | - Castro-Oliden
- Instituto Nacional de Enfermedades Neoplásicas, Av. Angamos Este 2520, Lima, Peru
| | - M Chacón
- Instituto Alexander Fleming, Av. Cramer 1180. CP, C1426ANZ Buenos Aires, Argentina
| | - M A Clara-Altamirano
- Instituto Nacional de Cancerologia, Torre Nueva de Hospitalización, primer piso. Av. San Fernando 86, Colonia Niño Jesus. CP, 14080 Tlalpan Mexico
| | - P Collini
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy
| | - R Correa Genoroso
- Hospital Clínico Universitario Virgen de la Victoria, Campus Universitario de Teatinos s/n, 29010, Malaga, Spain
| | - F D Costa
- A.C.Camargo Cancer Center, Rua prof Antonio Prudente, 211 - Liberdade, São Paulo 01509-010, Brazil
| | - M Cuellar
- Instituto Nacional de Cancerologia, Torre Nueva de Hospitalización, primer piso. Av. San Fernando 86, Colonia Niño Jesus. CP, 14080 Tlalpan Mexico
| | - A P Dei Tos
- Treviso General Hospital Treviso, University of Padua, Padova, Italy
| | - H R Dominguez Malagon
- Instituto Nacional de Cancerologia, Torre Nueva de Hospitalización, primer piso. Av. San Fernando 86, Colonia Niño Jesus. CP, 14080 Tlalpan Mexico
| | - D M Donati
- IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Pupilli, 1, 40136, Bologna, Italy
| | - A Dufresne
- Léon Bérard Center, 28 rue Laennec 69373 Lyon Cedex 08, France
| | - M Eriksson
- Skane University Hospital and Lund University, Lund, Sweden
| | - M Farias-Loza
- Instituto Nacional de Enfermedades Neoplásicas, Av. Angamos Este 2520, Lima, Peru
| | - A M Frezza
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy
| | - T Frisoni
- IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Pupilli, 1, 40136, Bologna, Italy
| | - D Y Garcia-Ortega
- Instituto Nacional de Cancerologia, Torre Nueva de Hospitalización, primer piso. Av. San Fernando 86, Colonia Niño Jesus. CP, 14080 Tlalpan Mexico
| | - H Gerderblom
- Leiden University Medical Center, Leiden, The Netherlands
| | - F Gouin
- Léon Bérard Center, 28 rue Laennec 69373 Lyon Cedex 08, France
| | - M C Gómez-Mateo
- Hospital Universitario Miguel Servet, Paseo Isabel la Católica, 1-3, 50009 Zaragoza, Spain
| | - A Gronchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy
| | - J Haro
- Instituto Nacional de Enfermedades Neoplásicas, Av. Angamos Este 2520, Lima, Peru
| | - N Hindi
- Research Health Institute Fundacion Jimenez Diaz (IIS/FJD), 28015 Madrid, Spain; Hospital Fundación Jimenez Diaz University Hospital, 28040 Madrid, Spain; General de Villalba University Hospital, 28400 Madrid, Spain
| | - L Huanca
- Instituto Nacional de Enfermedades Neoplásicas, Av. Angamos Este 2520, Lima, Peru
| | - N Jimenez
- Hospital San Vicente de Paúl, Avenue 16, streets 10 and 14, Heredia, Costa Rica
| | - M Karanian
- Léon Bérard Center, 28 rue Laennec 69373 Lyon Cedex 08, France
| | - B Kasper
- University of Heidelberg, Mannheim Cancer Center, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - A Lopes
- A.C.Camargo Cancer Center, Rua prof Antonio Prudente, 211 - Liberdade, São Paulo 01509-010, Brazil
| | - B B Lopes David
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy
| | - A Lopez-Pousa
- Hospital de la Santa Creu i Sant Pau, Carrer de Sant Quintí, 89, 08041 Barcelona, Spain
| | - G Lutter
- Instituto Alexander Fleming, Av. Cramer 1180. CP, C1426ANZ Buenos Aires, Argentina
| | - R G Maki
- University of Pennsylvania, Abramson Cancer Center, 3400 Civic Center Boulevard, Philadelphia, PA 19104 USA
| | - H Martinez-Said
- Centro Oncologico Integral, Hospital Medica Sur, Planta Baja Torre III - Cons. 305, Col. Toriello Guerra, Deleg. Tlalpan. C.P., 14050, Mexico, D.F
| | - J L Martinez-Tlahuel
- Instituto Nacional de Cancerologia, Torre Nueva de Hospitalización, primer piso. Av. San Fernando 86, Colonia Niño Jesus. CP, 14080 Tlalpan Mexico
| | - C A Mello
- A.C.Camargo Cancer Center, Rua prof Antonio Prudente, 211 - Liberdade, São Paulo 01509-010, Brazil
| | - J M Morales Pérez
- Centro Oncologico Integral, Hospital Medica Sur, Planta Baja Torre III - Cons. 305, Col. Toriello Guerra, Deleg. Tlalpan. C.P., 14050, Mexico, D.F
| | - D S Moura
- Hospital Universitario Virgen del Rocio, Av Manuel Siurot s/n, 41013 Sevilla, Spain
| | - S A Nakagawa
- A.C.Camargo Cancer Center, Rua prof Antonio Prudente, 211 - Liberdade, São Paulo 01509-010, Brazil
| | - A G Nascimento
- A.C.Camargo Cancer Center, Rua prof Antonio Prudente, 211 - Liberdade, São Paulo 01509-010, Brazil
| | - E J Ortiz-Cruz
- Hospital Universitario La Paz, MD Anderson Cancer Center, Calle de Arturo Soria, 270, 28033 Madrid, Spain
| | - S Patel
- UT MD Anderson Cancer Center, Houston, TX, USA
| | - Y Pfluger
- Instituto Alexander Fleming, Av. Cramer 1180. CP, C1426ANZ Buenos Aires, Argentina
| | - S Provenzano
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy
| | - A Righi
- IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Pupilli, 1, 40136, Bologna, Italy
| | - A Rodriguez
- Instituto Alexander Fleming, Av. Cramer 1180. CP, C1426ANZ Buenos Aires, Argentina
| | - T G Santos
- A.C.Camargo Cancer Center, Rua prof Antonio Prudente, 211 - Liberdade, São Paulo 01509-010, Brazil
| | - K Scotlandi
- IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Pupilli, 1, 40136, Bologna, Italy
| | - Silva Mlg
- A.C.Camargo Cancer Center, Rua prof Antonio Prudente, 211 - Liberdade, São Paulo 01509-010, Brazil
| | - T Soulé
- Instituto Alexander Fleming, Av. Cramer 1180. CP, C1426ANZ Buenos Aires, Argentina
| | - S Stacchiotti
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy
| | - C M Valverde
- Vall d´Hebrón University Hospital, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - F Waisberg
- Instituto Alexander Fleming, Av. Cramer 1180. CP, C1426ANZ Buenos Aires, Argentina
| | - E Zamora Estrada
- Hospital Dr. R. A. Calderón Guardia, 7-9 Av, 15-17 St, Aranjuez, San José, Costa Rica
| | - J Martin-Broto
- Research Health Institute Fundacion Jimenez Diaz (IIS/FJD), 28015 Madrid, Spain; Hospital Fundación Jimenez Diaz University Hospital, 28040 Madrid, Spain; General de Villalba University Hospital, 28400 Madrid, Spain
| |
Collapse
|
16
|
Clinical Perspectives for 18F-FDG PET Imaging in Pediatric Oncology: Μetabolic Tumor Volume and Radiomics. Metabolites 2022; 12:metabo12030217. [PMID: 35323660 PMCID: PMC8956064 DOI: 10.3390/metabo12030217] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 11/17/2022] Open
Abstract
Pediatric cancer, although rare, requires the most optimized treatment approach to obtain high survival rates and minimize serious long-term side effects in early adulthood. 18F-FDG PET/CT is most helpful and widely used in staging, recurrence detection, and response assessment in pediatric oncology. The well-known 18F-FDG PET metabolic indices of metabolic tumor volume (MTV) and tumor lesion glycolysis (TLG) have already revealed an independent significant prognostic value for survival in oncologic patients, although the corresponding cut-off values remain study-dependent and not validated for use in clinical practice. Advanced tumor “radiomic” analysis sheds new light into these indices. Numerous patterns of texture 18F-FDG uptake features can be extracted from segmented PET tumor images due to new powerful computational systems supporting complex “deep learning” algorithms. This high number of “quantitative” tumor imaging data, although not decrypted in their majority and once standardized for the different imaging systems and segmentation methods, could be used for the development of new “clinical” models for specific cancer types and, more interestingly, for specific age groups. In addition, data from novel techniques of tumor genome analysis could reveal new genes as biomarkers for prognosis and/or targeted therapies in childhood malignancies. Therefore, this ever-growing information of “radiogenomics”, in which the underlying tumor “genetic profile” could be expressed in the tumor-imaging signature of “radiomics”, possibly represents the next model for precision medicine in pediatric cancer management. This paper reviews 18F-FDG PET image segmentation methods as applied to pediatric sarcomas and lymphomas and summarizes reported findings on the values of metabolic and radiomic features in the assessment of these pediatric tumors.
Collapse
|
17
|
Menendez N, Epelman M, Shao L, Douglas D, Meyers AB. Pediatric Osteosarcoma: Pearls and Pitfalls. Semin Ultrasound CT MR 2022; 43:97-114. [PMID: 35164914 DOI: 10.1053/j.sult.2021.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Osteosarcoma is a malignant bone tumor most commonly presenting in children. It has a bimodal distribution with a peak incidence occurring during the ages of 10-14 years old and in adults greater than age 65. The first peak of osteosarcoma correlates with the increased proliferation of bone during the pubertal growth period. Osteosarcoma most frequently presents with localized bone pain, swelling, and an antalgic gait. The patient may attribute symptoms to trauma or strenuous exercise, causing the patient to be managed conservatively. In these cases, the pain persists and eventually leads to further evaluation. The most common type of osteosarcoma is the conventional high-grade osteosarcoma. For conventional osteosarcoma, the diagnosis is typically made or strongly suggested based upon the initial radiographic appearance. Other types of osteosarcomas include low grade central, telangiectatic, small-cell, surface and intracortical. Consequently, it is important for radiologists to be aware of these subtypes and the imaging features that differentiate them from other etiologies to prevent a delay in treatment.
Collapse
Affiliation(s)
- Nelson Menendez
- University of Central Florida College of Medicine, Orlando, FL; Department of Radiology, Nemours Children's Health System/Nemours Children's Hospital, Orlando, FL
| | - Monica Epelman
- University of Central Florida College of Medicine, Orlando, FL; Department of Radiology, Nemours Children's Health System/Nemours Children's Hospital, Orlando, FL
| | - Lei Shao
- University of Central Florida College of Medicine, Orlando, FL; Department of Pathology and Lab Medicine, Nemours Children's Health System/Nemours Children's Hospital, Orlando, FL
| | - Dorothea Douglas
- University of Central Florida College of Medicine, Orlando, FL; Department of Pediatrics, Nemours Children's Health System/Nemours Children's Hospital, Orlando, FL
| | - Arthur B Meyers
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Dept. of Radiology, Cincinnati, OH.
| |
Collapse
|
18
|
Purandare NC, Shah S, Agrawal A, Puranik A, Rangarajan V. Spectrum of Flurodeoxyglucose Positron Emission Tomography/Computerized Tomography Findings in Tumors and Tumor-Like Conditions of the Musculoskeletal System. Indian J Nucl Med 2021; 36:327-339. [PMID: 34658562 PMCID: PMC8481850 DOI: 10.4103/ijnm.ijnm_242_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/12/2021] [Accepted: 02/24/2021] [Indexed: 11/18/2022] Open
Abstract
Bone and soft-tissue tumors display a wide range of metabolic activity on flurodeoxyglucose positron emission tomography/computerized tomography (FDG PET/CT) imaging due to their varying histopathological features. Several benign tumors show high FDG uptake similar to that seen in malignant lesions and their metabolic characteristics can overlap. Certain benign tumors can potentially undergo malignant transformation and FDG PET/CT can play an important role in detecting malignant change. The intensity of metabolic activity on FDG PET/CT correlates with histological grade of malignant tumors and also acts as a valuable prognostic factor. FDG PET/CT plays an important role in the staging work up of bone and soft-tissue malignancies. It has been found to be superior to conventional imaging techniques primarily for detecting distant metastatic disease. Because of its ability to detect metabolic changes, FDG PET/CT is a very useful in assessing response to treatment. Metabolic response seen on FDG PET is a powerful surrogate marker of histopathological response to chemotherapy. The purpose of this article is to study the variable patterns of FDG uptake in tumors of the musculoskeletal system, describe the clinical utility of FDG PET/CT in predicting malignant change in benign tumors and discuss its role in staging, response assessment, and prognostication of malignant lesions.
Collapse
Affiliation(s)
- Nilendu C Purandare
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National University (HBNI), Mumbai, Maharashtra, India
| | - Sneha Shah
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National University (HBNI), Mumbai, Maharashtra, India
| | - Archi Agrawal
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National University (HBNI), Mumbai, Maharashtra, India
| | - Ameya Puranik
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National University (HBNI), Mumbai, Maharashtra, India
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National University (HBNI), Mumbai, Maharashtra, India
| |
Collapse
|
19
|
Osteosarcoma: An Evolving Understanding of a Complex Disease. J Am Acad Orthop Surg 2021; 29:e993-e1004. [PMID: 34623342 DOI: 10.5435/jaaos-d-20-00838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/16/2021] [Indexed: 02/01/2023] Open
Abstract
Osteosarcoma is the most common primary bone sarcoma and affects both children and adults. The cornerstone of treatment for patients with localized and oligometastatic disease remains neoadjuvant chemotherapy, surgical resection of all sites of disease, followed by adjuvant chemotherapy. This approach is associated with up to an 80% 5-year survival. However, survival of patients with metastatic disease remains poor, and overall, osteosarcoma remains a challenging disease to treat. Advances in the understanding of molecular drivers of the disease, identification of poor prognostic factors, development of risk-stratified treatment protocols, successful completion of large collaborative trials, and surgical advances have laid the ground work for progress. Advances in computer navigation, implant design, and surgical techniques have allowed surgeons to improve patients' physical functional without sacrificing oncologic outcomes. Future goals include identifying effective risk stratification algorithms which minimize patient toxicity while maximizing oncologic outcomes and continuing to improve the durability, function, and patient acceptance of oncologic reconstructions.
Collapse
|
20
|
Mercolini F, Zucchetta P, Jehanno N, Corradini N, Van Rijn RR, Rogers T, Cameron A, Scarzello G, Coppadoro B, Minard-Colin V, Gallego S, Chisholm J, Merks JH, Bisogno G. Role of 18F-FDG-PET/CT in the staging of metastatic rhabdomyosarcoma: a report from the European paediatric Soft tissue sarcoma Study Group. Eur J Cancer 2021; 155:155-162. [PMID: 34385068 DOI: 10.1016/j.ejca.2021.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/25/2021] [Accepted: 07/08/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Initial staging of rhabdomyosarcoma is crucial for prognosis and to tailor the treatment. The standard radiology workup (SRW) includes magnetic resonance imaging, chest computed tomography (CT) and bone scintigraphy, but 18 Fluorine-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) (18F-FDG-PET/CT (PET-CT)) use is increasing. The aim of this study was to evaluate the impact of PET-CT in the initial staging of patients with metastatic rhabdomyosarcoma enrolled in the European protocol MTS2008. METHODS Two authors retrospectively reviewed the SRW and PET-CT reports comparing the number and sites of metastases detected. For bone marrow involvement, PET-CT and bone marrow aspirates/biopsies were compared. RESULTS Among 263 metastatic patients enrolled from October 2008 to December 2016, 121 had PET-CT performed at diagnosis, and for 118 of 121 patients, both PET-CT and radiological reports were available for review. PET-CT showed higher sensitivity than SRW in the ability to detect locoregional (96.2% versus 78.5%, P value = 0.0013) and distant lymph node involvement (94.8% versus 79.3%, P value = 0.0242), but sensitivity was lower for intrathoracic sites (lung 79.6% versus 100%, P value = 0.0025). For bone metastasis, PET-CT was more sensitive than bone scintigraphy (96.4% versus 67.9%, P value = 0.0116). The PET-CT sensitivity and specificity to detect marrow involvement were 91.8% and 93.8%, respectively. The mean number of metastatic sites was 1.94 (range 0-5) with PET-CT and 1.72 (range 0-5) with SRW. In four patients (3.4%), PET-CT changed the staging from localised to metastatic disease. CONCLUSION PET can identify metastatic disease not evident on SRW in a small number of patients. This is because of its higher ability to recognise lymph node and bone involvement. Chest CT remains essential to detect lesions in intrathoracic sites, which can be performed in a one stop-shot routine examination or on a dedicated chest CT scan. PET-CT could replace bone scintigraphy to study bone involvement.
Collapse
Affiliation(s)
- Federico Mercolini
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Bolzano Hospital, Bolzano, Italy.
| | - Pietro Zucchetta
- Nuclear Medicine Unit, Department of Medicine - DIMED, University Hospital of Padova, Padova, Italy
| | - Nina Jehanno
- Department of Nuclear Medicine, Institut Curie, PSL Research University, Paris, France
| | - Nadege Corradini
- Department of Pediatric Hematology and Oncology-IHOPe, Centre Léon Bérard, Lyon, France
| | - Rick R Van Rijn
- Department of Radiology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Timothy Rogers
- Department of Paediatric Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Alison Cameron
- Bristol Haematology and Oncology Hospital, University Hospitals Bristol and Weston, Bristol, UK
| | - Giovanni Scarzello
- Radiotherapy Division, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Beatrice Coppadoro
- Hematology Oncology Division, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Veronique Minard-Colin
- Département de cancérologie de l'enfant et l'adolescent, INSERM U1015, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France
| | - Soledad Gallego
- Servicio de Oncología y Hematología Pediatrica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Julia Chisholm
- Children and Young Peoples Unit, Royal Marsden Hospital, Down's Road, Sutton, Surrey, UK
| | - J Hans Merks
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Gianni Bisogno
- Hematology Oncology Division, Department of Women's and Children's Health, University of Padova, Padova, Italy
| |
Collapse
|
21
|
Vali R, Alessio A, Balza R, Borgwardt L, Bar-Sever Z, Czachowski M, Jehanno N, Kurch L, Pandit-Taskar N, Parisi M, Piccardo A, Seghers V, Shulkin BL, Zucchetta P, Lim R. SNMMI Procedure Standard/EANM Practice Guideline on Pediatric 18F-FDG PET/CT for Oncology 1.0. J Nucl Med 2021; 62:99-110. [PMID: 33334912 PMCID: PMC8679588 DOI: 10.2967/jnumed.120.254110] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 07/21/2020] [Indexed: 02/06/2023] Open
Abstract
The Society of Nuclear Medicine and Molecular Imaging (SNMMI) is an international scientific and professional organization founded in 1954 to promote the science, technology, and practical application of nuclear medicine. The European Association of Nuclear Medicine (EANM) is a professional nonprofit medical association founded in 1985 to facilitate communication worldwide among individuals pursuing clinical and academic excellence in nuclear medicine. SNMMI and EANM members are physicians, technologists, and scientists specializing in the research and practice of nuclear medicine. The SNMMI and EANM will periodically put forth new standards/guidelines for nuclear medicine practice to help advance the science of nuclear medicine and improve service to patients. Existing standards/guidelines will be reviewed for revision or renewal, as appropriate, on their fifth anniversary or sooner, if indicated. Each standard/guideline, representing a policy statement by the SNMMI/EANM, has undergone a thorough consensus process, entailing extensive review. The SNMMI and EANM recognize that the safe and effective use of diagnostic nuclear medicine imaging requires particular training and skills, as described in each document. These standards/guidelines are educational tools designed to assist practitioners in providing appropriate and effective nuclear medicine care for patients. These guidelines are consensus documents, and are not inflexible rules or requirements of practice. They are not intended, nor should they be used, to establish a legal standard of care. For these reasons and those set forth below, the SNMMI and the EANM cautions against the use of these standards/guidelines in litigation in which the clinical decisions of a practitioner are called into question. The ultimate judgment regarding the propriety of any specific procedure or course of action must be made by medical professionals taking into account the unique circumstances of each case. Thus, there is no implication that action differing from what is laid out in the standards/guidelines, standing alone, is below standard of care. To the contrary, a conscientious practitioner may responsibly adopt a course of action different from that set forth in the standards/guidelines when, in the reasonable judgment of the practitioner, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology subsequent to publication of the standards/guidelines. The practice of medicine involves not only the science, but also the art of dealing with the prevention, diagnosis, alleviation, and treatment of disease. The variety and complexity of human conditions make it impossible for general guidelines to consistently allow for an accurate diagnosis to be reached or a particular treatment response to be predicted. Therefore, it should be recognized that adherence to these standards/guidelines will not ensure a successful outcome. All that should be expected is that the practitioner follows a reasonable course of action, based on their level of training, the current knowledge, the available resources, and the needs/context of the particular patient being treated. PET and computerized tomography (CT) have been widely used in oncology. 18F-FDG is the most common radiotracer used for PET imaging. The purpose of this document is to provide imaging specialists and clinicians guidelines for recommending, performing, and interpreting 18F-FDG PET/CT in pediatric patients in oncology. There is not a high level of evidence for all recommendations suggested in this paper. These recommendations represent the expert opinions of experienced leaders in this field. Further studies are needed to have evidence-based recommendations for the application of 18F-FDG PET/CT in pediatric oncology. These recommendations should be viewed in the context of good practice of nuclear medicine and are not intended to be a substitute for national and international legal or regulatory provisions.
Collapse
Affiliation(s)
- Reza Vali
- Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Adam Alessio
- Michigan State University, East Lansing, Michigan
| | - Rene Balza
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lise Borgwardt
- Department for Clinical Physiology, Nuclear Medicine & PET, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Zvi Bar-Sever
- Schneider Children's Medical Center, Petach Tikva, Israel
| | | | - Nina Jehanno
- Department of Nuclear Medicine, Institut Curie, Paris, France
| | - Lars Kurch
- University Hospital Leipzig, Department of Nuclear Medicine, Leipzig, Germany
| | | | - Marguerite Parisi
- University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington
| | | | - Victor Seghers
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Barry L Shulkin
- St. Jude Children's Research Hospital, Memphis, Tennessee; and
| | | | - Ruth Lim
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
22
|
Staging and Classification of Primary Musculoskeletal Bone and Soft Tissue Tumors Based on the 2020 WHO Update, From the AJR Special Series on Cancer Staging. AJR Am J Roentgenol 2021; 217:1038-1052. [PMID: 33852362 DOI: 10.2214/ajr.21.25658] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Staging of primary musculoskeletal bone and soft tissue tumors is most commonly performed using the AJCC and the Enneking or Musculoskeletal Tumor Society (MSTS) staging systems. Radiologic imaging is integral in achieving adequate musculoskeletal neoplastic staging by defining lesion extent and identifying regional lymph node involvement and distant metastatic disease. Additional important features in surgical planning, though not distinct components of the staging systems, include cortical involvement, joint invasion, and neurovascular encasement; these features are optimally evaluated by MRI. In 2020, the WHO updated the classification of primary musculoskeletal tumors of soft tissue and bone. The update reflects the continued explosion in identification of novel gene alterations in many bone and soft tissue neoplasms. This has resulted in newly designated lesions, reclassification of lesion categories, and improved specificity of diagnosis. While radiologists do not need to have a comprehensive knowledge of the pathologic details, a broad working understanding of the most recent update is important to aid accurate and timely diagnosis given that histologic grading is a component of all staging systems. By approaching primary musculoskeletal neoplasms through a multidisciplinary approach with colleagues in pathology, orthopedic oncology, radiation oncology, and medical oncology, radiologists may promote improved diagnosis, treatment, and outcomes.
Collapse
|
23
|
Harrison DJ, Parisi MT, Khalatbari H, Shulkin BL. PET with 18F-Fluorodeoxyglucose/Computed Tomography in the Management of Pediatric Sarcoma. PET Clin 2021; 15:333-347. [PMID: 32498989 DOI: 10.1016/j.cpet.2020.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The role for PET with fludeoxyglucose F 18 (18F-FDG PET)/computed tomography (CT) in the management of pediatric sarcomas continues to be controversial. The literature supports a role for PET/CT in the staging and surveillance of certain specific pediatric sarcoma subtypes; however, the data are less clear regarding whether PET/CT can be used as a biomarker for prognostication. Despite the interest in using this imaging modality in the management of pediatric sarcomas, most studies are limited by retrospective design and small sample size. Additional data are necessary to fully understand how best to use 18F-FDG PET/CT in pediatric sarcoma management.
Collapse
Affiliation(s)
- Douglas J Harrison
- Division of Pediatrics, MD Anderson Cancer Center, Unit 87, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Marguerite T Parisi
- Department of Radiology, Seattle Children's Hospital, M/S MA.7.220, 4850 Sand Point Way Northeast, Seattle, WA 98105, USA; Department of Pediatrics, Seattle Children's Hospital, M/S MA.7.220, 4850 Sand Point Way Northeast, Seattle, WA 98105, USA
| | - Hedieh Khalatbari
- Department of Radiology, Seattle Children's Hospital, M/S MA.7.220, 4850 Sand Point Way Northeast, Seattle, WA 98105, USA
| | - Barry L Shulkin
- Department of Radiology, Seattle Children's Hospital, M/S MA.7.220, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA.
| |
Collapse
|
24
|
Abstract
We present a review of several bone (osteoid)-forming tumors including enostosis, osteoid osteoma, osteoblastoma, and osteosarcoma. These entities were chosen because they are reasonably common-neither seen every day nor rare. When applicable, recent information about the lesions is included.
Collapse
Affiliation(s)
- Behrang Amini
- Department of Musculoskeletal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Raul Fernando Valenzuela
- Department of Musculoskeletal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Justin E Bird
- Department of Orthopaedic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tamara Miner Haygood
- Department of Musculoskeletal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
25
|
Can C, Gündoğan C, Kömek H. Is 68Ga-Prostate-Specific Membrane Antigen PET/CT Superior than 18F-FDG PET/CT for Evaluation of Metastatic Osteosarcoma? Clin Nucl Med 2021; 46:e233-e235. [PMID: 33031232 DOI: 10.1097/rlu.0000000000003320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT We present the case of a 75-year-old man with osteosarcoma of the sternum in whom 68Ga-prostate-specific membrane antigen (PSMA) PET/CT showed high radiotracer activity in the primary tumor and metastatic lesions than 18F-FDG PET/CT. The present case shows that 68Ga-PSMA PET/CT is very useful for staging of osteosarcoma due to in vivo expression of PSMA. 68Ga-PSMA PET/CT can have potential effects on prognosis and in response assessment following treatment in osteosarcoma. The use of PSMA-targeted radioligand treatments may be beneficial especially in metastatic chemorefractory osteosarcoma.
Collapse
Affiliation(s)
- Canan Can
- From the Department of Nuclear Medicine, Gazi Yaşargil Training and Research Hospital, University of Health Sciences, Diyarbakir, Turkey
| | | | | |
Collapse
|
26
|
Jia H, Zhao X, Qin L, Cai X. Imaging Method for Osteosarcoma Diagnosis and Clinical Staging Information Optimization. JOURNAL OF MEDICAL IMAGING AND HEALTH INFORMATICS 2021. [DOI: 10.1166/jmihi.2021.3421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In order to better assist clinicians in the diagnosis and treatment of osteosarcoma, and our understanding of the advantages and disadvantages of different examination techniques of DR, CT and MRI, this article collects the pathological diagnosis of the PACS Medical system of Liaocheng
People’s Hospital 2015 to 2018. 130 patients with osteosarcoma and imaging examination data, retrospectively analyzed the diagnostic and clinical staging information contained in DR, CT and MRI examination data of osteosarcoma patients, and detected the diagnosis and clinical staging
information of osteosarcoma by comparing various examination methods ability to obtain the optimal imaging examination method that can provide complete diagnosis and clinical staging information of osteosarcoma, and is recommended as a routine clinical examination program. Finally, we conclude
that: DR, CT, and MRI examinations have no significant differences in the detection capacity of osteosarcoma bone destruction, periosteal response, and periosteal triangle; MRI has less ability to detect tumor bone than DR and CT; DR has soft tissue. The ability to detect masses is inferior
to CT and MRI. Among the single DR, CT or MRI examinations, CT examinations have the best comprehensive detection ability for all imaging diagnostic signs of osteosarcoma. MR examination has the best comprehensive display of clinical staging information such as infiltration range and infiltration
boundary of osteosarcoma. Combined DR, CT, and MRI examinations are optimized imaging procedures that provide complete osteosarcoma diagnosis and clinical staging information.
Collapse
Affiliation(s)
- Huijuan Jia
- Computerized Tomography Room, Liaocheng People’s Hospital, Shandong Liaocheng, 252000, China
| | - Xiuqin Zhao
- Magnetic Resonance Imaging Room, Liaocheng People’s Hospital, Shandong Liaocheng, 252000, China
| | - Lei Qin
- Department of Nuclear Medicine, Liaocheng People’s Hospital, Shandong Liaocheng, 252000, China
| | - Xiansheng Cai
- Department of Nuclear Medicine, Liaocheng People’s Hospital, Shandong Liaocheng, 252000, China
| |
Collapse
|
27
|
Tal AL, Doshi H, Parkar F, Abraham T, Love C, Ye K, Yang R, Hoang B, Loeb D, Chou A, Geller D, Moadel R. The Utility of 18FDG PET/CT Versus Bone Scan for Identification of Bone Metastases in a Pediatric Sarcoma Population and a Review of the Literature. J Pediatr Hematol Oncol 2021; 43:52-58. [PMID: 32815877 DOI: 10.1097/mph.0000000000001917] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 07/13/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Outcome of patients with osteosarcoma (OS) and Ewing sarcoma (EWS) is dependent on presence of metastases. Imaging guidelines for OS and EWS include radiographs, computed tomography (CT), and magnetic resonance imaging for primary tumor evaluation and CT chest and bone scintigraphy (BS) for metastatic detection. 18Fluorodeoxyglucose (18FDG) positron emission tomography (PET)/CT has become more common for disease evaluation, yet there is no consensus for its use in this population. OBJECTIVE We aimed to compare identification of osseous metastases using BS versus 18FDG PET/CT in our patient population. We hypothesized that 18FDG PET/CT is more likely to detect osseous metastases both at diagnosis and relapse. MATERIALS AND METHODS We performed retrospective chart reviews of pediatric sarcoma patients treated at our institution from 2008 to 2019. Paired BS and 18FDG PET/CT scans were reviewed. Review of the literature was also performed. RESULTS Thirty-three patients had paired BS and 18FDG PET/CT during diagnosis or treatment. Fifteen patients had distant osseous metastases. In the OS cohort, 8/16 patients had osseous metastases; 100% of these patients were detected on 18FDG PET/CT and 75% on BS. Thirty-one bony lesions were seen on imaging in OS patients; 100% of these were identified on 18FDG PET/CT but only 29% on BS. In the EWS cohort, 6/15 patients had osseous metastases; 100% of these patients were detected on 18FDG PET/CT and 50% on BS. Eighteen bony lesions were seen on imaging in EWS patients; 94% of these were identified on 18FDG PET/CT, but only 28% on BS. CONCLUSION For patients in our institution with OS or EWS, osseous metastases were more likely detected using 18FDG PET/CT.
Collapse
Affiliation(s)
- Adit L Tal
- Department of Pediatrics, Division of Pediatric Hematology/Oncology
| | - Hiten Doshi
- Department of Radiology, Division of Nuclear Medicine
| | | | - Tony Abraham
- Department of Radiology, Division of Nuclear Medicine
| | - Charito Love
- Department of Radiology, Division of Nuclear Medicine
| | - Kenny Ye
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY
| | - Rui Yang
- Department of Orthopedic Surgery, Montefiore Medical Center, Bronx
| | - Bang Hoang
- Department of Orthopedic Surgery, Montefiore Medical Center, Bronx
| | - David Loeb
- Department of Pediatrics, Division of Pediatric Hematology/Oncology
| | - Alexander Chou
- Department of Pediatrics, Division of Pediatric Hematology/Oncology
| | - David Geller
- Department of Orthopedic Surgery, Montefiore Medical Center, Bronx
| | - Renee Moadel
- Department of Radiology, Division of Nuclear Medicine
| |
Collapse
|
28
|
Bıçakçı N, Elli M. 18Fluorine-fluorodeoxyglucose PET/CT Imaging in Childhood Malignancies. Mol Imaging Radionucl Ther 2021; 30:18-27. [PMID: 33586403 PMCID: PMC7885281 DOI: 10.4274/mirt.galenos.2020.64436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives: The aim of the study was to evaluate the utility of 18fluorine-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in the diagnosis, staging, restaging, and treatment response of childhood malignancies. Methods: This study included 52 patients (32 boys, 20 girls) who were referred to our clinic between November 2008 and December 2018 with the diagnosis of malignancy. The patients were evaluated retrospectively. Median age of the patients was 13 years (range 2-17). 18F-FDG was given to the patients intravenously, and time of flight with PET/16 slice CT was performed 1 hour thereafter. The lowest dose was 2 mCi (74 MBq) and the highest dose was 10 mCi (370 MBq). Fasting blood sugars of all patients were found below 200 mg/dL (11.1 mmol/L). Results: 18F-FDG PET/CT was performed to evaluate the response to treatment in 38 of 52 children, staging in 11 patients (staging and evaluation of the response to treatment in nine of them), restaging in 2 patients, restaging, and evaluation of the response to treatment in 1 patient. 18F-FDG PET/CT examination was reported as normal in 13 patients (5 girls, 8 boys). The pathological 18F-FDG uptake was detected in 39 patients (14 girls, 25 boys), which indicated metastasis and/or recurrence of the primary disease. Total number of deaths was 30 (13 girls, 17 boys). Conclusion: 18F-FDG PET/CT has a significant role for staging, restaging, treatment response, and detection of metastatic disease but it is limited for the early diagnosis of childhood cancers
Collapse
Affiliation(s)
- Nilüfer Bıçakçı
- University of Health Sciences Turkey, Samsun Training and Research Hospital, Clinic of Nuclear Medicine, Samsun, Turkey
| | - Murat Elli
- İstanbul Medipol University Faculty of Medicine, Department of Pediatric Oncology, İstanbul, Turkey
| |
Collapse
|
29
|
Rajakulasingam R, Attard V, Botchu R, James SL, Saifuddin A. The value of chest and skeletal staging in parosteal osteosarcoma: two-centre experience and literature review. Skeletal Radiol 2021; 50:301-309. [PMID: 32705301 DOI: 10.1007/s00256-020-03557-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/14/2020] [Accepted: 07/14/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the value of chest and skeletal staging in patients with parosteal osteosarcoma (POS), and the incidence of late local and chest recurrence. MATERIALS AND METHODS Retrospective review of patients across two institutions with histological confirmation of POS diagnosed between January 2007 and March 2020. Data collected included age, sex, skeletal location, results of chest CT and whole-body bone scintigraphy (WB-BSc) or whole-body MRI (WB-MRI) obtained at initial diagnosis. The histological tumour grade based on surgical resection specimens was classified as low-grade POS (LG-POS) and dedifferentiated POS (DD-POS). Findings of chest CT and skeletal staging were correlated with tumour grade. Follow-up chest CT and MRI studies were reviewed to determine the rate of late lung metastases and local recurrence. RESULTS There were 27 males and 44 females, mean age 33 years (range 12-79 years). The femur (n = 43) and tibia (n = 14) were the most commonly involved bones. From surgical resection histology, 42 (59.2%) were LG-POS and 29 (40.8%) were DD-POS. WB-BSc/WB-MRI showed no skeletal metastases, while 1 case of DD-POS presented with bilateral calcified lung metastases. At follow-up, 7 patients (9.9%) developed lung metastases (mean of 18.9 months, range 10-48 months) from initial presentation, of which all were DD-POS. All but 1 patient who developed subsequent lung metastases had a local recurrence. CONCLUSIONS Skeletal staging is unlikely to be of value in POS. Staging chest CT is very unlikely to demonstrate lung metastases in LG-POS and could be limited to DD-POS, particularly at the time of local recurrence.
Collapse
Affiliation(s)
- R Rajakulasingam
- Department of Medical Imaging, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
| | - V Attard
- Department of Medical Imaging, Mater Dei Hospital, Msida, MSD, 2090, Malta
| | - R Botchu
- Department of Medical Imaging, Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Birmingham, B31 2AP, UK
| | - S L James
- Department of Medical Imaging, Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Birmingham, B31 2AP, UK
| | - A Saifuddin
- Department of Medical Imaging, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| |
Collapse
|
30
|
Ikuta K, Kawamoto T, Hara H, Fukase N, Morishita M, Kuroda R, Akisue T. Solitary pancreatic lesion as the initial metastasis from osteosarcoma: Report of a rare case. J Orthop Sci 2020; 25:724-728. [PMID: 28993057 DOI: 10.1016/j.jos.2017.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 09/17/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Kemmei Ikuta
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Teruya Kawamoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Hitomi Hara
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naomasa Fukase
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masayuki Morishita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Toshihiro Akisue
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan; Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe, Japan
| |
Collapse
|
31
|
Saifuddin A, Sharif B, Oliveira I, Kalus S, Barnett J, Pressney I. The incidence of skip metastases on whole bone MRI in high-grade bone sarcomas. Skeletal Radiol 2020; 49:945-954. [PMID: 31919587 DOI: 10.1007/s00256-019-03369-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 12/21/2019] [Accepted: 12/29/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Skip metastases have been described with osteosarcoma, Ewing sarcoma and rarely chondrosarcoma. The aim of this study was to determine the incidence of skip metastases on whole bone MRI in all primary high-grade sarcomas of the major long bones. MATERIALS AND METHOD Retrospective review of patients from April 2007 to April 2019 with high-grade primary bone sarcomas of the humerus, radius, ulna, femur, tibia or fibula who had whole bone MRI at initial staging. Data collected included age, sex, tumour type, presence and location of skip metastases based on whole bone MRI and presence of distant metastases (the skeleton and lung). RESULTS The study included 216 males and 171 females with mean age 30.6 years (range 4-92 years). Tumour types were as follows: High-grade osteosarcoma n = 202, Ewing sarcoma n = 68, high-grade chondrosarcoma n = 44, dedifferentiated chondrosarcoma n = 37, high-grade spindle cell sarcoma n = 29 and angiosarcoma n = 7. Skip lesions were identified in 63 (16.3%). However, after taking into account the presence of distant skeletal (n = 11) and pulmonary (n = 33) metastases, the overall incidence of skip metastases was 6.5%, occurring in 15 (7.5%) high-grade osteosarcomas, 3 (4.5%) Ewing sarcoma, 1 (2.8%) high-grade chondrosarcoma, 4 (10.8%) dedifferentiated chondrosarcomas, and 2 (6.9%) high-grade spindle cell sarcomas. A false positive MRI diagnosis of skip metastasis was made in 4 cases, 3 enchondromata and one focal nodular marrow hyperplasia. CONCLUSION The current study has documented the incidence of skip metastases in common types of high-grade primary bone sarcoma. The possibility of false positive skip metastases has also been highlighted.
Collapse
Affiliation(s)
- Asif Saifuddin
- Department of Imaging, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Ban Sharif
- Department of Imaging, Northwick Park Hospital, Harrow, UK.
| | - Ines Oliveira
- Department of Imaging, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Sarah Kalus
- Department of Imaging, Royal National Orthopaedic Hospital, Stanmore, UK
| | - James Barnett
- Department of Orthopaedics, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Ian Pressney
- Department of Imaging, Royal National Orthopaedic Hospital, Stanmore, UK
| |
Collapse
|
32
|
The Spectrum of Rib Neoplasms in Adults: A Practical Approach and Multimodal Imaging Review. AJR Am J Roentgenol 2020; 215:165-177. [PMID: 32374664 DOI: 10.2214/ajr.19.21554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. Adult neoplasms of the ribs are a heterogeneous group consisting of both benign and aggressive entities. Rib neoplasms have a variety of overlapping imaging features, with much of the imaging data disjointed across the musculoskeletal, thoracic, and oncologic imaging literature. Arrival at accurate diagnosis can therefore be quite challenging. This article consolidates this information and introduces the reader to an algorithmic approach to rib lesion evaluation based on imaging. CONCLUSION. Rib neoplasms are a diverse group of benign and malignant entities, which often makes determining an accurate diagnosis challenging. Evaluation requires a multipronged approach that incorporates radiographic imaging features, nonradiographic imaging findings, lesion location, and clinical data.
Collapse
|
33
|
Muehe AM, Siedek F, Theruvath AJ, Seekins J, Spunt SL, Pribnow A, Hazard FK, Liang T, Daldrup-Link H. Differentiation of benign and malignant lymph nodes in pediatric patients on ferumoxytol-enhanced PET/MRI. Am J Cancer Res 2020; 10:3612-3621. [PMID: 32206111 PMCID: PMC7069081 DOI: 10.7150/thno.40606] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/30/2020] [Indexed: 12/24/2022] Open
Abstract
The composition of lymph nodes in pediatric patients is different from that in adults. Most notably, normal lymph nodes in children contain less macrophages. Therefore, previously described biodistributions of iron oxide nanoparticles in benign and malignant lymph nodes of adult patients may not apply to children. The purpose of our study was to evaluate if the iron supplement ferumoxytol improves the differentiation of benign and malignant lymph nodes in pediatric cancer patients on 18F-FDG PET/MRI. Methods: We conducted a prospective clinical trial from May 2015 to December 2018 to investigate the value of ferumoxytol nanoparticles for staging of children with cancer with 18F-FDG PET/MRI. Ferumoxytol is an FDA-approved iron supplement for the treatment of anemia and has been used "off-label" as an MRI contrast agent in this study. Forty-two children (7-18 years, 29 male, 13 female) received a 18F-FDG PET/MRI at 2 (n=20) or 24 hours (h) (n=22) after intravenous injection of ferumoxytol (dose 5 mg Fe/kg). The morphology of benign and malignant lymph nodes on ferumoxytol-enhanced T2-FSE sequences at 2 and 24 h were compared using a linear regression analysis. In addition, ADCmean-values, SUV-ratio (SUVmax lesion/SUVmean liver) and R2*-relaxation rate of benign and malignant lymph nodes were compared with a Mann-Whitney-U test. The accuracy of different criteria was assessed with a receiver operating characteristics (ROC) curve. Follow-up imaging for at least 6 months served as the standard of reference. Results: We examined a total of 613 lymph nodes, of which 464 (75.7%) were benign and 149 (24.3%) were malignant. On ferumoxytol-enhanced T2-FSE images, benign lymph nodes showed a hypointense hilum and hyperintense parenchyma, while malignant lymph nodes showed no discernible hilum. This pattern was not significantly different at 2 h and 24 h postcontrast (p=0.82). Benign and malignant lymph nodes showed significantly different ferumoxytol enhancement patterns, ADCmean values of 1578 and 852 x10-6 mm2/s, mean SUV-ratios of 0.5 and 2.8, and mean R2*-relaxation rate of 127.8 and 84.4 Hertz (Hz), respectively (all p<0.001). The accuracy of ADCmean, SUV-ratio and pattern (area under the curve (AUC): 0.99; 0.98; 0.97, respectively) was not significantly different (p=0.07). Compared to these three parameters, the accuracy of R2* was significantly lower (AUC: 0.93; p=0.001). Conclusion: Lymph nodes in children show different ferumoxytol-enhancement patterns on MRI than previously reported for adult patients. We found high accuracy (>90%) of ADCmean, SUV-ratio, pattern, and R2* measurements for the characterization of benign and malignant lymph nodes in children. Ferumoxytol nanoparticle accumulation at the hilum can be used to diagnose a benign lymph node. In the future, the delivery of clinically applicable nanoparticles to the hilum of benign lymph nodes could be harnessed to deliver theranostic drugs for immune cell priming.
Collapse
|
34
|
Abstract
Pediatric musculoskeletal tumors can arise in both bone and soft tissues. The overwhelming majority of these are benign; however, rarely, malignant neoplasms do occur. These are collectively termed sarcomas, indicating their mesenchymal origin. Sarcoma management requires careful adherence to the well-described tenets of tumor management. This article summarizes the basic principles and recent advances in the management of soft tissue and bone tumors.
Collapse
Affiliation(s)
- Amit Singla
- Department of Orthopaedic Surgery, Montefiore Medical Center, 3400 Bainbridge Avenue, 6th Floor, Bronx, NY 10467, USA.
| | - David S Geller
- Department of Orthopaedic Surgery, Montefiore Medical Center, 3400 Bainbridge Avenue, 6th Floor, Bronx, NY 10467, USA
| |
Collapse
|
35
|
Functional and anatomical imaging in pediatric oncology: which is best for which tumors. Pediatr Radiol 2019; 49:1534-1544. [PMID: 31620853 DOI: 10.1007/s00247-019-04489-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/19/2019] [Accepted: 07/29/2019] [Indexed: 02/07/2023]
Abstract
Functional imaging techniques are playing an increasingly important role in the management of pediatric cancer. Technological advances have pushed the development of hybrid imaging techniques, including positron emission tomography (PET)/CT, PET/MR and single-photon emission computed tomography (SPECT)/CT. Together with an increasing need to identify surrogate biomarkers for response to novel therapies, the use of functional imaging techniques, which had been reserved primarily for lymphoma patients, is now being recognized as standard of care for the management of many other pediatric solid tumors. The purpose of this review is to summarize recent data describing the use of functional and metabolic imaging strategies for the staging and response assessment of common pediatric solid tumors, and to offer some guidance as to which techniques are most appropriate for which tumor types.
Collapse
|
36
|
Stitzlein RN, Wojcik J, Sebro RA, Balamuth NJ, Weber KL. Team Approach: Osteosarcoma of the Distal Part of the Femur in Adolescents. JBJS Rev 2019; 5:e5. [PMID: 29278618 DOI: 10.2106/jbjs.rvw.17.00030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Russell N Stitzlein
- Departments of Orthopaedic Surgery (R.N.S. and K.L.W.), Pathology and Laboratory Medicine (J.W.), Radiology (R.A.S.), and Pediatrics (N.J.B.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - John Wojcik
- Departments of Orthopaedic Surgery (R.N.S. and K.L.W.), Pathology and Laboratory Medicine (J.W.), Radiology (R.A.S.), and Pediatrics (N.J.B.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Ronnie A Sebro
- Departments of Orthopaedic Surgery (R.N.S. and K.L.W.), Pathology and Laboratory Medicine (J.W.), Radiology (R.A.S.), and Pediatrics (N.J.B.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Naomi J Balamuth
- Departments of Orthopaedic Surgery (R.N.S. and K.L.W.), Pathology and Laboratory Medicine (J.W.), Radiology (R.A.S.), and Pediatrics (N.J.B.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.,Divisions of Oncology (N.J.B.) and Orthopaedics (K.L.W.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kristy L Weber
- Departments of Orthopaedic Surgery (R.N.S. and K.L.W.), Pathology and Laboratory Medicine (J.W.), Radiology (R.A.S.), and Pediatrics (N.J.B.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.,Divisions of Oncology (N.J.B.) and Orthopaedics (K.L.W.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| |
Collapse
|
37
|
Liu F, Zhang Q, Zhou D, Dong J. Effectiveness of 18F-FDG PET/CT in the diagnosis and staging of osteosarcoma: a meta-analysis of 26 studies. BMC Cancer 2019; 19:323. [PMID: 30953476 PMCID: PMC6451259 DOI: 10.1186/s12885-019-5488-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 03/19/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Multiple trials have attempted to assess the diagnostic value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in osteosarcoma with results remaining inconclusive. This study aims to investigate the effectiveness of 18F-FDG PET and PET/CT in the diagnosis, staging, recurrence and metastasis formation observations of osteosarcoma through systematic review followed by meta-analysis. METHODS Three electronic databases, Medline/PubMed, Embase and the Cochrane Library were utilized in this study. Eligible studies that assessed the performance of 18F-FDG PET/CT for the diagnosis, staging, restaging and recurrence monitoring of osteosarcoma were retrieved utilizing specific search criteria. After screening and diluting out the non-conforming articles, all relevant articles and their data were identified and extracted to calculate the summary metrics involving sensitivity, specificity, diagnostic odd ratio (DOR), and area under the curve (AUC) to determine the effectiveness of 18F-FDG PET in diagnosing osteosarcoma clinically. RESULTS Out of 1976 articles searched, twenty-six studies were identified that were viable. All data from these articles, utilized in the quantitative analyses, showed after meta-analysis that when utilizing 18F-FDG PET or PET/CT it was better with a success rate of 90-100% for detecting primary lesions and distant metastases of patients with osteosarcoma. Similar results were also obtained for detecting lung and bone metastases in a subgroup analysis. CONCLUSIONS As such the investigation demonstrated that 18F-FDG PET and PET/CT are very accurate for the diagnosis, staging and recurrence monitoring of osteosarcoma. 18F-FDG-avid lesions should be further examined in osteosarcoma, especially for suspicious lung lesions.
Collapse
Affiliation(s)
- Fanxiao Liu
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong University, No.324, Road Jing Wu Wei Qi, Jinan, 250021 Shandong China
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistrasse 23, 81377 Munich, Germany
| | - Qingyu Zhang
- Department of Orthopeadics, Qilu Hospital, Shandong University, Jinan, Shandong China
| | - Dongsheng Zhou
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong University, No.324, Road Jing Wu Wei Qi, Jinan, 250021 Shandong China
| | - Jinlei Dong
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong University, No.324, Road Jing Wu Wei Qi, Jinan, 250021 Shandong China
| |
Collapse
|
38
|
Saifuddin A, Sharif B, Gerrand C, Whelan J. The current status of MRI in the pre-operative assessment of intramedullary conventional appendicular osteosarcoma. Skeletal Radiol 2019; 48:503-516. [PMID: 30288560 DOI: 10.1007/s00256-018-3079-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/08/2018] [Accepted: 09/16/2018] [Indexed: 02/08/2023]
Abstract
Osteosarcoma is the commonest primary malignant bone tumour in children and adolescents, the majority of cases being conventional intra-medullary high-grade tumours affecting the appendicular skeleton. Treatment is typically with a combination of neo-adjuvant chemotherapy, tumour resection with limb reconstruction and post-operative chemotherapy. The current article reviews the role of magnetic resonance imaging (MRI) in the pre-operative assessment of high-grade central conventional osteosarcoma.
Collapse
Affiliation(s)
- Asif Saifuddin
- Department of Imaging, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Ban Sharif
- Department of Imaging, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK.
| | - Craig Gerrand
- Department of Orthopaedic Oncology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Jeremy Whelan
- Medical Oncology, University College London Hospital, 235 Euston Rd, London, NW1 2BU, UK
| |
Collapse
|
39
|
Chambers G, Frood R, Patel C, Scarsbrook A. 18F-FDG PET-CT in paediatric oncology: established and emerging applications. Br J Radiol 2019; 92:20180584. [PMID: 30383441 PMCID: PMC6404840 DOI: 10.1259/bjr.20180584] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/01/2018] [Accepted: 10/27/2018] [Indexed: 12/11/2022] Open
Abstract
Accurate staging and response assessment is vital in the management of childhood malignancies. Fluorine-18 fluorodeoxyglucose positron emission tomography/CT (FDG PET-CT) provides complimentary anatomical and functional information. Oncological applications of FDG PET-CT are not as well-established within the paediatric population compared to adults. This article will comprehensively review established oncological PET-CT applications in paediatric oncology and provide an overview of emerging and future developments in this domain.
Collapse
Affiliation(s)
- Greg Chambers
- Department of Nuclear Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Russell Frood
- Department of Nuclear Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Chirag Patel
- Department of Nuclear Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | |
Collapse
|
40
|
Im HJ, Solaiyappan M, Lee I, Bradshaw T, Daw NC, Navid F, Shulkin BL, Cho SY. Multi-level otsu method to define metabolic tumor volume in positron emission tomography. AMERICAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING 2018; 8:373-386. [PMID: 30697457 PMCID: PMC6334209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 12/04/2018] [Indexed: 06/09/2023]
Abstract
This study was to validate reliability and clinical utility of a PET tumor segmentation method using multi-level Otsu (MO-PET) in standard National Electrical Manufacturers Association (NEMA) image quality (IQ) phantom and patients with osteosarcoma. The NEMA IQ phantom was prepared with a lesion-to-background ratio (LBR) of either 8:1, 4:1, or 1.5:1. The artificial lesions in the phantom were segmented using MO-PET, gradient-based method (PETedge), relative threshold methods, and background threshold methods. Metabolic tumor volumes (MTVs) using MO-PET and PETedge were named as MTV (MO-PET) and MTV (PETedge), respectively. Among the MTVs using multiple methods, only MTV (MO-PET) and MTV (PETedge) showed excellent agreements with the actual volume of NEMA IQ phantom across the different LBRs (intraclass correlation coefficient, ICC = 0.987, 0.985 in LBR 8:1, 0.981, 0.993 in LBR 4:1 and 0.947, 0.994 in LBR 1.5:1). Repeated measurements of MTV (MO-PET) of the primary tumors showed excellent reproducibility with ICC of 0.994 (0.989-0.997) in patients with osteosarcoma. Also, MTV (MO-PET) was found to be predictive of Event Free Survival (EFS) [Hazard ratio (95% CI) = 6.1 (2.1-17.2), log rank P = 0.0003] in patients with osteosarcoma. We have validated in NEMA IQ phantom that the MTV (MO-PET) is accurate, and importantly, stable and consistent across a range of lesion sizes and LBRs representative of clinical tumor lesions. Furthermore, MTV (MO-PET) showed excellent reproducibility and was predictive for EFS in patients with osteosarcoma.
Collapse
Affiliation(s)
- Hyung-Jun Im
- Radiology, University of WisconsinMadison, WI, USA
- Graduate School of Convergence Science and Technology, Seoul National UniversitySeoul, Republic of Korea
| | | | - Inki Lee
- Radiology, University of WisconsinMadison, WI, USA
- Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institutes of Radiological and Medical SciencesSeoul, Republic of Korea
| | - Tyler Bradshaw
- Medical Physics, University of WisconsinMadison, WI, USA
| | - Najat C Daw
- Division of Pediatrics, MD Anderson Cancer CenterHouston, TX, USA
| | - Fariba Navid
- Department of Pediatrics, Children’s Hospital Los AngelesLos Angeles, CA, USA
- Keck School of Medicine, University of Southern CaliforniaLos Angeles, CA, USA
| | - Barry L Shulkin
- Department of Diagnostic Imaging, St. Jude Children’s Research HospitalMemphis, TN, USA
| | - Steve Y Cho
- Radiology, University of WisconsinMadison, WI, USA
- University of Wisconsin Carbone Cancer CenterMadison, WI, USA
| |
Collapse
|
41
|
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.
Collapse
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.
| |
Collapse
|
42
|
Liu H, Wei W, Wang X, Guan X, Chen Q, Pu Z, Xu X, Wei A. miR‑23b‑3p promotes the apoptosis and inhibits the proliferation and invasion of osteosarcoma cells by targeting SIX1. Mol Med Rep 2018; 18:5683-5692. [PMID: 30387818 DOI: 10.3892/mmr.2018.9611] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 09/04/2018] [Indexed: 11/06/2022] Open
Abstract
Osteosarcoma (OS) is the most common primary malignant bone tumor and the third most common cancer that occurs during childhood and adolescence. Increasing evidence has suggested that microRNA (miR)‑23b‑3p has an important role in OS tumorigenesis; however, the underlying molecular mechanisms remain unknown. The aim of the present study was to investigate the expression levels of miR‑23b‑3p and sine oculis homeobox homolog 1 (SIX1) in OS tissues and cell lines (MG‑63, SaOS‑2 and U2OS), as well as to observe the effects of miR‑23b‑3p on U2OS cell viability, cell cycle, apoptosis and invasive ability. The results revealed that the expression levels of miR‑23b‑3p were significantly decreased in OS tissues and cell lines compared with tumor‑adjacent normal tissues and a non‑cancerous human fetal osteoblastic cell line (hFOB1.19). To investigate the underlying mechanisms of miR‑23b‑3p in OS tumorigenesis and progression, human U2OS cell lines over‑ or under expressing miR‑23b‑3p were established. The effects of miR‑23b‑3p on U2OS cell viability, cell cycle, apoptosis and invasion properties were determined by performing Cell Counting Kit‑8, flow cytometry and Transwell invasion assays. miR‑23b‑3p was revealed to suppress cell viability, proliferation and invasion, and to enhance the levels of cell apoptosis. Furthermore, SIX1 mRNA and protein expression levels in OS tissues and cell lines were significantly upregulated when compared with tumor‑adjacent normal tissues and hFOB 1.19 cells, which suggested that SIX1 expression levels may be inversely associated with miR‑23b‑3p levels in OS. Luciferase reporter system analysis demonstrated that miR‑23b‑3p binds to the SIX1 3'‑untranslated region. miR‑23b‑3p downregulation contributed to SIX1 upregulation, which facilitated the potentiation of cyclin D1 and vascular endothelial growth factor‑C expression levels, as well as the inhibition of caspase‑3 expression. Collectively, these results suggested that miR‑23b‑3p is downregulated and SIX1 is upregulated in OS cells, and that miR‑23b‑3p inhibition may suppress the proliferation and invasion of OS cells, and contribute to cell apoptosis via negative regulation of SIX1. miR‑23b‑3p/SIX1 may therefore represent a potential target for the treatment of OS.
Collapse
Affiliation(s)
- Hua Liu
- Department of Orthopedics, Haian Hospital of Traditional Chinese Medicine, Haian, Jiangsu 226600, P.R. China
| | - Wei Wei
- Department of Orthopedics, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing, Jiangsu 210001, P.R. China
| | - Xiaojian Wang
- Department of Orthopedics, Haian Hospital of Traditional Chinese Medicine, Haian, Jiangsu 226600, P.R. China
| | - Xiaojun Guan
- Department of Orthopedics, Haian Hospital of Traditional Chinese Medicine, Haian, Jiangsu 226600, P.R. China
| | - Qingqing Chen
- Department of Orthopedics, Haian Hospital of Traditional Chinese Medicine, Haian, Jiangsu 226600, P.R. China
| | - Zhongjin Pu
- Department of Tumor, Haian Hospital of Traditional Chinese Medicine, Haian, Jiangsu 226600, P.R. China
| | - Xudong Xu
- Department of Orthopedics, Haian Hospital of Traditional Chinese Medicine, Haian, Jiangsu 226600, P.R. China
| | - Aichun Wei
- Department of Orthopedics, Haian Hospital of Traditional Chinese Medicine, Haian, Jiangsu 226600, P.R. China
| |
Collapse
|
43
|
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.
Collapse
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
| |
Collapse
|
44
|
Gallicchio R, Nardelli A, Pedicini P, Guglielmi G, Storto G. PET/CT and Bone Scintigraphy: Metabolic Results in Musculoskeletal Lesions. CURRENT RADIOLOGY REPORTS 2018. [DOI: 10.1007/s40134-018-0290-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
45
|
Lee I, Byun BH, Lim I, Kim BI, Kong CB, Song WS, Cho WH, Koh JS, Lim SM. Comparison of 99mTc-methyl diphosphonate bone scintigraphy and 18F-fluorodeoxyglucose positron emission tomography/computed tomography to predict histologic response to neoadjuvant chemotherapy in patients with osteosarcoma. Medicine (Baltimore) 2018; 97:e12318. [PMID: 30212975 PMCID: PMC6155965 DOI: 10.1097/md.0000000000012318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
We compared the usefulness of Tc-methyl diphosphonate (Tc-MDP) bone scintigraphy and F-fluorodeoxyglucose (FDG) for positron emission tomography/computed tomography (PET/CT) in predicting histologic response in patients with osteosarcoma receiving neoadjuvant chemotherapy (NAC).We retrospectively reviewed 62 patients with high-grade osteosarcoma who had received 2 cycles of NAC and surgery. All patients underwent Tc-MDP bone scintigraphy and F-FDG PET/CT before and after NAC. Tc-MDP uptake in the primary tumor was measured quantitatively as the maximum tumor-to-nontumor ratio (T/NTmax) and F-FDG uptake was measured as the maximum standardized uptake value (SUVmax), before and after NAC. The percent changes of T/NTmax (percent changes of the maximum tumor-to-nontumor ratio [Δ%T/NTmax]) and SUVmax (percent changes of the maximum standardized uptake value [Δ%SUVmax]) after NAC were calculated and the correlations between these parameters were evaluated. After surgery, the effects of NAC were graded histopathologically (good vs poor) and the optimum cut-off values of Δ%T/NTmax and Δ%SUVmax for predicting histologic response were assessed using the receiver operating characteristic (ROC) curve analysis.Δ%T/NTmax and Δ%SUVmax were positively correlated with each other (r = 0.494, P < .01). Based on the ROC curve analysis, both Δ%T/NTmax (area under the curve [AUC] = .772, P < .01) and Δ%SUVmax (AUC = .829, P < .01) predicted good histologic response. However, there was no significant difference between the AUCs of Δ%T/NTmax and Δ%SUVmax (P = .44). The sensitivity and specificity for predicting good histologic response were 83.3% and 75.0%, for the criterion Δ%T/NTmax <-12.5%, and 80.0% and 81.3% for the criterion Δ%SUVmax <-49.0%, respectively.The Tc-MDP bone scan and F-FDG PET scan are non-inferior to each other in predicting the histologic response of osteosarcoma treatments. The Tc-MDP bone scan and F-FDG PET scan showed respective advantages with differing features. Therefore, physicians should consider which scan is appropriate for their own institute based on the advantages of each scan and the circumstances of the institute.
Collapse
Affiliation(s)
- Inki Lee
- Department of Nuclear Medicine Department of Orthopedic Surgery Department of Pathology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Ren Y, Zhu F, Liu Z. Inhibitory effect of icariin on osteosarcoma cell proliferation via the Wnt/β-catenin signaling pathway. Oncol Lett 2018; 16:1405-1410. [PMID: 30008817 PMCID: PMC6036372 DOI: 10.3892/ol.2018.8821] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 11/17/2017] [Indexed: 12/25/2022] Open
Abstract
Osteosarcoma, is a kind of malignant tumor derived from malignant interstitial cells. The pathogenesis of osteosarcoma remains unclear and despite use of chemotherapy drugs, resistance to these drugs affects the success of treatment. The present study was conducted to investigate the effects of icariin (ICA) on osteosarcoma cell proliferation and to investigate the role of the Wnt/β-catenin signaling pathway in the inhibition process of ICA on osteosarcoma cell proliferation. Different concentrations of ICA were selected to treat the osteosarcoma cell line 143B for 24 h, and then the onset concentration of ICA when it inhibited the growth of osteosarcoma cancer cell line 143B was detected via an MTT assay. The effect of ICA on the apoptosis of colon cancer cell line 143B under this concentration was detected using a flow cytometer. RNA in osteosarcoma cell line 143B was extracted, followed by reverse transcription. The expression levels of related and apoptotic proteins in the Wnt/β-catenin signaling pathway using ICA were detected by semi-quantitative PCR and western blot analysis, respectively. The expression quantities of vascular endothelial growth factor (VEGF) and MMP-9 were detected by ELISA. MTT assay showed that ICA inhibited the growth of 143B when its concentration was 5 µM (p<0.01). Flow cytometry showed that the number of apoptotic cells after ICA treatment was significantly higher than that in control group (p<0.01). RNA in osteosarcoma cell line 143B was extracted, followed by reverse transcription. Semi-quantitative PCR and western blot analysis revealed that the expression levels of p-GSK3β, β-catenin, c-Myc and cyclin D1 in cells after ICA treatment were significantly downregulated (p<0.01), while the expression level of caspase-3 was significantly increased (p<0.01). ELISA showed that the expression quantities of VEGF and MMP-9 were significantly decreased (p<0.01). Thus, ICA can significantly inhibit osteosarcoma cell proliferation and promote osteosarcoma cell apoptosis, which may be realized by affecting the expression of the Wnt/β-catenin signaling pathway and blocking the expression of related proteins.
Collapse
Affiliation(s)
- Yuxin Ren
- Department of Spinal Surgery, Dezhou People's Hospital, Dezhou, Shandong 253014, P.R. China
| | - Fuqiang Zhu
- Department of Spinal Surgery, Dezhou People's Hospital, Dezhou, Shandong 253014, P.R. China
| | - Zhendong Liu
- Department of Orthopedics, Dezhou People's Hospital, Dezhou, Shandong 253014, P.R. China
| |
Collapse
|
47
|
Maruyama N, Nishihara K, Nakasone T, Saio M, Maruyama T, Tedokon I, Ohira T, Nimura F, Matayoshi A, Karube KN, Yoshimi N, Arasaki A. Triple primary malignancies of surface osteosarcoma of jaw, myelodysplastic syndrome and colorectal cancer as a second primary cancer detected by PET2-[ 18F]-fluoro-2-deoxy-D-glucose positron emission tomography: A case report. Oncol Lett 2018; 15:9901-9907. [PMID: 29928362 PMCID: PMC6004675 DOI: 10.3892/ol.2018.8594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 04/12/2018] [Indexed: 11/06/2022] Open
Abstract
Second primary malignancy (SPM) is a severe issue for cancer survivors, particularly for osteosarcoma (OS) survivors. To date, the associations between subsequent SPM and OS have been well reported. Hematogenic and solid malignancies tend to occur following OS treatment. Reportedly, 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) is mainly used in OS patients for initial cancer staging, to evaluate the response of neoadjuvant chemotherapy, and when recurrence or metastasis is clinically suspected. The present case report describes a 70-year-old man diagnosed with three primary malignancies: jaw OS, myelodysplastic syndrome and colorectal adenocarcinoma. To the best of our knowledge, this combination of malignancies has not been reported previously. Until now, there is no specific protocol of postoperative FDG-PET for OS patients. Few studies have described OS follow-up methods; therefore, there is no consensus on proper follow-up methods. In the present case report, the colorectal early-stage SPM was observed, without any symptoms, by FDG-PET/computed tomography. To avoid overlooking solid SPMs, it is suggested that FDG-PET should be performed in the long-term follow-up of OS patients.
Collapse
Affiliation(s)
- Nobuyuki Maruyama
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan.,Department of Oral and Maxillofacial Surgery, University Hospital of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Kazuhide Nishihara
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan.,Department of Oral and Maxillofacial Surgery, University Hospital of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Toshiyuki Nakasone
- Department of Oral and Maxillofacial Surgery, University Hospital of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Masanao Saio
- Department of Pathology and Oncology, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan.,Department of Pathology, University Hospital of the Ryukyus, Nishihara, Okinawa 903-0215, Japan.,Department of Laboratory Sciences, Gunma University Graduate School of Health Sciences, Gunma 371-8514, Japan
| | - Tessho Maruyama
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan.,Department of Oral and Maxillofacial Surgery, University Hospital of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Iori Tedokon
- Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology (Second Department of Internal Medicine), Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Tetsuya Ohira
- Department of Endoscopy, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Fumikazu Nimura
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Akira Matayoshi
- Department of Oral and Maxillofacial Surgery, University Hospital of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Ken-Nosuke Karube
- Department of Pathology and Cell Biology, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Naoki Yoshimi
- Department of Pathology and Oncology, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan.,Department of Pathology, University Hospital of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Akira Arasaki
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan.,Department of Oral and Maxillofacial Surgery, University Hospital of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| |
Collapse
|
48
|
Liu J, Li M, Liu X, Liu F, Zhu J. miR-27a-3p promotes the malignant phenotypes of osteosarcoma by targeting ten-eleven translocation 1. Int J Oncol 2018; 52:1295-1304. [PMID: 29484426 DOI: 10.3892/ijo.2018.4275] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 02/09/2018] [Indexed: 11/06/2022] Open
Abstract
Osteosarcoma has become one of the most common primary malignant tumors affecting children and adolescents. Although increasing evidence has indicated that microRNAs (miRNAs or miRs) play important roles in the development of osteosarcoma, the expression of miR‑27a‑3p and its effects on osteosarcoma are not yet fully understood. In the present study, our data demonstrated that the expression of miR‑27a‑3p in osteosarcoma cell lines was significantly higher than that in the normal human osteoblastic cell line, hFOB 1.19 cell (P<0.01). In order to explore the role of miR‑27a‑3p in the development and progression of osteosarcoma, the expression of miR‑27a‑3p was inhibited by transfection of the MG-63 cells with miR‑27a‑3p inhibitor. The results revealed that the cell proliferative ability significantly decreased (P<0.01), the number of apoptotic cells significantly increased (P<0.01) and the number of cells passing through the Transwell membrane was significantly reduced in the group transfected with the miR‑27a‑3p inhibitor (P<0.01). At the same time, the expression of E-cadherin and α-catenin was significantly upregulated (P<0.01), while the expression of vimentin was significantly downregulated in the group transfected with the miR‑27a‑3p inhibitor (P<0.01). Our results also revealed that the mRNA expression of ten-eleven translocation 1 (TET1) in the osteosarcoma cells was significantly downregulated compared with that in the hFOB 1.19 cells (P<0.01). Luciferase reporter system analysis indicated that miR‑27a‑3p recognized the TET1 3'-UTR. The protein expression of TET1 significantly increased in the group transfected with the miR‑27a‑3p inhibitor. The results from CCK-8 assay, flow cytometric assay and Transwell invasion analysis revealed that TET1 knockdown inhibited the biological effects induced by the downregulation of miR‑27a‑3p. Taken together, the findings of this study indicate that miR‑27a‑3p is upregulated, while TET1 is downregulated in human osteosarcoma cells. miR‑27a‑3p inhibition suppresses the proliferation and invasion of osteosarcoma cells, and promotes cell apoptosis via the negative regulation of TET1. miR‑27a‑3p/TET1 may thus be a potential target for the treatment of osteosarcoma.
Collapse
Affiliation(s)
- Jin Liu
- Department of Orthopedics, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Mingpeng Li
- Department of Orthopedics, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Xiancheng Liu
- Department of Orthopedics, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Fan Liu
- Department of Orthopedics, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Jianwei Zhu
- Department of Orthopedics, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| |
Collapse
|
49
|
Im HJ, Zhang Y, Wu H, Wu J, Daw NC, Navid F, Shulkin BL, Cho SY. Prognostic Value of Metabolic and Volumetric Parameters of FDG PET in Pediatric Osteosarcoma: A Hypothesis-generating Study. Radiology 2018; 287:303-312. [PMID: 29357275 DOI: 10.1148/radiol.2017162758] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Purpose To preliminarily assess the potential prognostic value of various fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) parameters before, during, and after neoadjuvant chemotherapy (NCT). Materials and Methods Thirty-four patients with osteosarcoma were enrolled prospectively from 2008 to 2012 and underwent FDG PET/computed tomography (CT) imaging before (baseline scan), during (interim scan) and after NCT (posttherapy scan). The study was approved by the institutional review board and informed consent was received from patients. Maximum and peak standardized uptake value (SUVmax and SUVpeak), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were measured. Predictive value of FDG PET parameters for event-free survival (EFS) and overall survival (OS) were evaluated. Multivariable Cox regression analysis for EFS and OS was performed by using histologic response and initial presence of metastasis as covariates. Results At baseline scan, SUVpeak, MTV, and TLG were predictive of EFS (P = .006-.03) and OS (P = .001-.03) but not associated with histologic response. At interim and posttherapy scan, SUVmax, SUVpeak, MTV, and TLG were associated with histologic response (P = .0002-.04) and predictive of EFS (P = .004-.02) and OS (P = .001-.03). Multivariable Cox regression analysis revealed that the FDG PET parameters either at baseline, interim, or posttherapy were independently predictive of EFS and OS. In particular, baseline MTV was an independent predictor of EFS (hazard ratio, 5.0 [95% confidence interval {CI}: 1.5, 16.8]) and OS (hazard ratio, 29.4 [95% CI: 2.2, 392.2]). Conclusion SUVpeak, MTV, and TLG either at baseline, interim, or posttherapy were predictive of EFS and OS and may be useful prognostic biomarkers for osteosarcoma. © RSNA, 2018 Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Hyung-Jun Im
- From the Department of Radiology, Nuclear Medicine/PET Section, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Madison, WI 53705 (H.J.I., Y.Z., S.Y.C.); Departments of Biostatistics (H.W., J.W.) and Diagnostic Imaging (B.L.S.), St. Jude Children's Research Hospital, Memphis, Tenn; Department of Pediatrics, MD Anderson Cancer Center, Houston, Tex (N.C.D.); Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, Calif (F.N.); Keck School of Medicine, University of Southern California, Los Angeles, Calif (F.N.); and University of Wisconsin Carbone Cancer Center, Madison, Wis (S.Y.C.)
| | - Yi Zhang
- From the Department of Radiology, Nuclear Medicine/PET Section, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Madison, WI 53705 (H.J.I., Y.Z., S.Y.C.); Departments of Biostatistics (H.W., J.W.) and Diagnostic Imaging (B.L.S.), St. Jude Children's Research Hospital, Memphis, Tenn; Department of Pediatrics, MD Anderson Cancer Center, Houston, Tex (N.C.D.); Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, Calif (F.N.); Keck School of Medicine, University of Southern California, Los Angeles, Calif (F.N.); and University of Wisconsin Carbone Cancer Center, Madison, Wis (S.Y.C.)
| | - Huiyun Wu
- From the Department of Radiology, Nuclear Medicine/PET Section, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Madison, WI 53705 (H.J.I., Y.Z., S.Y.C.); Departments of Biostatistics (H.W., J.W.) and Diagnostic Imaging (B.L.S.), St. Jude Children's Research Hospital, Memphis, Tenn; Department of Pediatrics, MD Anderson Cancer Center, Houston, Tex (N.C.D.); Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, Calif (F.N.); Keck School of Medicine, University of Southern California, Los Angeles, Calif (F.N.); and University of Wisconsin Carbone Cancer Center, Madison, Wis (S.Y.C.)
| | - Jianrong Wu
- From the Department of Radiology, Nuclear Medicine/PET Section, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Madison, WI 53705 (H.J.I., Y.Z., S.Y.C.); Departments of Biostatistics (H.W., J.W.) and Diagnostic Imaging (B.L.S.), St. Jude Children's Research Hospital, Memphis, Tenn; Department of Pediatrics, MD Anderson Cancer Center, Houston, Tex (N.C.D.); Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, Calif (F.N.); Keck School of Medicine, University of Southern California, Los Angeles, Calif (F.N.); and University of Wisconsin Carbone Cancer Center, Madison, Wis (S.Y.C.)
| | - Najat C Daw
- From the Department of Radiology, Nuclear Medicine/PET Section, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Madison, WI 53705 (H.J.I., Y.Z., S.Y.C.); Departments of Biostatistics (H.W., J.W.) and Diagnostic Imaging (B.L.S.), St. Jude Children's Research Hospital, Memphis, Tenn; Department of Pediatrics, MD Anderson Cancer Center, Houston, Tex (N.C.D.); Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, Calif (F.N.); Keck School of Medicine, University of Southern California, Los Angeles, Calif (F.N.); and University of Wisconsin Carbone Cancer Center, Madison, Wis (S.Y.C.)
| | - Fariba Navid
- From the Department of Radiology, Nuclear Medicine/PET Section, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Madison, WI 53705 (H.J.I., Y.Z., S.Y.C.); Departments of Biostatistics (H.W., J.W.) and Diagnostic Imaging (B.L.S.), St. Jude Children's Research Hospital, Memphis, Tenn; Department of Pediatrics, MD Anderson Cancer Center, Houston, Tex (N.C.D.); Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, Calif (F.N.); Keck School of Medicine, University of Southern California, Los Angeles, Calif (F.N.); and University of Wisconsin Carbone Cancer Center, Madison, Wis (S.Y.C.)
| | - Barry L Shulkin
- From the Department of Radiology, Nuclear Medicine/PET Section, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Madison, WI 53705 (H.J.I., Y.Z., S.Y.C.); Departments of Biostatistics (H.W., J.W.) and Diagnostic Imaging (B.L.S.), St. Jude Children's Research Hospital, Memphis, Tenn; Department of Pediatrics, MD Anderson Cancer Center, Houston, Tex (N.C.D.); Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, Calif (F.N.); Keck School of Medicine, University of Southern California, Los Angeles, Calif (F.N.); and University of Wisconsin Carbone Cancer Center, Madison, Wis (S.Y.C.)
| | - Steve Y Cho
- From the Department of Radiology, Nuclear Medicine/PET Section, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Madison, WI 53705 (H.J.I., Y.Z., S.Y.C.); Departments of Biostatistics (H.W., J.W.) and Diagnostic Imaging (B.L.S.), St. Jude Children's Research Hospital, Memphis, Tenn; Department of Pediatrics, MD Anderson Cancer Center, Houston, Tex (N.C.D.); Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, Calif (F.N.); Keck School of Medicine, University of Southern California, Los Angeles, Calif (F.N.); and University of Wisconsin Carbone Cancer Center, Madison, Wis (S.Y.C.)
| |
Collapse
|
50
|
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.
Collapse
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
| |
Collapse
|