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Beuriat PA, Flaus A, Portefaix A, Szathmari A, Janier M, Hermier M, Lorthois-Ninou S, Scheiber C, Isal S, Costes N, Merida I, Lancelot S, Vasiljevic A, Leblond P, Faure Conter C, Saunier C, Kassai B, Vinchon M, Di Rocco F, Mottolese C. Preoperative 11 C-Methionine PET-MRI in Pediatric Infratentorial Tumors. Clin Nucl Med 2024; 49:381-386. [PMID: 38498623 DOI: 10.1097/rlu.0000000000005174] [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: 03/20/2024]
Abstract
PURPOSE MRI is the main imaging modality for pediatric brain tumors, but amino acid PET can provide additional information. Simultaneous PET-MRI acquisition allows to fully assess the tumor and lower the radiation exposure. Although symptomatic posterior fossa tumors are typically resected, the patient management is evolving and will benefit from an improved preoperative tumor characterization. We aimed to explore, in children with newly diagnosed posterior fossa tumor, the complementarity of the information provided by amino acid PET and MRI parameters and the correlation to histopathological results. PATIENTS AND METHODS Children with a newly diagnosed posterior fossa tumor prospectively underwent a preoperative 11 C-methionine (MET) PET-MRI. Images were assessed visually and semiquantitatively. Using correlation, minimum apparent diffusion coefficient (ADC min ) and contrast enhancement were compared with MET SUV max . The diameter of the enhancing lesions was compared with metabolic tumoral volume. Lesions were classified according to the 2021 World Health Organization (WHO) classification. RESULTS Ten children were included 4 pilocytic astrocytomas, 2 medulloblastomas, 1 ganglioglioma, 1 central nervous system embryonal tumor, and 1 schwannoma. All lesions showed visually increased MET uptake. A negative moderate correlation was found between ADC min and SUV max values ( r = -0.39). Mean SUV max was 3.8 (range, 3.3-4.2) in WHO grade 4 versus 2.5 (range, 1.7-3.0) in WHO grade 1 lesions. A positive moderate correlation was found between metabolic tumoral volume and diameter values ( r = 0.34). There was no correlation between SUV max and contrast enhancement intensity ( r = -0.15). CONCLUSIONS Preoperative 11 C-MET PET and MRI could provide complementary information to characterize pediatric infratentorial tumors.
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Affiliation(s)
| | | | | | - Alexandru Szathmari
- From the Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon
| | | | - Marc Hermier
- Department of Neuroradiology, Hôpital Neurologique et Neurochirurgical P. Wertheimer, Hospices Civils de Lyon
| | - Sylvie Lorthois-Ninou
- Department of Pediatric Radiology, Hôpital Femme Mère Enfant, Hospices Civils de Lyon
| | | | - Sibel Isal
- Department of Nuclear Medicine, Hospices Civils de Lyon
| | | | | | | | | | - Pierre Leblond
- Institut d'Hématologie et d'Oncologie Pédiatrique (IHOPe), Centre Léon Bérard, Lyon, France
| | - Cécile Faure Conter
- Institut d'Hématologie et d'Oncologie Pédiatrique (IHOPe), Centre Léon Bérard, Lyon, France
| | - Clarisse Saunier
- EPICIME-CIC 1407 de Lyon, Inserm, Département d'Épidémiologie Clinique, Hospices Civils de Lyon
| | | | - Matthieu Vinchon
- From the Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon
| | | | - Carmine Mottolese
- From the Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon
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Akram MSH, Nishikido F, Levin CS, Takyu S, Obata T, Yamaya T. MRI compatibility study of a prototype radiofrequency penetrable oval PET insert at 3 T. Jpn J Radiol 2024; 42:382-390. [PMID: 38110835 DOI: 10.1007/s11604-023-01514-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/10/2023] [Indexed: 12/20/2023]
Abstract
PURPOSE To perform an MRI compatibility study of an RF field-penetrable oval-shaped PET insert that implements an MRI built-in body RF coil both as a transmitter and a receiver. METHODS Twelve electrically floating RF shielded PET detector modules were used to construct the prototype oval PET insert with a major axis of 440 mm, a minor axis of 350 mm, and an axial length of 225 mm. The electric floating of the PET detector modules was accomplished by isolating the cable shield from the detector shield using plastic tape. Studies were conducted on the transmit (B1) RF field, the image signal-to-noise ratio (SNR), and the RF pulse amplitude for a homogeneous cylindrical (diameter: 160 mm and length: 260 mm) phantom (NaCl + NiSO4 solution) in a 3 T clinical MRI system (Verio, Siemens, Erlangen, Germany). RESULTS The B1 maps for the oval insert were similar to the MRI-only field responses. Compared to the MRI-only values, SNR reductions of 51%, 45%, and 59% were seen, respectively, for the spin echo (SE), gradient echo (GE), and echo planar (EPI) images for the case of oval PET insert. Moreover, the required RF pulse amplitudes for the SE, GE, and EPI sequences were, respectively, 1.93, 1.85, and 1.36 times larger. However, a 30% reduction in the average RF reception sensitivity was observed for the oval insert. CONCLUSIONS The prototype floating PET insert was a safety concern for the clinical MRI system, and this compatibility study provided clearance for developing a large body size floating PET insert for the existing MRI system. Because of the RF shield of the insert, relatively large RF powers compared to the MRI-only case were required. Because of this and also due to low RF sensitivity of the body coil, the SNRs reduced largely.
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Affiliation(s)
- Md Shahadat Hossain Akram
- Department of Advanced Nuclear Medicine Sciences, Institute of Quantum Medical Science, National Institutes for Quantum Science and Technology (QST), 4-9-1 Anagawa, Inage, Chiba, 263-8555, Japan.
| | - Fumihiko Nishikido
- Department of Advanced Nuclear Medicine Sciences, Institute of Quantum Medical Science, National Institutes for Quantum Science and Technology (QST), 4-9-1 Anagawa, Inage, Chiba, 263-8555, Japan
| | - Craig S Levin
- Department of Radiology, School of Medicine, Stanford University, Stanford, CA, 94305-5128, USA
| | - Sodai Takyu
- Department of Advanced Nuclear Medicine Sciences, Institute of Quantum Medical Science, National Institutes for Quantum Science and Technology (QST), 4-9-1 Anagawa, Inage, Chiba, 263-8555, Japan
| | - Takayuki Obata
- Department of Applied MRI Research, Institute of Quantum Medical Science, National Institutes for Quantum Science and Technology (QST), 4-9-1 Anagawa, Inage, Chiba, 263-8555, Japan
| | - Taiga Yamaya
- Department of Advanced Nuclear Medicine Sciences, Institute of Quantum Medical Science, National Institutes for Quantum Science and Technology (QST), 4-9-1 Anagawa, Inage, Chiba, 263-8555, Japan
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3
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Kurch L, Kluge R. Update on FDG-PET in pediatric lymphoma. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2024; 68:58-69. [PMID: 38587361 DOI: 10.23736/s1824-4785.24.03560-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Lymphoma represent the third most common malignant disease in childhood and adolescence. They are divided into pediatric Hodgkin lymphoma (P-HL) and pediatric non-Hodgkin lymphoma (P-NHL). In P-HL, excellent cure rates are achieved through combined modality treatment using chemotherapy and radiotherapy. For more than 20 years, FDG-PET has been an integral part of the treatment and guides its intensity through improved staging and precise assessment of chemotherapy response. In P-NHL, good cure rates are achieved with chemotherapy alone. At present FDG-PET plays only a subordinate role in the treatment setting. Its potential to contribute to treatment management is far from being fully utilised. In this article, the current status of FDG-PET in pediatric lymphoma is presented in detail. The core elements are the sections on staging and response assessment. In addition, challenges and pitfalls are discussed and future developments are outlined.
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Affiliation(s)
- Lars Kurch
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany -
| | - Regine Kluge
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany
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4
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Morakote W, Baratto L, Ramasamy SK, Adams LC, Liang T, Sarrami AH, Daldrup-Link HE. Comparison of diffusion-weighted MRI and [ 18F]FDG PET/MRI for treatment monitoring in pediatric Hodgkin and non-Hodgkin lymphoma. Eur Radiol 2024; 34:643-653. [PMID: 37542653 PMCID: PMC10993778 DOI: 10.1007/s00330-023-10015-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/16/2023] [Accepted: 07/16/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE To compare tumor therapy response assessments with whole-body diffusion-weighted imaging (WB-DWI) and 18F-fluorodeoxyglucose ([18F]FDG) PET/MRI in pediatric patients with Hodgkin lymphoma and non-Hodgkin lymphoma. MATERIALS AND METHODS In a retrospective, non-randomized single-center study, we reviewed serial simultaneous WB-DWI and [18F]FDG PET/MRI scans of 45 children and young adults (27 males; mean age, 13 years ± 5 [standard deviation]; age range, 1-21 years) with Hodgkin lymphoma (n = 20) and non-Hodgkin lymphoma (n = 25) between February 2018 and October 2022. We measured minimum tumor apparent diffusion coefficient (ADCmin) and maximum standardized uptake value (SUVmax) of up to six target lesions and assessed therapy response according to Lugano criteria and modified criteria for WB-DWI. We evaluated the agreement between WB-DWI- and [18F]FDG PET/MRI-based response classifications with Gwet's agreement coefficient (AC). RESULTS After induction chemotherapy, 95% (19 of 20) of patients with Hodgkin lymphoma and 72% (18 of 25) of patients with non-Hodgkin lymphoma showed concordant response in tumor metabolism and proton diffusion. We found a high agreement between treatment response assessments on WB-DWI and [18F]FDG PET/MRI (Gwet's AC = 0.94; 95% confidence interval [CI]: 0.82, 1.00) in patients with Hodgkin lymphoma, and a lower agreement for patients with non-Hodgkin lymphoma (Gwet's AC = 0.66; 95% CI: 0.43, 0.90). After completion of therapy, there was an excellent agreement between WB-DWI and [18F]FDG PET/MRI response assessments (Gwet's AC = 0.97; 95% CI: 0.91, 1). CONCLUSION Therapy response of Hodgkin lymphoma can be evaluated with either [18F]FDG PET or WB-DWI, whereas patients with non-Hodgkin lymphoma may benefit from a combined approach. CLINICAL RELEVANCE STATEMENT Hodgkin lymphoma and non-Hodgkin lymphoma exhibit different patterns of tumor response to induction chemotherapy on diffusion-weighted MRI and PET/MRI. KEY POINTS • Diffusion-weighted imaging has been proposed as an alternative imaging to assess tumor response without ionizing radiation. • After induction therapy, whole-body diffusion-weighted imaging and PET/MRI revealed a higher agreement in patients with Hodgkin lymphoma than in those with non-Hodgkin lymphoma. • At the end of therapy, whole-body diffusion-weighted imaging and PET/MRI revealed an excellent agreement for overall tumor therapy responses for all lymphoma types.
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Affiliation(s)
- Wipawee Morakote
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, 725 Welch Rd, Palo Alto, CA, 94304, USA
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Lucia Baratto
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, 725 Welch Rd, Palo Alto, CA, 94304, USA
| | - Shakthi K Ramasamy
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, 725 Welch Rd, Palo Alto, CA, 94304, USA
| | - Lisa C Adams
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, 725 Welch Rd, Palo Alto, CA, 94304, USA
| | - Tie Liang
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, 725 Welch Rd, Palo Alto, CA, 94304, USA
| | - Amir H Sarrami
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, 725 Welch Rd, Palo Alto, CA, 94304, USA
| | - Heike E Daldrup-Link
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, 725 Welch Rd, Palo Alto, CA, 94304, USA.
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5
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Giraudo C, Carraro S, Zucchetta P, Cecchin D. Pediatric Imaging Using PET/MR Imaging. Magn Reson Imaging Clin N Am 2023; 31:625-636. [PMID: 37741646 DOI: 10.1016/j.mric.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Abstract
PET/MR imaging is a one-stop shop technique for pediatric diseases allowing not only an accurate clinical assessment of tumors at staging and restaging but also the diagnosis of neurologic, inflammatory, and infectious diseases in complex cases. Moreover, applying PET kinetic analyses and sequences such as diffusion-weighted imaging as well as quantitative analysis investigating the relationship between disease metabolic activity and cellularity can be applied. Complex radiomics analysis can also be performed.
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Affiliation(s)
- Chiara Giraudo
- Complex Unit of Nuclear Medicine, Department of Medicine (DIMED), University Hospital of Padova, Via Nicolo' Giustiniani 2, 35128, Padova, Italy
| | - Silvia Carraro
- Unit of Pediatric Allergy and Respiratory Medicine, Women's and Children's Health Department, University Hospital of Padova, Via Nicolo' Giustiniani 2, 35128, Padova, Italy
| | - Pietro Zucchetta
- Complex Unit of Nuclear Medicine, Department of Medicine (DIMED), University Hospital of Padova, Via Nicolo' Giustiniani 2, 35128, Padova, Italy
| | - Diego Cecchin
- Complex Unit of Nuclear Medicine, Department of Medicine (DIMED), University Hospital of Padova, Via Nicolo' Giustiniani 2, 35128, Padova, Italy.
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Jha A, Civelek AC. Editorial: Global excellence in nuclear medicine: North America. Front Med (Lausanne) 2023; 10:1300179. [PMID: 37954553 PMCID: PMC10635407 DOI: 10.3389/fmed.2023.1300179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 09/28/2023] [Indexed: 11/14/2023] Open
Affiliation(s)
- Abhishek Jha
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Ali Cahid Civelek
- Nuclear Medicine, Radiology, and Radiological Science, Johns Hopkins Medicine, Baltimore, MD, United States
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7
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Veit-Haibach P, Ahlström H, Boellaard R, Delgado Bolton RC, Hesse S, Hope T, Huellner MW, Iagaru A, Johnson GB, Kjaer A, Law I, Metser U, Quick HH, Sattler B, Umutlu L, Zaharchuk G, Herrmann K. International EANM-SNMMI-ISMRM consensus recommendation for PET/MRI in oncology. Eur J Nucl Med Mol Imaging 2023; 50:3513-3537. [PMID: 37624384 PMCID: PMC10547645 DOI: 10.1007/s00259-023-06406-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023]
Abstract
PREAMBLE 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 non-profit medical association that facilitates communication worldwide between individuals pursuing clinical and research excellence in nuclear medicine. The EANM was founded in 1985. The merged International Society for Magnetic Resonance in Medicine (ISMRM) is an international, nonprofit, scientific association whose purpose is to promote communication, research, development, and applications in the field of magnetic resonance in medicine and biology and other related topics and to develop and provide channels and facilities for continuing education in the field.The ISMRM was founded in 1994 through the merger of the Society of Magnetic Resonance in Medicine and the Society of Magnetic Resonance Imaging. SNMMI, ISMRM, and EANM members are physicians, technologists, and scientists specializing in the research and practice of nuclear medicine and/or magnetic resonance imaging. The SNMMI, ISMRM, and EANM will periodically define new guidelines for nuclear medicine practice to help advance the science of nuclear medicine and/or magnetic resonance imaging and to improve the quality of service to patients throughout the world. Existing practice guidelines will be reviewed for revision or renewal, as appropriate, on their fifth anniversary or sooner, if indicated. Each practice guideline, representing a policy statement by the SNMMI/EANM/ISMRM, has undergone a thorough consensus process in which it has been subjected to extensive review. The SNMMI, ISMRM, and EANM recognize that the safe and effective use of diagnostic nuclear medicine imaging and magnetic resonance imaging requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guideline by those entities not providing these services is not authorized. These guidelines are an educational tool designed to assist practitioners in providing appropriate care for patients. They are not inflexible rules or requirements of practice and 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, the ISMRM, and the EANM caution against the use of these 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 the physician or medical physicist in light of all the circumstances presented. Thus, there is no implication that an approach differing from the guidelines, standing alone, is below the standard of care. To the contrary, a conscientious practitioner may responsibly adopt a course of action different from that set forth in the 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 guidelines. The practice of medicine includes both the art and the science of the prevention, diagnosis, alleviation, and treatment of disease. The variety and complexity of human conditions make it impossible to always reach the most appropriate diagnosis or to predict with certainty a particular response to treatment. Therefore, it should be recognized that adherence to these guidelines will not ensure an accurate diagnosis or a successful outcome. All that should be expected is that the practitioner will follow a reasonable course of action based on current knowledge, available resources, and the needs of the patient to deliver effective and safe medical care. The sole purpose of these guidelines is to assist practitioners in achieving this objective.
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Affiliation(s)
- Patrick Veit-Haibach
- Joint Department Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, Toronto General Hospital, 1 PMB-275, 585 University Avenue, Toronto, Ontario, M5G 2N2, Canada
- Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Håkan Ahlström
- Department of Surgical Sciences, Uppsala University, 751 85, Uppsala, Sweden
- Antaros Medical AB, BioVenture Hub, 431 53, Mölndal, Sweden
| | - Ronald Boellaard
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Roberto C Delgado Bolton
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), Logroño, La Rioja, Spain
| | - Swen Hesse
- Department of Nuclear Medicine, University of Leipzig Medical Center, Leipzig, Germany
| | - Thomas Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Martin W Huellner
- Department of Nuclear Medicine, University Hospital Zürich, University of Zürich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Andrei Iagaru
- Department of Radiology, Division of Nuclear Medicine, Stanford University Medical Center, Stanford, CA, USA
| | - Geoffrey B Johnson
- Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Andreas Kjaer
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Copenhagen, Denmark
| | - Ur Metser
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Harald H Quick
- High-Field and Hybrid MR Imaging, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Erwin L. Hahn Institute for MR Imaging, University of Duisburg-Essen, Essen, Germany
| | - Bernhard Sattler
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Greg Zaharchuk
- Division of Neuroradiology, Department of Radiology, Stanford University, 300 Pasteur Drive, Room S047, Stanford, CA, 94305-5105, USA
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany.
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8
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Georgi TW, Stoevesandt D, Kurch L, Bartelt JM, Hasenclever D, Dittmann H, Ferda J, Francis P, Franzius C, Furth C, Gräfe D, Gussew A, Hüllner M, Menezes LJ, Mustafa M, Stegger L, Umutlu L, Zöphel K, Zucchetta P, Körholz D, Sabri O, Mauz-Körholz C, Kluge R. Optimized Whole-Body PET MRI Sequence Workflow in Pediatric Hodgkin Lymphoma Patients. J Nucl Med 2023; 64:96-101. [PMID: 35835583 PMCID: PMC9841249 DOI: 10.2967/jnumed.122.264112] [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: 03/10/2022] [Revised: 07/07/2022] [Accepted: 07/07/2022] [Indexed: 01/28/2023] Open
Abstract
18F-FDG PET/MRI might be the diagnostic method of choice for Hodgkin lymphoma patients, as it combines significant metabolic information from PET with excellent soft-tissue contrast from MRI and avoids radiation exposure from CT. However, a major issue is longer examination times than for PET/CT, especially for younger children needing anesthesia. Thus, a targeted selection of suitable whole-body MRI sequences is important to optimize the PET/MRI workflow. Methods: The initial PET/MRI scans of 84 EuroNet-PHL-C2 study patients from 13 international PET centers were evaluated. In each available MRI sequence, 5 PET-positive lymph nodes were assessed. If extranodal involvement occurred, 2 splenic lesions, 2 skeletal lesions, and 2 lung lesions were also assessed. A detection rate was calculated dividing the number of visible, anatomically assignable, and measurable lesions in the respective MRI sequence by the total number of lesions. Results: Relaxation time-weighted (T2w) transverse sequences with fat saturation (fs) yielded the best result, with detection rates of 95% for nodal lesions, 62% for splenic lesions, 94% for skeletal lesions, and 83% for lung lesions, followed by T2w transverse sequences without fs (86%, 49%, 16%, and 59%, respectively) and longitudinal relaxation time-weighted contrast-enhanced transverse sequences with fs (74%, 35%, 57%, and 55%, respectively). Conclusion: T2w transverse sequences with fs yielded the highest detection rates and are well suited for accurate whole-body PET/MRI in lymphoma patients. There is no evidence to recommend the use of contrast agents.
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Affiliation(s)
- Thomas W. Georgi
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | | | - Lars Kurch
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Jörg M. Bartelt
- Department of Radiology, University of Halle, Halle/Saale, Germany
| | - Dirk Hasenclever
- Institute for Medical Informatics, Statistics, and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Helmut Dittmann
- Department of Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tuebingen, Tuebingen, Germany
| | - Jiri Ferda
- Department of Imaging, University Hospital Pilsen, Pilsen, Czech Republic
| | - Peter Francis
- Department of Nuclear Medicine, Royal Children’s Hospital, Melbourne, Victoria, Australia
| | - Christiane Franzius
- Center for Modern Diagnostics–MRI and PET/MRI and Center for Nuclear Medicine and PET/CT, Bremen, Germany
| | - Christian Furth
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt–Universität zu Berlin, and Department of Nuclear Medicine, Berlin Institute of Health, Berlin, Germany
| | - Daniel Gräfe
- Paediatric Radiology, Department of Radiology, University of Leipzig, Leipzig, Germany
| | - Alexander Gussew
- Department of Radiology, University of Halle, Halle/Saale, Germany
| | - Martin Hüllner
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Leon J. Menezes
- UCL Institute of Nuclear Medicine, University College London Hospitals, London, United Kingdom
| | - Mona Mustafa
- Department of Nuclear Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Lars Stegger
- Department of Nuclear Medicine, University Hospital Muenster, Muenster, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Klaus Zöphel
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Pietro Zucchetta
- Nuclear Medicine Unit, Department of Medicine, Padova University Hospital, Padova, Italy
| | - Dieter Körholz
- Department of Pediatric Oncology, Justus Liebig University, Giessen, Germany; and
| | - Osama Sabri
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Christine Mauz-Körholz
- Department of Pediatric Oncology, Justus Liebig University, Giessen, Germany; and,Medical Faculty, Martin Luther University of Halle–Wittenberg, Halle/Saale, Germany
| | - Regine Kluge
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
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9
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PET/MR imaging in gynecologic cancer: tips for differentiating normal gynecologic anatomy and benign pathology versus cancer. Abdom Radiol (NY) 2022; 47:3189-3204. [PMID: 34687323 DOI: 10.1007/s00261-021-03264-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 01/18/2023]
Abstract
Positron emission tomography/magnetic resonance imaging (PET/MR) is used in the pre-treatment and surveillance settings to evaluate women with gynecologic malignancies, including uterine, cervical, vaginal and vulvar cancers. PET/MR combines the excellent spatial and contrast resolution of MR imaging for gynecologic tissues, with the functional metabolic information of PET, to aid in a more accurate assessment of local disease extent and distant metastatic disease. In this review, the optimal protocol and utility of whole-body PET/MR imaging in patients with gynecologic malignancies will be discussed, with an emphasis on the advantages of PET/MR over PET/CT and how to differentiate normal or benign gynecologic tissues from cancer in the pelvis.
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10
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Rashidi A, Baratto L, Theruvath AJ, Greene EB, Hawk KE, Lu R, Link MP, Spunt SL, Daldrup-Link HE. Diagnostic Accuracy of 2-[ 18F]FDG-PET and whole-body DW-MRI for the detection of bone marrow metastases in children and young adults. Eur Radiol 2022; 32:4967-4979. [PMID: 35099603 PMCID: PMC9232918 DOI: 10.1007/s00330-021-08529-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To compare the diagnostic accuracy of 2-[18F]fluoro-2-deoxy-D-glucose-enhanced positron emission tomography (2-[18F]FDG-PET) and diffusion-weighted magnetic resonance imaging (DW-MRI) for the detection of bone marrow metastases in children and young adults with solid malignancies. METHODS In this cross-sectional single-center institutional review board-approved study, we investigated twenty-three children and young adults (mean age, 16.8 years ± 5.1 [standard deviation]; age range, 7-25 years; 16 males, 7 females) with 925 bone marrow metastases who underwent 66 simultaneous 2-[18F]FDG-PET and DW-MRI scans including 23 baseline scans and 43 follow-up scans after chemotherapy between May 2015 and July 2020. Four reviewers evaluated all foci of bone marrow metastasis on 2-[18F]FDG-PET and DW-MRI to assess concordance and measured the tumor-to-bone marrow contrast. Results were assessed with a one-sample Wilcoxon test and generalized estimation equation. Bone marrow biopsies and follow-up imaging served as the standard of reference. RESULTS The reviewers detected 884 (884/925, 95.5%) bone marrow metastases on 2-[18F]FDG-PET and 893 (893/925, 96.5%) bone marrow metastases on DW-MRI. We found different "blind spots" for 2-[18F]FDG-PET and MRI: 2-[18F]FDG-PET missed subcentimeter lesions while DW-MRI missed lesions in small bones. Sensitivity and specificity were 91.0% and 100% for 18F-FDG-PET, 89.1% and 100.0% for DW-MRI, and 100.0% and 100.0% for combined modalities, respectively. The diagnostic accuracy of combined 2-[18F]FDG-PET/MRI (100.0%) was significantly higher compared to either 2-[18F]FDG-PET (96.9%, p < 0.001) or DW-MRI (96.3%, p < 0.001). CONCLUSIONS Both 2-[18F]FDG-PET and DW-MRI can miss bone marrow metastases. The combination of both imaging techniques detected significantly more lesions than either technique alone. KEY POINTS • DW-MRI and 2-[18F]FDG-PET have different strengths and limitations for the detection of bone marrow metastases in children and young adults with solid tumors. • Both modalities can miss bone marrow metastases, although the "blind spot" of each modality is different. • A combined PET/MR imaging approach will achieve maximum sensitivity and specificity for the detection of bone marrow metastases in children with solid tumors.
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Affiliation(s)
- Ali Rashidi
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University School of Medicine, Stanford, CA, USA
| | - Lucia Baratto
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University School of Medicine, Stanford, CA, USA
| | - Ashok Joseph Theruvath
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University School of Medicine, Stanford, CA, USA
| | - Elton Benjamin Greene
- Department of Radiology, Pediatric Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA, USA
| | - K Elizabeth Hawk
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University School of Medicine, Stanford, CA, USA
| | - Rong Lu
- Quantitative Sciences Unit, School of Medicine, Stanford University, Stanford, CA, USA
| | - Michael P Link
- Department of Pediatrics, Hematology/Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Sheri L Spunt
- Department of Pediatrics, Hematology/Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Heike E Daldrup-Link
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University School of Medicine, Stanford, CA, USA.
- Department of Pediatrics, Hematology/Oncology, Stanford University School of Medicine, Stanford, CA, USA.
- Department of Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA, 94305-5654, USA.
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11
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Marie E, Navallas M, Katz DS, Farajirad E, Punnett A, Davda S, Shammas A, Oudjhane K, Vali R. Non-Hodgkin Lymphoma Imaging Spectrum in Children, Adolescents, and Young Adults. Radiographics 2022; 42:1214-1238. [PMID: 35714040 DOI: 10.1148/rg.210162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In children, adolescents, and young adults (CAYA), non-Hodgkin lymphoma (NHL) is characterized by various age-related dissimilarities in tumor aggressiveness, prevailing pathologic subtypes, and imaging features, as well as potentially different treatment outcomes. Understanding the imaging spectrum of NHL in CAYA with particular attention to children and adolescents is critical for radiologists to support the clinical decision making by the treating physicians and other health care practitioners. The authors discuss the currently performed imaging modalities including radiography, US, CT, MRI, and PET in the diagnosis, staging, and assessment of the treatment response. Familiarity with diagnostic imaging challenges during image acquisition, processing, and interpretation is required when managing patients with NHL. The authors describe potentially problematic and life-threatening scenarios that require prompt management. Moreover, the authors address the unprecedented urge to understand the imaging patterns of possible treatment-related complications of the therapeutic agents used in NHL clinical trials and in practice. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Eman Marie
- From the Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, Canada L8N 3Z5 (E.M.); Department of Diagnostic Imaging, Hospital Universitario 12 de Octubre, Madrid, Spain (M.N.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); LHSC Victoria Hospital, Western Ontario University, London, ON, Canada (E.F.); Department of Pediatrics, Division of Hematology/Oncology (A.P.), Department of Diagnostic Imaging (K.O), Division of Nuclear Medicine (A.S., R.V.), The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Great Ormond Street Hospital for Children, NHS, London, England (S.D.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (K.O.)
| | - María Navallas
- From the Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, Canada L8N 3Z5 (E.M.); Department of Diagnostic Imaging, Hospital Universitario 12 de Octubre, Madrid, Spain (M.N.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); LHSC Victoria Hospital, Western Ontario University, London, ON, Canada (E.F.); Department of Pediatrics, Division of Hematology/Oncology (A.P.), Department of Diagnostic Imaging (K.O), Division of Nuclear Medicine (A.S., R.V.), The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Great Ormond Street Hospital for Children, NHS, London, England (S.D.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (K.O.)
| | - Douglas S Katz
- From the Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, Canada L8N 3Z5 (E.M.); Department of Diagnostic Imaging, Hospital Universitario 12 de Octubre, Madrid, Spain (M.N.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); LHSC Victoria Hospital, Western Ontario University, London, ON, Canada (E.F.); Department of Pediatrics, Division of Hematology/Oncology (A.P.), Department of Diagnostic Imaging (K.O), Division of Nuclear Medicine (A.S., R.V.), The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Great Ormond Street Hospital for Children, NHS, London, England (S.D.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (K.O.)
| | - Elnaz Farajirad
- From the Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, Canada L8N 3Z5 (E.M.); Department of Diagnostic Imaging, Hospital Universitario 12 de Octubre, Madrid, Spain (M.N.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); LHSC Victoria Hospital, Western Ontario University, London, ON, Canada (E.F.); Department of Pediatrics, Division of Hematology/Oncology (A.P.), Department of Diagnostic Imaging (K.O), Division of Nuclear Medicine (A.S., R.V.), The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Great Ormond Street Hospital for Children, NHS, London, England (S.D.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (K.O.)
| | - Angela Punnett
- From the Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, Canada L8N 3Z5 (E.M.); Department of Diagnostic Imaging, Hospital Universitario 12 de Octubre, Madrid, Spain (M.N.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); LHSC Victoria Hospital, Western Ontario University, London, ON, Canada (E.F.); Department of Pediatrics, Division of Hematology/Oncology (A.P.), Department of Diagnostic Imaging (K.O), Division of Nuclear Medicine (A.S., R.V.), The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Great Ormond Street Hospital for Children, NHS, London, England (S.D.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (K.O.)
| | - Sunit Davda
- From the Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, Canada L8N 3Z5 (E.M.); Department of Diagnostic Imaging, Hospital Universitario 12 de Octubre, Madrid, Spain (M.N.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); LHSC Victoria Hospital, Western Ontario University, London, ON, Canada (E.F.); Department of Pediatrics, Division of Hematology/Oncology (A.P.), Department of Diagnostic Imaging (K.O), Division of Nuclear Medicine (A.S., R.V.), The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Great Ormond Street Hospital for Children, NHS, London, England (S.D.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (K.O.)
| | - Amer Shammas
- From the Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, Canada L8N 3Z5 (E.M.); Department of Diagnostic Imaging, Hospital Universitario 12 de Octubre, Madrid, Spain (M.N.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); LHSC Victoria Hospital, Western Ontario University, London, ON, Canada (E.F.); Department of Pediatrics, Division of Hematology/Oncology (A.P.), Department of Diagnostic Imaging (K.O), Division of Nuclear Medicine (A.S., R.V.), The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Great Ormond Street Hospital for Children, NHS, London, England (S.D.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (K.O.)
| | - Kamaldine Oudjhane
- From the Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, Canada L8N 3Z5 (E.M.); Department of Diagnostic Imaging, Hospital Universitario 12 de Octubre, Madrid, Spain (M.N.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); LHSC Victoria Hospital, Western Ontario University, London, ON, Canada (E.F.); Department of Pediatrics, Division of Hematology/Oncology (A.P.), Department of Diagnostic Imaging (K.O), Division of Nuclear Medicine (A.S., R.V.), The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Great Ormond Street Hospital for Children, NHS, London, England (S.D.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (K.O.)
| | - Reza Vali
- From the Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, Canada L8N 3Z5 (E.M.); Department of Diagnostic Imaging, Hospital Universitario 12 de Octubre, Madrid, Spain (M.N.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); LHSC Victoria Hospital, Western Ontario University, London, ON, Canada (E.F.); Department of Pediatrics, Division of Hematology/Oncology (A.P.), Department of Diagnostic Imaging (K.O), Division of Nuclear Medicine (A.S., R.V.), The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Great Ormond Street Hospital for Children, NHS, London, England (S.D.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (K.O.)
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12
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Pedersen C, Aboian M, McConathy JE, Daldrup-Link H, Franceschi AM. PET/MRI in Pediatric Neuroimaging: Primer for Clinical Practice. AJNR Am J Neuroradiol 2022; 43:938-943. [PMID: 35512826 DOI: 10.3174/ajnr.a7464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/13/2021] [Indexed: 11/07/2022]
Abstract
Modern pediatric imaging seeks to provide not only exceptional anatomic detail but also physiologic and metabolic information of the pathology in question with as little radiation penalty as possible. Hybrid PET/MR imaging combines exquisite soft-tissue information obtained by MR imaging with functional information provided by PET, including metabolic markers, receptor binding, perfusion, and neurotransmitter release data. In pediatric neuro-oncology, PET/MR imaging is, in many ways, ideal for follow-up compared with PET/CT, given the superiority of MR imaging in neuroimaging compared with CT and the lower radiation dose, which is relevant in serial imaging and long-term follow-up of pediatric patients. In addition, although MR imaging is the main imaging technique for the evaluation of spinal pathology, PET/MR imaging may provide useful information in several clinical scenarios, including tumor staging and follow-up, treatment response assessment of spinal malignancies, and vertebral osteomyelitis. This review article covers neuropediatric applications of PET/MR imaging in addition to considerations regarding radiopharmaceuticals, imaging protocols, and current challenges to clinical implementation.
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Affiliation(s)
- C Pedersen
- From the Department of Radiology (C.P., M.A.), Yale School of Medicine, New Haven, Connecticut
| | - M Aboian
- From the Department of Radiology (C.P., M.A.), Yale School of Medicine, New Haven, Connecticut
| | - J E McConathy
- Division of Molecular Imaging and Therapeutics (J.E.M.), Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - H Daldrup-Link
- Department of Radiology and Pediatrics (H.D.-L.), Stanford University School of Medicine, Palo Alto, California
| | - A M Franceschi
- Neuroradiology Division (A.M.F.), Department of Radiology, Northwell Health/Donald and Barbara Zucker School of Medicine, Lenox Hill Hospital, New York, New York
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13
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Daldrup-Link HE, Theruvath AJ, Baratto L, Hawk KE. One-stop local and whole-body staging of children with cancer. Pediatr Radiol 2022; 52:391-400. [PMID: 33929564 PMCID: PMC10874282 DOI: 10.1007/s00247-021-05076-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/04/2021] [Accepted: 03/30/2021] [Indexed: 12/19/2022]
Abstract
Accurate staging and re-staging of cancer in children is crucial for patient management. Currently, children with a newly diagnosed cancer must undergo a series of imaging tests, which are stressful, time-consuming, partially redundant, expensive, and can require repetitive anesthesia. New approaches for pediatric cancer staging can evaluate the primary tumor and metastases in a single session. However, traditional one-stop imaging tests, such as CT and positron emission tomography (PET)/CT, are associated with considerable radiation exposure. This is particularly concerning for children because they are more sensitive to ionizing radiation than adults and they live long enough to experience secondary cancers later in life. In this review article we discuss child-tailored imaging tests for tumor detection and therapy response assessment - tests that can be obtained with substantially reduced radiation exposure compared to traditional CT and PET/CT scans. This includes diffusion-weighted imaging (DWI)/MRI and integrated [F-18]2-fluoro-2-deoxyglucose (18F-FDG) PET/MRI scans. While several investigators have compared the value of DWI/MRI and 18F-FDG PET/MRI for staging pediatric cancer, the value of these novel imaging technologies for cancer therapy monitoring has received surprisingly little attention. In this article, we share our experiences and review existing literature on this subject.
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Affiliation(s)
- Heike E Daldrup-Link
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Lucile Packard Children's Hospital, Stanford University, 725 Welch Road, Room 1665, Stanford, CA, 94305-5614, USA.
- Department of Pediatrics, Stanford University, Stanford, CA, USA.
- Cancer Imaging and Early Detection Program, Stanford Cancer Institute, Stanford, CA, USA.
| | - Ashok J Theruvath
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Lucile Packard Children's Hospital, Stanford University, 725 Welch Road, Room 1665, Stanford, CA, 94305-5614, USA
- Cancer Imaging and Early Detection Program, Stanford Cancer Institute, Stanford, CA, USA
| | - Lucia Baratto
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Lucile Packard Children's Hospital, Stanford University, 725 Welch Road, Room 1665, Stanford, CA, 94305-5614, USA
- Cancer Imaging and Early Detection Program, Stanford Cancer Institute, Stanford, CA, USA
| | - Kristina Elizabeth Hawk
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Lucile Packard Children's Hospital, Stanford University, 725 Welch Road, Room 1665, Stanford, CA, 94305-5614, USA
- Cancer Imaging and Early Detection Program, Stanford Cancer Institute, Stanford, CA, USA
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14
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PET imaging in ovarian cancer. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00130-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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15
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Characterization of Extramedullary Disease in B-ALL and Response to CAR T-cell Therapy. Blood Adv 2021; 6:2167-2182. [PMID: 34920453 PMCID: PMC9006258 DOI: 10.1182/bloodadvances.2021006035] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/16/2021] [Indexed: 11/30/2022] Open
Abstract
A substantial fraction of patients with relapsed/refractory B-ALL will have non-CNS EMD. CAR T cells may have limited efficacy in multifocal non-CNS EMD, and serial imaging is needed to identify and monitor EMD.
Chimeric antigen receptor (CAR) T cells effectively eradicate medullary B-cell acute lymphoblastic leukemia (B-ALL) and can traffic to and clear central nervous system (CNS) involvement. CAR T-cell activity in non-CNS extramedullary disease (EMD) has not been well characterized. We systematically evaluated CAR T-cell kinetics, associated toxicities, and efficacy in B-ALL non-CNS EMD. We conducted a retrospective review of B-ALL patients with non-CNS EMD who were screened for/enrolled on one of three CAR trials (CD19, CD22, and CD19/22) at our institution. Non-CNS EMD was identified according to histology or radiographic imaging at extramedullary sites excluding the cerebrospinal fluid and CNS parenchyma. Of ∼180 patients with relapsed/refractory B-ALL screened across multiple early-phase trials over an 8-year period, 38 (21.1%) presented with isolated non-CNS EMD (n = 5) or combined medullary/non-CNS EMD (n = 33) on 18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) imaging. A subset receiving CAR T cells (18 infusions) obtained FDG PET/CT scans preinfusion and postinfusion to monitor response. At best response, 72.2% (13 of 18) of patients showed a medullary minimal residual disease–negative complete remission and complete (n = 7) or partial (n = 6) non-CNS EMD response. Non-CNS EMD responses to CAR T cells were delayed (n = 3), and residual non-CNS EMD was substantial; rarely, discrepant outcomes (marrow response without EMD response) were observed (n = 2). Unique CAR-associated toxicities at non-CNS EMD sites were seen in select patients. CAR T cells are active in B-ALL non-CNS EMD. Still, non-CNS EMD response to CAR T cells may be delayed and suboptimal, particularly with multifocal disease. Serial FDG PET/CT scans are necessary for identifying and monitoring non-CNS EMD.
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16
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Theruvath AJ, Siedek F, Yerneni K, Muehe AM, Spunt SL, Pribnow A, Moseley M, Lu Y, Zhao Q, Gulaka P, Chaudhari A, Daldrup-Link HE. Validation of Deep Learning-based Augmentation for Reduced 18F-FDG Dose for PET/MRI in Children and Young Adults with Lymphoma. Radiol Artif Intell 2021; 3:e200232. [PMID: 34870211 DOI: 10.1148/ryai.2021200232] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 08/30/2021] [Accepted: 09/17/2021] [Indexed: 11/11/2022]
Abstract
Purpose To investigate if a deep learning convolutional neural network (CNN) could enable low-dose fluorine 18 (18F) fluorodeoxyglucose (FDG) PET/MRI for correct treatment response assessment of children and young adults with lymphoma. Materials and Methods In this secondary analysis of prospectively collected data (ClinicalTrials.gov identifier: NCT01542879), 20 patients with lymphoma (mean age, 16.4 years ± 6.4 [standard deviation]) underwent 18F-FDG PET/MRI between July 2015 and August 2019 at baseline and after induction chemotherapy. Full-dose 18F-FDG PET data (3 MBq/kg) were simulated to lower 18F-FDG doses based on the percentage of coincidence events (representing simulated 75%, 50%, 25%, 12.5%, and 6.25% 18F-FDG dose [hereafter referred to as 75%Sim, 50%Sim, 25%Sim, 12.5%Sim, and 6.25%Sim, respectively]). A U.S. Food and Drug Administration-approved CNN was used to augment input simulated low-dose scans to full-dose scans. For each follow-up scan after induction chemotherapy, the standardized uptake value (SUV) response score was calculated as the maximum SUV (SUVmax) of the tumor normalized to the mean liver SUV; tumor response was classified as adequate or inadequate. Sensitivity and specificity in the detection of correct response status were computed using full-dose PET as the reference standard. Results With decreasing simulated radiotracer doses, tumor SUVmax increased. A dose below 75%Sim of the full dose led to erroneous upstaging of adequate responders to inadequate responders (43% [six of 14 patients] for 75%Sim; 93% [13 of 14 patients] for 50%Sim; and 100% [14 of 14 patients] below 50%Sim; P < .05 for all). CNN-enhanced low-dose PET/MRI scans at 75%Sim and 50%Sim enabled correct response assessments for all patients. Use of the CNN augmentation for assessing adequate and inadequate responses resulted in identical sensitivities (100%) and specificities (100%) between the assessment of 100% full-dose PET, augmented 75%Sim, and augmented 50%Sim images. Conclusion CNN enhancement of PET/MRI scans may enable 50% 18F-FDG dose reduction with correct treatment response assessment of children and young adults with lymphoma.Keywords: Pediatrics, PET/MRI, Computer Applications Detection/Diagnosis, Lymphoma, Tumor Response, Whole-Body Imaging, Technology AssessmentClinical trial registration no: NCT01542879 Supplemental material is available for this article. © RSNA, 2021.
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Affiliation(s)
- Ashok J Theruvath
- Department of Radiology, Molecular Imaging Program at Stanford (A.J.T., F.S., K.Y., A.M.M., M.M., A.C., H.E.D.L.), Department of Pediatrics, Division of Hematology/Oncology, Lucile Packard Children's Hospital (S.L.S., A.P., H.E.D.L.), and Department of Biomedical Data Science (Y.L., Q.Z.), Stanford University, 725 Welch Rd, Stanford, CA 94304; and Subtle Medical, Menlo Park, Calif (P.G.)
| | - Florian Siedek
- Department of Radiology, Molecular Imaging Program at Stanford (A.J.T., F.S., K.Y., A.M.M., M.M., A.C., H.E.D.L.), Department of Pediatrics, Division of Hematology/Oncology, Lucile Packard Children's Hospital (S.L.S., A.P., H.E.D.L.), and Department of Biomedical Data Science (Y.L., Q.Z.), Stanford University, 725 Welch Rd, Stanford, CA 94304; and Subtle Medical, Menlo Park, Calif (P.G.)
| | - Ketan Yerneni
- Department of Radiology, Molecular Imaging Program at Stanford (A.J.T., F.S., K.Y., A.M.M., M.M., A.C., H.E.D.L.), Department of Pediatrics, Division of Hematology/Oncology, Lucile Packard Children's Hospital (S.L.S., A.P., H.E.D.L.), and Department of Biomedical Data Science (Y.L., Q.Z.), Stanford University, 725 Welch Rd, Stanford, CA 94304; and Subtle Medical, Menlo Park, Calif (P.G.)
| | - Anne M Muehe
- Department of Radiology, Molecular Imaging Program at Stanford (A.J.T., F.S., K.Y., A.M.M., M.M., A.C., H.E.D.L.), Department of Pediatrics, Division of Hematology/Oncology, Lucile Packard Children's Hospital (S.L.S., A.P., H.E.D.L.), and Department of Biomedical Data Science (Y.L., Q.Z.), Stanford University, 725 Welch Rd, Stanford, CA 94304; and Subtle Medical, Menlo Park, Calif (P.G.)
| | - Sheri L Spunt
- Department of Radiology, Molecular Imaging Program at Stanford (A.J.T., F.S., K.Y., A.M.M., M.M., A.C., H.E.D.L.), Department of Pediatrics, Division of Hematology/Oncology, Lucile Packard Children's Hospital (S.L.S., A.P., H.E.D.L.), and Department of Biomedical Data Science (Y.L., Q.Z.), Stanford University, 725 Welch Rd, Stanford, CA 94304; and Subtle Medical, Menlo Park, Calif (P.G.)
| | - Allison Pribnow
- Department of Radiology, Molecular Imaging Program at Stanford (A.J.T., F.S., K.Y., A.M.M., M.M., A.C., H.E.D.L.), Department of Pediatrics, Division of Hematology/Oncology, Lucile Packard Children's Hospital (S.L.S., A.P., H.E.D.L.), and Department of Biomedical Data Science (Y.L., Q.Z.), Stanford University, 725 Welch Rd, Stanford, CA 94304; and Subtle Medical, Menlo Park, Calif (P.G.)
| | - Michael Moseley
- Department of Radiology, Molecular Imaging Program at Stanford (A.J.T., F.S., K.Y., A.M.M., M.M., A.C., H.E.D.L.), Department of Pediatrics, Division of Hematology/Oncology, Lucile Packard Children's Hospital (S.L.S., A.P., H.E.D.L.), and Department of Biomedical Data Science (Y.L., Q.Z.), Stanford University, 725 Welch Rd, Stanford, CA 94304; and Subtle Medical, Menlo Park, Calif (P.G.)
| | - Ying Lu
- Department of Radiology, Molecular Imaging Program at Stanford (A.J.T., F.S., K.Y., A.M.M., M.M., A.C., H.E.D.L.), Department of Pediatrics, Division of Hematology/Oncology, Lucile Packard Children's Hospital (S.L.S., A.P., H.E.D.L.), and Department of Biomedical Data Science (Y.L., Q.Z.), Stanford University, 725 Welch Rd, Stanford, CA 94304; and Subtle Medical, Menlo Park, Calif (P.G.)
| | - Qian Zhao
- Department of Radiology, Molecular Imaging Program at Stanford (A.J.T., F.S., K.Y., A.M.M., M.M., A.C., H.E.D.L.), Department of Pediatrics, Division of Hematology/Oncology, Lucile Packard Children's Hospital (S.L.S., A.P., H.E.D.L.), and Department of Biomedical Data Science (Y.L., Q.Z.), Stanford University, 725 Welch Rd, Stanford, CA 94304; and Subtle Medical, Menlo Park, Calif (P.G.)
| | - Praveen Gulaka
- Department of Radiology, Molecular Imaging Program at Stanford (A.J.T., F.S., K.Y., A.M.M., M.M., A.C., H.E.D.L.), Department of Pediatrics, Division of Hematology/Oncology, Lucile Packard Children's Hospital (S.L.S., A.P., H.E.D.L.), and Department of Biomedical Data Science (Y.L., Q.Z.), Stanford University, 725 Welch Rd, Stanford, CA 94304; and Subtle Medical, Menlo Park, Calif (P.G.)
| | - Akshay Chaudhari
- Department of Radiology, Molecular Imaging Program at Stanford (A.J.T., F.S., K.Y., A.M.M., M.M., A.C., H.E.D.L.), Department of Pediatrics, Division of Hematology/Oncology, Lucile Packard Children's Hospital (S.L.S., A.P., H.E.D.L.), and Department of Biomedical Data Science (Y.L., Q.Z.), Stanford University, 725 Welch Rd, Stanford, CA 94304; and Subtle Medical, Menlo Park, Calif (P.G.)
| | - Heike E Daldrup-Link
- Department of Radiology, Molecular Imaging Program at Stanford (A.J.T., F.S., K.Y., A.M.M., M.M., A.C., H.E.D.L.), Department of Pediatrics, Division of Hematology/Oncology, Lucile Packard Children's Hospital (S.L.S., A.P., H.E.D.L.), and Department of Biomedical Data Science (Y.L., Q.Z.), Stanford University, 725 Welch Rd, Stanford, CA 94304; and Subtle Medical, Menlo Park, Calif (P.G.)
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Kurch L, Kluge R, Sabri O, Fischer L, Wendt S, Graf Einsiedel H, Starke S, Kühl JS, Christiansen H, Hirsch FW, Sorge I, Roth C. Whole-body [ 18F]-FDG-PET/MRI for staging of pediatric non-Hodgkin lymphoma: first results from a single-center evaluation. EJNMMI Res 2021; 11:62. [PMID: 34216300 PMCID: PMC8254839 DOI: 10.1186/s13550-021-00804-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/10/2021] [Indexed: 12/17/2022] Open
Abstract
Aim In 2015, the revised International Pediatric Non-Hodgkin Lymphoma Staging System was published. It mentions [18F]-FDG-PET/MRI as the latest method to perform whole-body imaging. However, supporting data are pending. Our aim was to investigate the performance of whole-body [18F]-FDG-PET/MRI in pediatric non-Hodgkin lymphoma patients by using a limited number of MRI sequences. Materials and methods Ten pediatric patients with histologically proven non-Hodgkin lymphoma underwent whole-body [18F]-FDG-PET/MRI at staging. The retrospective analysis included three steps: First, [18F]-FDG-PET and MR scans were evaluated separately by a nuclear medicine physician and a pediatric radiologist. Nineteen nodal and two extranodal regions as well as six organs were checked for involvement. Second, discrepant findings were reviewed together in order to reach consensus. Third, [18F]-FDG-PET/MRI findings were correlated with the results of other clinical investigations. Results Of the 190 lymph node regions evaluated, four were rated controversial. Consensus was reached by considering metabolic, functional and morphologic information combined. Concordantly, [18F]-FDG-PET and MRI detected Waldeyer’s ring involvement in two patients whose Waldeyer’s ring was negative on clinical assessment. In four patients MRI showed pleural effusion. However, in only two of them an increased glucose metabolism as a reliable sign of pleural involvement was detectable. In six patients [18F]-FDG-PET and MRI detected skeletal lesions although bone marrow biopsy was positive in only one of them. Conclusion Despite the small number of cases evaluated, whole-body [18F]-FDG-PET turned out to be a valuable tool for staging of pediatric non-Hodgkin lymphoma.
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Affiliation(s)
- L Kurch
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany.
| | - R Kluge
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - O Sabri
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - L Fischer
- Department of Pediatric Oncology, Hematology and Hemostaseology, University Hospital Leipzig, Leipzig, Germany
| | - S Wendt
- Department of Pediatric Oncology, Hematology and Hemostaseology, University Hospital Leipzig, Leipzig, Germany
| | - H Graf Einsiedel
- Department of Pediatric Oncology, Hematology and Hemostaseology, University Hospital Leipzig, Leipzig, Germany
| | - S Starke
- Department of Pediatric Oncology, Hematology and Hemostaseology, University Hospital Leipzig, Leipzig, Germany
| | - J-S Kühl
- Department of Pediatric Oncology, Hematology and Hemostaseology, University Hospital Leipzig, Leipzig, Germany
| | - H Christiansen
- Department of Pediatric Oncology, Hematology and Hemostaseology, University Hospital Leipzig, Leipzig, Germany
| | - F W Hirsch
- Institute of Pediatric Radiology, University Hospital Leipzig, Leipzig, Germany
| | - I Sorge
- Institute of Pediatric Radiology, University Hospital Leipzig, Leipzig, Germany
| | - C Roth
- Institute of Pediatric Radiology, University Hospital Leipzig, Leipzig, Germany
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Response-Assessment von pädiatrischen Malignomen mit der Ganzkörper-MRT und der FDG-PET/MRT. ROFO-FORTSCHR RONTG 2021. [DOI: 10.1055/a-1242-0257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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19
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Qi J, Thakrar PD, Browning MB, Vo N, Kumbhar SS. Clinical utilization of whole-body PET/MRI in childhood sarcoma. Pediatr Radiol 2021; 51:471-479. [PMID: 33040234 DOI: 10.1007/s00247-020-04834-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/12/2020] [Accepted: 08/27/2020] [Indexed: 01/10/2023]
Abstract
Hybrid positron emission tomography (PET)/magnetic resonance imaging (MRI) has emerged as a useful tool that combines the superior tissue contrast of MRI with the targeted functional imaging of PET. In the assessment of sarcomas in children, PET/MRI has the potential to serve as a single point of service, allowing superior anatomical imaging and evaluation of metabolic uptake during one imaging session. In this pictorial essay, we review our preliminary experience with PET/MRI in the evaluation of pediatric sarcoma. The limitations and contraindications of PET/MRI are also discussed.
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Affiliation(s)
- Jing Qi
- Department of Radiology, Children's Wisconsin and the Medical College of Wisconsin, 9000 W. Wisconsin Ave., MS-721, Milwaukee, WI, 53226, USA.
| | - Pooja D Thakrar
- Department of Radiology, Children's Wisconsin and the Medical College of Wisconsin, 9000 W. Wisconsin Ave., MS-721, Milwaukee, WI, 53226, USA
| | - Meghen B Browning
- Department of Pediatric Hematology and Oncology, Children's Wisconsin and the Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nghia Vo
- Department of Radiology, Children's Wisconsin and the Medical College of Wisconsin, 9000 W. Wisconsin Ave., MS-721, Milwaukee, WI, 53226, USA
| | - Sachin S Kumbhar
- Department of Radiology, Children's Wisconsin and the Medical College of Wisconsin, 9000 W. Wisconsin Ave., MS-721, Milwaukee, WI, 53226, USA
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20
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Verhagen MV, Menezes LJ, Neriman D, Watson TA, Punwani S, Taylor SA, Shankar A, Daw S, Humphries PD. 18F-FDG PET/MRI for Staging and Interim Response Assessment in Pediatric and Adolescent Hodgkin Lymphoma: A Prospective Study with 18F-FDG PET/CT as the Reference Standard. J Nucl Med 2021; 62:1524-1530. [PMID: 33608429 DOI: 10.2967/jnumed.120.260059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/29/2021] [Indexed: 02/07/2023] Open
Abstract
Treatment regimens for pediatric Hodgkin lymphoma (HL) depend on accurate staging and treatment response assessment, based on accurate disease distribution and metabolic activity depiction. With the aim of radiation dose reduction, we compared the diagnostic performance of 18F-FDG PET/MRI with a 18F-FDG PET/CT reference standard for staging and response assessment. Methods: Twenty-four patients (mean age, 15.4 y; range, 8-19.5 y) with histologically proven HL were prospectively and consecutively recruited in 2015 and 2016, undergoing both 18F-FDG PET/CT and 18F-FDG PET/MRI at initial staging (n = 24) and at response assessment (n = 21). The diagnostic accuracy of 18F-FDG PET/MRI for both nodal and extranodal disease was compared with that of 18F-FDG PET/CT, which was considered the reference standard. Discrepancies were retrospectively classified as perceptual or technical errors, and 18F-FDG PET/MRI and 18F-FDG PET/CT were corrected by removing perceptual error. Agreement with Ann Arbor staging and Deauville grading was also assessed. Results: For nodal and extranodal sites combined, corrected staging 18F-FDG PET/MRI sensitivity was 100% (95% CI, 96.7%-100%) and specificity was 99.5% (95% CI, 98.3%-99.9%). Corrected response-assessment 18F-FDG PET/MRI sensitivity was 83.3% (95% CI, 36.5%-99.1%) and specificity was 100% (95% CI, 99.2%-100%). Modified Ann Arbor staging agreement between 18F-FDG PET/CT and 18F-FDG PET/MRI was perfect (κ = 1.0, P = 0.000). Deauville grading agreement between 18F-FDG PET/MRI and 18F-FDG PET/CT was excellent (κ = 0.835, P = 0.000). Conclusion: 18F-FDG PET/MRI is a promising alternative to 18F-FDG PET/CT for staging and response assessment in children with HL.
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Affiliation(s)
- Martijn V Verhagen
- Department of Radiology, University College London Hospital, London, United Kingdom.,Department of Radiology, Great Ormond Street Hospital, London, United Kingdom
| | - Leon J Menezes
- UCL Institute of Nuclear Medicine, University College London Hospital, London, United Kingdom.,NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Deena Neriman
- UCL Institute of Nuclear Medicine, University College London Hospital, London, United Kingdom
| | - Tom A Watson
- Department of Radiology, Great Ormond Street Hospital, London, United Kingdom
| | - Shonit Punwani
- Department of Radiology, University College London Hospital, London, United Kingdom
| | - Stuart A Taylor
- Department of Radiology, University College London Hospital, London, United Kingdom.,Centre for Medical Imaging, CBH, London, United Kingdom; and
| | - Ananth Shankar
- Centre for Medical Imaging, CBH, London, United Kingdom; and.,Department of Pediatrics, University College London Hospital, London, United Kingdom
| | - Stephen Daw
- Department of Pediatrics, University College London Hospital, London, United Kingdom
| | - Paul D Humphries
- Department of Radiology, University College London Hospital, London, United Kingdom; .,Department of Radiology, Great Ormond Street Hospital, London, United Kingdom
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21
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Pediatric Molecular Imaging. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00075-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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22
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Cassarino G, Evangelista L, Giraudo C, Capizzi A, Carretta G, Zucchetta P, Cecchin D. 18F-FDG PET/MRI in adult sarcomas. Clin Transl Imaging 2020. [DOI: 10.1007/s40336-020-00395-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Abstract
Aim
This mini-review aims to summarize the main findings on PET/MRI in patients with sarcomas.
Materials and methods
A literature search was carried out on MEDLINE databases, such as PubMed, Scopus, Web of Science and Google Scholar, using the search terms “PET”, “positron emission tomography”, “PET/MRI”, “positron emission tomography/magnetic resonance imaging”, and “sarcoma”. No restrictions (i.e. language, age, type of manuscript, or the like) were applied to the search strategy. Abstracts, reviews, letters to editors, and editorials were excluded.
Results
Eight studies were ultimately included. From 2013 to 2019, a total of 154 adult patients with sarcomas underwent 18F-fluorodeoxyglucose (18F-FDG) PET/MRI. Of these patients, 129 had soft tissue sarcomas (STS), 5 had bone sarcomas, and 20 had cardiac masses. Thirty-two patients had PET/MRI for early-stage disease, 45 for recurrences, and 57 for the assessment of response to treatment. For staging purposes, the studies suggest that PET/MRI can significantly improve the delineation of surgical margins. At restaging, PET/MRI can also detect sarcoma recurrences more accurately than conventional imaging.
Conclusions
18F-FDG PET/MRI has promising indications in patients with sarcomas, from disease staging to the assessment of response to treatment. Further studies are warranted to confirm these results, especially in subgroups with specific histopathological features.
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Guo R, Xu P, Cheng S, Lin M, Zhong H, Li W, Huang H, Ouyang B, Yi H, Chen J, Lin X, Shi K, Zhao W, Li B. Comparison of Nasopharyngeal MR, 18 F-FDG PET/CT, and 18 F-FDG PET/MR for Local Detection of Natural Killer/T-Cell Lymphoma, Nasal Type. Front Oncol 2020; 10:576409. [PMID: 33178609 PMCID: PMC7591820 DOI: 10.3389/fonc.2020.576409] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/18/2020] [Indexed: 12/11/2022] Open
Abstract
Objectives The present study aims to compare the diagnostic efficacy of MR, 18F-FDG PET/CT, and 18F-FDG PET/MR for the local detection of early-stage extranodal natural killer/T-cell lymphoma, nasal type (ENKTL). Patients and Methods Thirty-six patients with histologically proven early-stage ENKTL were enrolled from a phase 2 study (Cohort A). Eight nasopharyngeal anatomical regions from each patient were imaged using 18F-FDG PET/CT and MR. A further nine patients were prospectively enrolled from a multicenter, phase 3 study; these patients underwent 18F-FDG PET/CT and PET/MR after a single 18F-FDG injection (Cohort B). Region-based sensitivity and specificity were calculated. The standardized uptake values (SUV) obtained from PET/CT and PET/MR were compared, and the relationship between the SUV and apparent diffusion coefficients (ADC) of PET/MR were analyzed. Results In Cohort A, of the 288 anatomic regions, 86 demonstrated lymphoma involvement. All lesions were detected by 18F-FDG PET/CT, while only 70 were detected by MR. 18F-FDG PET/CT exhibited a higher sensitivity than MR (100% vs. 81.4%, χ2 = 17.641, P < 0.001) for local detection of malignancies. The specificity of 18F-FDG PET/CT and MR were 98.5 and 97.5%, respectively (χ2 = 0.510, P = 0.475). The accuracy of 18F-FDG PET/CT was 99.0% and the accuracy of MR was 92.7% (χ2 = 14.087, P < 0.001). In Cohort B, 72 anatomical regions were analyzed. PET/CT and PET/MR have a sensitivity of 100% and a specificity of 92.5%. The two methods were consistent (κ = 0.833, P < 0.001). There was a significant correlation between PET/MR SUVmax and PET/CT SUVmax (r = 0.711, P < 0.001), and SUVmean (r = 0.685, P < 0.001). No correlation was observed between the SUV and the ADC. Conclusion In early-stage ENKTL, nasopharyngeal MR showed a lower sensitivity and a similar specificity when compared with 18F-FDG PET/CT. PET/MR showed similar performance compared with PET/CT.
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Affiliation(s)
- Rui Guo
- Department of Nuclear Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Pengpeng Xu
- State Key Laboratory of Medical Genomics, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shu Cheng
- State Key Laboratory of Medical Genomics, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mu Lin
- Siemens Healthcare, Beijing, China
| | - Huijuan Zhong
- State Key Laboratory of Medical Genomics, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Weixia Li
- Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hengye Huang
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Bingsheng Ouyang
- Department of Pathology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hongmei Yi
- Department of Pathology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jiayi Chen
- Department of Radiation, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaozhu Lin
- Department of Nuclear Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Kuangyu Shi
- Department of Nuclear Medicine, University Hospital Bern, Bern, Switzerland.,Faculty of Informatics, Technical University of Munich, Munich, Germany
| | - Weili Zhao
- State Key Laboratory of Medical Genomics, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Biao Li
- Department of Nuclear Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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25
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Setiawan CT, Landrigan-Ossar M. Pediatric Anesthesia Outside the Operating Room: Case Management. Anesthesiol Clin 2020; 38:587-604. [PMID: 32792186 DOI: 10.1016/j.anclin.2020.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Anesthesiology teams care for children in diverse locations, including diagnostic and interventional radiology, gastroenterology and pulmonary endoscopy suites, radiation oncology units, and cardiac catheterization laboratories. To provide safe, high-quality care, anesthesiologists working in these environments must understand the unique environmental and perioperative considerations and risks involved with each remote location and patient population. Once these variables are addressed, anesthesia and procedural teams can coordinate to ensure that patients and families receive the same high-quality care that they have come to expect in the operating room. This article also describes some of the considerations for anesthetic care in outfield locations.
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Affiliation(s)
- Christopher Tan Setiawan
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Anesthesiology, Children's Medical Center, 1935 Medical District Drive, Dallas, TX 75235, USA
| | - Mary Landrigan-Ossar
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Harvard Medical School, Boston, MA, USA.
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Theruvath AJ, Siedek F, Muehe AM, Garcia-Diaz J, Kirchner J, Martin O, Link MP, Spunt S, Pribnow A, Rosenberg J, Herrmann K, Gatidis S, Schäfer JF, Moseley M, Umutlu L, Daldrup-Link HE. Therapy Response Assessment of Pediatric Tumors with Whole-Body Diffusion-weighted MRI and FDG PET/MRI. Radiology 2020; 296:143-151. [PMID: 32368961 DOI: 10.1148/radiol.2020192508] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Whole-body diffusion-weighted (DW) MRI can help detect cancer with high sensitivity. However, the assessment of therapy response often requires information about tumor metabolism, which is measured with fluorine 18 fluorodeoxyglucose (FDG) PET. Purpose To compare tumor therapy response with whole-body DW MRI and FDG PET/MRI in children and young adults. Materials and Methods In this prospective, nonrandomized multicenter study, 56 children and young adults (31 male and 25 female participants; mean age, 15 years ± 4 [standard deviation]; age range, 6-22 years) with lymphoma or sarcoma underwent 112 simultaneous whole-body DW MRI and FDG PET/MRI between June 2015 and December 2018 before and after induction chemotherapy (ClinicalTrials.gov identifier: NCT01542879). The authors measured minimum tumor apparent diffusion coefficients (ADCs) and maximum standardized uptake value (SUV) of up to six target lesions and assessed therapy response after induction chemotherapy according to the Lugano classification or PET Response Criteria in Solid Tumors. The authors evaluated agreements between whole-body DW MRI- and FDG PET/MRI-based response classifications with Krippendorff α statistics. Differences in minimum ADC and maximum SUV between responders and nonresponders and comparison of timing for discordant and concordant response assessments after induction chemotherapy were evaluated with the Wilcoxon test. Results Good agreement existed between treatment response assessments after induction chemotherapy with whole-body DW MRI and FDG PET/MRI (α = 0.88). Clinical response prediction according to maximum SUV (area under the receiver operating characteristic curve = 100%; 95% confidence interval [CI]: 99%, 100%) and minimum ADC (area under the receiver operating characteristic curve = 98%; 95% CI: 94%, 100%) were similar (P = .37). Sensitivity and specificity were 96% (54 of 56 participants; 95% CI: 86%, 99%) and 100% (56 of 56 participants; 95% CI: 54%, 100%), respectively, for DW MRI and 100% (56 of 56 participants; 95% CI: 93%, 100%) and 100% (56 of 56 participants; 95% CI: 54%, 100%) for FDG PET/MRI. In eight of 56 patients who underwent imaging after induction chemotherapy in the early posttreatment phase, chemotherapy-induced changes in tumor metabolism preceded changes in proton diffusion (P = .002). Conclusion Whole-body diffusion-weighted MRI showed significant agreement with fluorine 18 fluorodeoxyglucose PET/MRI for treatment response assessment in children and young adults. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Ashok J Theruvath
- From the Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, 725 Welch Rd, Stanford, CA 94304 (A.J.T., F.S., A.M.M., J.G.D., J.R., M.M., H.E.D.L.); Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany (A.J.T.); Institute of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany (F.S.); Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany (J.K., O.M.); Department of Pediatrics, Pediatric Oncology, Lucile Packard Children's Hospital, Stanford University, Stanford, Calif (M.P.L., S.S., A.P., H.E.D.L.); Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (K.H.); Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany (S.G., J.F.S.); Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (L.U.)
| | - Florian Siedek
- From the Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, 725 Welch Rd, Stanford, CA 94304 (A.J.T., F.S., A.M.M., J.G.D., J.R., M.M., H.E.D.L.); Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany (A.J.T.); Institute of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany (F.S.); Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany (J.K., O.M.); Department of Pediatrics, Pediatric Oncology, Lucile Packard Children's Hospital, Stanford University, Stanford, Calif (M.P.L., S.S., A.P., H.E.D.L.); Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (K.H.); Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany (S.G., J.F.S.); Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (L.U.)
| | - Anne M Muehe
- From the Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, 725 Welch Rd, Stanford, CA 94304 (A.J.T., F.S., A.M.M., J.G.D., J.R., M.M., H.E.D.L.); Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany (A.J.T.); Institute of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany (F.S.); Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany (J.K., O.M.); Department of Pediatrics, Pediatric Oncology, Lucile Packard Children's Hospital, Stanford University, Stanford, Calif (M.P.L., S.S., A.P., H.E.D.L.); Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (K.H.); Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany (S.G., J.F.S.); Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (L.U.)
| | - Jordi Garcia-Diaz
- From the Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, 725 Welch Rd, Stanford, CA 94304 (A.J.T., F.S., A.M.M., J.G.D., J.R., M.M., H.E.D.L.); Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany (A.J.T.); Institute of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany (F.S.); Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany (J.K., O.M.); Department of Pediatrics, Pediatric Oncology, Lucile Packard Children's Hospital, Stanford University, Stanford, Calif (M.P.L., S.S., A.P., H.E.D.L.); Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (K.H.); Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany (S.G., J.F.S.); Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (L.U.)
| | - Julian Kirchner
- From the Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, 725 Welch Rd, Stanford, CA 94304 (A.J.T., F.S., A.M.M., J.G.D., J.R., M.M., H.E.D.L.); Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany (A.J.T.); Institute of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany (F.S.); Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany (J.K., O.M.); Department of Pediatrics, Pediatric Oncology, Lucile Packard Children's Hospital, Stanford University, Stanford, Calif (M.P.L., S.S., A.P., H.E.D.L.); Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (K.H.); Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany (S.G., J.F.S.); Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (L.U.)
| | - Ole Martin
- From the Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, 725 Welch Rd, Stanford, CA 94304 (A.J.T., F.S., A.M.M., J.G.D., J.R., M.M., H.E.D.L.); Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany (A.J.T.); Institute of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany (F.S.); Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany (J.K., O.M.); Department of Pediatrics, Pediatric Oncology, Lucile Packard Children's Hospital, Stanford University, Stanford, Calif (M.P.L., S.S., A.P., H.E.D.L.); Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (K.H.); Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany (S.G., J.F.S.); Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (L.U.)
| | - Michael P Link
- From the Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, 725 Welch Rd, Stanford, CA 94304 (A.J.T., F.S., A.M.M., J.G.D., J.R., M.M., H.E.D.L.); Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany (A.J.T.); Institute of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany (F.S.); Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany (J.K., O.M.); Department of Pediatrics, Pediatric Oncology, Lucile Packard Children's Hospital, Stanford University, Stanford, Calif (M.P.L., S.S., A.P., H.E.D.L.); Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (K.H.); Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany (S.G., J.F.S.); Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (L.U.)
| | - Sheri Spunt
- From the Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, 725 Welch Rd, Stanford, CA 94304 (A.J.T., F.S., A.M.M., J.G.D., J.R., M.M., H.E.D.L.); Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany (A.J.T.); Institute of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany (F.S.); Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany (J.K., O.M.); Department of Pediatrics, Pediatric Oncology, Lucile Packard Children's Hospital, Stanford University, Stanford, Calif (M.P.L., S.S., A.P., H.E.D.L.); Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (K.H.); Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany (S.G., J.F.S.); Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (L.U.)
| | - Allison Pribnow
- From the Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, 725 Welch Rd, Stanford, CA 94304 (A.J.T., F.S., A.M.M., J.G.D., J.R., M.M., H.E.D.L.); Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany (A.J.T.); Institute of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany (F.S.); Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany (J.K., O.M.); Department of Pediatrics, Pediatric Oncology, Lucile Packard Children's Hospital, Stanford University, Stanford, Calif (M.P.L., S.S., A.P., H.E.D.L.); Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (K.H.); Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany (S.G., J.F.S.); Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (L.U.)
| | - Jarrett Rosenberg
- From the Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, 725 Welch Rd, Stanford, CA 94304 (A.J.T., F.S., A.M.M., J.G.D., J.R., M.M., H.E.D.L.); Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany (A.J.T.); Institute of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany (F.S.); Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany (J.K., O.M.); Department of Pediatrics, Pediatric Oncology, Lucile Packard Children's Hospital, Stanford University, Stanford, Calif (M.P.L., S.S., A.P., H.E.D.L.); Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (K.H.); Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany (S.G., J.F.S.); Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (L.U.)
| | - Ken Herrmann
- From the Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, 725 Welch Rd, Stanford, CA 94304 (A.J.T., F.S., A.M.M., J.G.D., J.R., M.M., H.E.D.L.); Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany (A.J.T.); Institute of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany (F.S.); Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany (J.K., O.M.); Department of Pediatrics, Pediatric Oncology, Lucile Packard Children's Hospital, Stanford University, Stanford, Calif (M.P.L., S.S., A.P., H.E.D.L.); Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (K.H.); Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany (S.G., J.F.S.); Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (L.U.)
| | - Sergios Gatidis
- From the Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, 725 Welch Rd, Stanford, CA 94304 (A.J.T., F.S., A.M.M., J.G.D., J.R., M.M., H.E.D.L.); Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany (A.J.T.); Institute of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany (F.S.); Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany (J.K., O.M.); Department of Pediatrics, Pediatric Oncology, Lucile Packard Children's Hospital, Stanford University, Stanford, Calif (M.P.L., S.S., A.P., H.E.D.L.); Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (K.H.); Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany (S.G., J.F.S.); Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (L.U.)
| | - Jürgen F Schäfer
- From the Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, 725 Welch Rd, Stanford, CA 94304 (A.J.T., F.S., A.M.M., J.G.D., J.R., M.M., H.E.D.L.); Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany (A.J.T.); Institute of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany (F.S.); Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany (J.K., O.M.); Department of Pediatrics, Pediatric Oncology, Lucile Packard Children's Hospital, Stanford University, Stanford, Calif (M.P.L., S.S., A.P., H.E.D.L.); Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (K.H.); Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany (S.G., J.F.S.); Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (L.U.)
| | - Michael Moseley
- From the Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, 725 Welch Rd, Stanford, CA 94304 (A.J.T., F.S., A.M.M., J.G.D., J.R., M.M., H.E.D.L.); Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany (A.J.T.); Institute of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany (F.S.); Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany (J.K., O.M.); Department of Pediatrics, Pediatric Oncology, Lucile Packard Children's Hospital, Stanford University, Stanford, Calif (M.P.L., S.S., A.P., H.E.D.L.); Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (K.H.); Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany (S.G., J.F.S.); Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (L.U.)
| | - Lale Umutlu
- From the Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, 725 Welch Rd, Stanford, CA 94304 (A.J.T., F.S., A.M.M., J.G.D., J.R., M.M., H.E.D.L.); Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany (A.J.T.); Institute of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany (F.S.); Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany (J.K., O.M.); Department of Pediatrics, Pediatric Oncology, Lucile Packard Children's Hospital, Stanford University, Stanford, Calif (M.P.L., S.S., A.P., H.E.D.L.); Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (K.H.); Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany (S.G., J.F.S.); Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (L.U.)
| | - Heike E Daldrup-Link
- From the Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, 725 Welch Rd, Stanford, CA 94304 (A.J.T., F.S., A.M.M., J.G.D., J.R., M.M., H.E.D.L.); Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany (A.J.T.); Institute of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany (F.S.); Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany (J.K., O.M.); Department of Pediatrics, Pediatric Oncology, Lucile Packard Children's Hospital, Stanford University, Stanford, Calif (M.P.L., S.S., A.P., H.E.D.L.); Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (K.H.); Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany (S.G., J.F.S.); Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (L.U.)
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Saade-Lemus S, Nevo E, Soliman I, Otero HJ, Magee RW, Drum ET, States LJ. Clinical pediatric positron emission tomography/magnetic resonance program: a guide to successful implementation. Pediatr Radiol 2020; 50:607-617. [PMID: 32076750 DOI: 10.1007/s00247-019-04578-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/16/2019] [Accepted: 11/13/2019] [Indexed: 11/29/2022]
Abstract
Children with malignancies undergo recurrent imaging as part of tumor diagnosis, staging and therapy response assessment. Simultaneous positron emission tomography (PET) and magnetic resonance (MR) allows for decreased radiation exposure and acts as a one-stop shop for disease in which MR imaging is required. Nevertheless, PET/MR is still less readily available than PET/CT across institutions. This article serves as a guide to successful implementation of a clinical pediatric PET/MR program based on our extensive clinical experience. Challenges include making scanners more affordable and increasing patient throughput by decreasing total scan time. With improvements in workflow and robust acquisition protocols, PET/MR imaging is expected to play an increasingly important role in pediatric oncology.
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Affiliation(s)
- Sandra Saade-Lemus
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Elad Nevo
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Iman Soliman
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Hansel J Otero
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Ralph W Magee
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Elizabeth T Drum
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Lisa J States
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
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Kaneta T. PET and SPECT imaging of the brain: a review on the current status of nuclear medicine in Japan. Jpn J Radiol 2020; 38:343-357. [DOI: 10.1007/s11604-019-00901-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 10/31/2019] [Indexed: 01/07/2023]
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Comparison of FDG PET/MRI and FDG PET/CT in Pediatric Oncology in Terms of Anatomic Correlation of FDG-positive Lesions. J Pediatr Hematol Oncol 2019; 41:542-550. [PMID: 30933019 DOI: 10.1097/mph.0000000000001465] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The aims of our study were to compare F-18 fluorodeoxyglucose (FDG) positron-emission tomography/magnetic resonance imaging (PET/MRI) and PET/computed tomography (CT) in pediatric oncology patients in terms of anatomic correlation of FDG-positive lesions, and also to compare diffusion-weighted imaging (DWI) with PET to assess the correlation between apparent diffusion coefficient (ADC) values and standardized uptake value (SUV). Sequential PET/CT and PET/MRI images and/or whole-body DWI and ADC mapping in 34 pediatric patients were retrospectively analyzed. FDG-positive lesions were visually scored for CT, T1-weighted, T2-weighted, and DWI images separately in terms of anatomic correlation of FDG-avid lesions. Correlation analysis was performed for SUV parameters and ADC values. Among 47 FDG-positive lesions identified concurrently on PET/CT and PET/MRI, 37 were positive on CT and 46 were positive on at least one MRI sequence (P=0.012). Among 32 FDG-positive lesions for which DWI were available, 31 could be clearly depicted on DWI, resulting in significant difference compared with CT alone in the detection of FDG-positive lesions. No correlation was found between ADC and SUV. FDG PET/MRI exhibits better performance than PET/CT in terms of anatomic correlation of FDG-avid lesions. Therefore, PET/MRI may be more advantageous than PET/CT, not only due to reduced ionizing radiation dose but also for a better depiction of FDG-avid lesions in pediatric PET imaging.
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Daldrup-Link H. Artificial intelligence applications for pediatric oncology imaging. Pediatr Radiol 2019; 49:1384-1390. [PMID: 31620840 PMCID: PMC6820135 DOI: 10.1007/s00247-019-04360-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 12/21/2018] [Accepted: 02/14/2019] [Indexed: 12/27/2022]
Abstract
Machine learning algorithms can help to improve the accuracy and efficiency of cancer diagnosis, selection of personalized therapies and prediction of long-term outcomes. Artificial intelligence (AI) describes a subset of machine learning that can identify patterns in data and take actions to reach pre-set goals without specific programming. Machine learning tools can help to identify high-risk populations, prescribe personalized screening tests and enrich patient populations that are most likely to benefit from advanced imaging tests. AI algorithms can also help to plan personalized therapies and predict the impact of genomic variations on the sensitivity of normal and tumor tissue to chemotherapy or radiation therapy. The two main bottlenecks for successful AI applications in pediatric oncology imaging to date are the needs for large data sets and appropriate computer and memory power. With appropriate data entry and processing power, deep convolutional neural networks (CNNs) can process large amounts of imaging data, clinical data and medical literature in very short periods of time and thereby accelerate literature reviews, correct diagnoses and personalized treatments. This article provides a focused review of emerging AI applications that are relevant for the pediatric oncology imaging community.
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Affiliation(s)
- Heike Daldrup-Link
- Department of Radiology, Lucile Packard Children's Hospital, Pediatric Molecular Imaging Program, Stanford University School of Medicine, 725 Welch Road, Room 1665, Stanford, CA, 94305-5614, USA. .,Department of Pediatrics, Hematology/Oncology Section, Stanford University School of Medicine, Stanford, CA, USA.
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Arthurs OJ, van Rijn RR, Granata C, Porto L, Hirsch FW, Rosendahl K. European Society of Paediatric Radiology 2019 strategic research agenda: improving imaging for tomorrow's children. Pediatr Radiol 2019; 49:983-989. [PMID: 31115616 PMCID: PMC6598945 DOI: 10.1007/s00247-019-04406-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 04/05/2019] [Indexed: 11/02/2022]
Abstract
The European Society of Paediatric Radiology (ESPR) research committee was established to initiate, drive forward and foster excellence in paediatric imaging, paediatric image-guided intervention and radiation protection research, by facilitating more evidence-based standards, protocols and multi-institutional collaborations. The ESPR Strategic Research Agenda outlines our current research approach, highlighting several areas of paediatric imaging where the society can help guide current and future research, and emphasizing those areas where early research ("seed") funding may need to be allocated by this and other societies as precursors to larger grant applications. The key aims are to evaluate normal variation in order to be able to confidently diagnose disease states, develop robust image-based classification systems to aid diagnosis and treatment monitoring, and help develop evidence-based clinical guidelines using current literature and experience to identify knowledge gaps. For this reason, the development of evidence-based imaging pipelines, broken down step-by-step to include diagnosis, classification and clinical effectiveness, should be the end goal for each disease entity for each affected child. Here, we outline the 2019 ESPR Strategic Research Agenda along three points in the clinical imaging pipeline: clinical referral, disease diagnosis and evolution, and clinical therapeutic evaluation and effectiveness. Through multicentre trials, using existing high-level experience and expertise, and nurturing the next generation of researchers, we will be able to achieve these aims.
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Affiliation(s)
- Owen J Arthurs
- Department of Radiology, Great Ormond Street Hospital, London, UK. .,NIHR UCL Great Ormond Street Institute of Child Health Biomedical Research Centre, London, UK.
| | - Rick R van Rijn
- Department of Radiology, Emma Children's Hospital - Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Claudio Granata
- Service of Radiology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Luciana Porto
- Department of Paediatric Neurology, Hospital of Goethe University, Frankfurt am Main, Germany
| | - F Wolfgang Hirsch
- Department of Paediatric Radiology, University Leipzig, Leipzig, Germany
| | - Karen Rosendahl
- Department of Radiology, Haukeland University Hospital, 5020, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Kwatra NS, Lim R, Gee MS, States LJ, Vossough A, Lee EY. PET/MR Imaging:. Magn Reson Imaging Clin N Am 2019; 27:387-407. [DOI: 10.1016/j.mric.2019.01.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Zucchetta P, Branchini M, Zorz A, Bodanza V, Cecchin D, Paiusco M, Bui F. Quantitative analysis of image metrics for reduced and standard dose pediatric 18F-FDG PET/MRI examinations. Br J Radiol 2019; 92:20180438. [PMID: 30673306 DOI: 10.1259/bjr.20180438] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE: The study performs a comprehensive analysis of image metrics to objectively support the reduction of injected activity in pediatric oncology 18F-FDG PET/MR (18F-fludeoxyglucose PET/MR) examinations. Contrast-to-Noise Ratio (CNR), Normalized Noise (NN), tumor burden, and standardized uptake value (SUV) parameters stability were investigated to robustly define the acceptable reduced activity level that preserves the clinical utility of images, considering different PET applications. METHODS: 21 PET/MRI examinations performed on a 3-Tesla Biograph mMR scanner were analyzed. Tracer activity reduction was stimulated by decreasing the count statistics of the original list-mode data (3 MBq kg-1). In addition to the already studied SUV metrics and subjective scoring on lesion detectability, a thorough analysis of CNR, NN, Metabolic Tumor Volume (MTV), and Total Lesion Glycolysis (TLG) was performed. RESULTS: SUVmax and SUVmean increased more than 5% only in 0.6 MBq kg-1 reconstructed images (+10% and +9%, respectively), while SUVpeak was almost unaffected (average variations < 2%). The quantified CNR, NN, MTV, and TLG behavior with the decrease of the injected activity clearly defines 1.5 MBq kg-1 as a threshold of activity after which the quality of the image degrades. Subjective and objective analyses yielded consistent results. All 56 lesions were detected until activity of 1.2 MBq kg-1, whereas five lesions were missed on the 0.6 MBq kg-1 image. Perceived image quality (IQ) decreased in Lower Tracer Activity (LTA) images but remained acceptable until 1.5 MBq kg-1. CONCLUSION: Results about the stability of image metrics beyond the semi-quantitative SUV parameters and subjective analysis, rigorously proves the feasibility of the reduction of injected activity to 1.5 MBqkg-1 for pediatric patients aged between 7 and 17 years. ADVANCES IN KNOWLEDGE: This is the first report on the quantitative evaluation of the effect of activity reduction on image quality in pediatric PET/MR. The findings offer objective corroboration to the feasibility of a significant dose reduction without consequences on clinical image reading and tumor burden metrics.
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Affiliation(s)
- Pietro Zucchetta
- 1 Nuclear Medicine Unit, Department of Medicine DIMED, University-Hospital of Padova , Padova , Italy
| | - Marco Branchini
- 2 Medical Physics Department, Veneto Institute of Oncology IOV-IRCCS , Padova , Italy
| | - Alessandra Zorz
- 2 Medical Physics Department, Veneto Institute of Oncology IOV-IRCCS , Padova , Italy
| | - Valentina Bodanza
- 1 Nuclear Medicine Unit, Department of Medicine DIMED, University-Hospital of Padova , Padova , Italy
| | - Diego Cecchin
- 1 Nuclear Medicine Unit, Department of Medicine DIMED, University-Hospital of Padova , Padova , Italy
| | - Marta Paiusco
- 2 Medical Physics Department, Veneto Institute of Oncology IOV-IRCCS , Padova , Italy
| | - Franco Bui
- 1 Nuclear Medicine Unit, Department of Medicine DIMED, University-Hospital of Padova , Padova , Italy
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How to Provide Gadolinium-Free PET/MR Cancer Staging of Children and Young Adults in Less than 1 h: the Stanford Approach. Mol Imaging Biol 2019; 20:324-335. [PMID: 28721605 DOI: 10.1007/s11307-017-1105-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To provide clinically useful gadolinium-free whole-body cancer staging of children and young adults with integrated positron emission tomography/magnetic resonance (PET/MR) imaging in less than 1 h. PROCEDURES In this prospective clinical trial, 20 children and young adults (11-30 years old, 6 male, 14 female) with solid tumors underwent 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) PET/MR on a 3T PET/MR scanner after intravenous injection of ferumoxytol (5 mg Fe/kg) and [18F]FDG (2-3 MBq/kg). Time needed for patient preparation, PET/MR image acquisition, and data processing was compared before (n = 5) and after (n = 15) time-saving interventions, using a Wilcoxon test. The ferumoxytol-enhanced PET/MR images were compared with clinical standard staging tests regarding radiation exposure and tumor staging results, using Fisher's exact tests. RESULTS Tailored workflows significantly reduced scan times from 36 to 24 min for head to mid thigh scans (p < 0.001). These streamlined PET/MR scans were obtained with significantly reduced radiation exposure (mean 3.4 mSv) compared to PET/CT with diagnostic CT (mean 13.1 mSv; p = 0.003). Using the iron supplement ferumoxytol "off label" as an MR contrast agent avoided gadolinium chelate administration. The ferumoxytol-enhanced PET/MR scans provided equal or superior tumor staging results compared to clinical standard tests in 17 out of 20 patients. Compared to PET/CT, PET/MR had comparable detection rates for pulmonary nodules with diameters of equal or greater than 5 mm (94 vs. 100 %), yet detected significantly fewer nodules with diameters of less than 5 mm (20 vs 100 %) (p = 0.03). [18F]FDG-avid nodules were detected with slightly higher sensitivity on the PET of the PET/MR compared to the PET of the PET/CT (59 vs 49 %). CONCLUSION Our streamlined ferumoxytol-enhanced PET/MR protocol provided cancer staging of children and young adults in less than 1 h with equivalent or superior clinical information compared to clinical standard staging tests. The detection of small pulmonary nodules with PET/MR needs to be improved.
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Yoder JS, Kogan F, Gold GE. Applications of PET-Computed Tomography-Magnetic Resonance in the Management of Benign Musculoskeletal Disorders. PET Clin 2019; 14:1-15. [PMID: 30420212 PMCID: PMC6245663 DOI: 10.1016/j.cpet.2018.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Although computed tomography (CT) and MR imaging alone have been used extensively to evaluate various musculoskeletal disorders, hybrid imaging modalities of PET-CT and PET-MR imaging were recently developed, combining the advantages of each method: molecular information from PET and anatomical information from CT or MR imaging. Furthermore, different radiotracers can be used in PET to uncover different disease mechanisms. In this article, potential applications of PET-CT and PET-MR imaging for benign musculoskeletal disorders are organized by benign cell proliferation/dysplasia, diabetic foot complications, joint prostheses, degeneration, inflammation, and trauma, metabolic bone disorders, and pain (acute and chronic) and peripheral nerve imaging.
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Affiliation(s)
- James S Yoder
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Feliks Kogan
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Garry E Gold
- Department of Radiology, Stanford University, Stanford, CA, USA; Department of Bioengineering, Stanford University, Stanford, CA, USA; Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA.
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Abstract
PURPOSE OF REVIEW This review article attempts to summarize the current state and applications of the hybrid imaging modality of PET-MRI to metabolic bone diseases. The advances of PET and MRI are also discussed for metabolic bone diseases as potentially applied via PET-MRI. RECENT FINDINGS Etiologies and mechanisms of metabolic bone disease can be complex where molecular changes precede structural changes. Although PET-MRI has yet to be applied directly to metabolic bone disease, possible applications exist since PET, specifically 18F-NaF PET, can quantitatively track changes in bone metabolism and is useful for assessing treatment, while MRI can give detailed information on bone water concentration, porosity, and architecture through novel techniques such as UTE and ZTE MRI. Earlier detection and further understanding of metabolic bone disease via PET and MRI could lead to better treatment and prevention. More research using this modality is needed to further understand how it can be implemented in this realm.
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Affiliation(s)
- James S Yoder
- Department of Radiology, Stanford University, 1201 Welch Rd, Stanford, CA, 94305, USA
| | - Feliks Kogan
- Department of Radiology, Stanford University, 1201 Welch Rd, Stanford, CA, 94305, USA
| | - Garry E Gold
- Department of Radiology, Stanford University, 1201 Welch Rd, Stanford, CA, 94305, USA.
- Bioengineering, Stanford University, Stanford, CA, USA.
- Orthopaedic Surgery, Stanford University, Stanford, CA, USA.
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Pawaskar A, Basu S, Jahangiri P, Alavi A. In Vivo Molecular Imaging of Musculoskeletal Inflammation and Infection. PET Clin 2018; 14:43-59. [PMID: 30420221 DOI: 10.1016/j.cpet.2018.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In vivo molecular imaging detects biologic processes at molecular level and provides diagnostic information at an earlier time point during disease onset or repair. It offers definite advantage over anatomic imaging in terms of improved sensitivity and ability to quantify. Radionuclide molecular imaging has been widely used in clinical practice. This article discusses the role of radionuclide imaging in various infective and inflammatory diseases affecting musculoskeletal system with a focus on PET. It appears that, as more data become available, combined PET/MR imaging could emerge as a front runner in the imaging of musculoskeletal infection and inflammation.
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Affiliation(s)
- Alok Pawaskar
- Oncolife Cancer Centre, Satara, Maharashtra 415519, India; Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Centre Annexe, Parel, Mumbai, Maharashtra 400012, India
| | - Sandip Basu
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Centre Annexe, Parel, Mumbai, Maharashtra 400012, India; Homi Bhabha National Institute, Mumbai, Maharashtra, India.
| | - Pegah Jahangiri
- Division of Nuclear Medicine, Hospital of University of Pennsylvania, Philadelphia, PA, USA
| | - Abass Alavi
- Division of Nuclear Medicine, Hospital of University of Pennsylvania, Philadelphia, PA, USA
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Frączek M, Kamecki H, Kamecka A, Sosnowski R, Sklinda K, Czarniecki M, Królicki L, Walecki J. Evaluation of lymph node status in patients with urothelial carcinoma-still in search of the perfect imaging modality: a systematic review. Transl Androl Urol 2018; 7:783-803. [PMID: 30456182 PMCID: PMC6212628 DOI: 10.21037/tau.2018.08.28] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
While accurate lymph node status evaluation in urothelial carcinoma patients is essential for the correct disease staging and, hence, establishing the most beneficial treatment strategy, the diagnostic performance of routine imaging in regards to this issue is not satisfactory. For the purpose of this article, we systematically reviewed the contemporary literature on the sensitivity and specificity of particular imaging modalities which have been studied for detecting lymph node metastases in patients diagnosed with urothelial carcinoma. The evidence reviewed shows that computed tomography (CT), although recognized as the imaging modality of choice, is associated with marked limitations, resulting in its low sensitivity for lymph node involvement detection in urothelial carcinoma patients, with no study reporting a value higher than 46% using standard cut-off values. Markedly higher sensitivity rates may be achieved with magnetic resonance imaging (MRI), especially when using ultrasmall superparamagnetic iron oxide as the contrast agent, however, no uniform protocol has been systematically studied up to date. The vast majority of recent evidence concerns positron emission tomography (PET), which is being reported to improve the diagnostic performance of CT alone, as has been demonstrated in multiple articles, which investigated the accuracy of PET/CT at primary or post-treatment staging of urothelial carcinoma patients. However, there has been substantial heterogeneity in terms of methodology and results between those studies, making it premature to draw any definitive conclusions. The results of this review lead to a conclusion, that while CT, despite being not fully satisfactory, still remains the gold-standard method of imaging for staging purposes in urothelial carcinoma, other imaging modalities are under investigation, with promising results.
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Affiliation(s)
- Michał Frączek
- Department of Radiology, Medical Center of Postgraduate Education, Warsaw, Poland
| | - Hubert Kamecki
- Department of Urogenital Cancer, Oncology Center-M. Skłodowska-Curie Institute, Warsaw, Poland
| | - Anna Kamecka
- Department of Pediatric Radiology, Public Children's Teaching Hospital, Warsaw, Poland
| | - Roman Sosnowski
- Department of Urogenital Cancer, Oncology Center-M. Skłodowska-Curie Institute, Warsaw, Poland
| | - Katarzyna Sklinda
- Department of Radiology, Medical Center of Postgraduate Education, Warsaw, Poland
| | - Marcin Czarniecki
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Leszek Królicki
- Department of Nuclear Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Jerzy Walecki
- Department of Radiology, Medical Center of Postgraduate Education, Warsaw, Poland
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Behzadi AH, Raza SI, Carrino JA, Kosmas C, Gholamrezanezhad A, Basques K, Matcuk GR, Patel J, Jadvar H. Applications of PET/CT and PET/MR Imaging in Primary Bone Malignancies. PET Clin 2018; 13:623-634. [PMID: 30219192 DOI: 10.1016/j.cpet.2018.05.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Primary bone malignancies are characterized with anatomic imaging. However, in recent years, there has been an increased interest in PET/computed tomography scanning and PET/MRI with fludeoxyglucose F 18 for evaluating and staging musculoskeletal neoplasms. These hybrid imaging modalities have shown promise largely owing to their high sensitivity, ability to perform more thorough staging, and ability to monitor treatment response. This article reviews the current role of PET/computed tomography scanning and PET/MRI in primary malignancies of bone, with an emphasis on imaging characteristics, clinical usefulness, and current limitations.
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Affiliation(s)
| | - Syed Imran Raza
- Department of Radiology, Weill Cornell Medical Center, 525 East 68th Street, New York, NY 10065, USA
| | - John A Carrino
- Department of Radiology and Imaging, 535 East 70th Street, Hospital for Special Surgery, New York, NY 10021, USA
| | - Christos Kosmas
- Department of Radiology and Imaging, University Hospitals of Cleveland, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Ali Gholamrezanezhad
- Division of Musculoskeletal Radiology, Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA 90007, USA
| | - Kyle Basques
- Department of Radiology and Imaging, University Hospitals of Cleveland, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - George R Matcuk
- Division of Musculoskeletal Radiology, Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA 90007, USA
| | - Jay Patel
- Department of Radiology, Weill Cornell Medical Center, 525 East 68th Street, New York, NY 10065, USA
| | - Hossein Jadvar
- Division of Nuclear Medicine, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90007, USA
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Wang YH, An Y, Fan XT, Lu J, Ren LK, Wei PH, Cui BX, Du JL, Lu C, Wang D, Zhang HQ, Shan YZ, Zhao GG. Comparison between simultaneously acquired arterial spin labeling and 18F-FDG PET in mesial temporal lobe epilepsy assisted by a PET/MR system and SEEG. NEUROIMAGE-CLINICAL 2018; 19:824-830. [PMID: 30013926 PMCID: PMC6024198 DOI: 10.1016/j.nicl.2018.06.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 06/02/2018] [Accepted: 06/04/2018] [Indexed: 11/26/2022]
Abstract
Objective In the detection of seizure onset zones, arterial spin labeling (ASL) can overcome the limitations of positron emission tomography (PET) with 18F-fluorodeoxyglucose (18F-FDG), which is invasive, expensive, and radioactive. PET/magnetic resonance (MR) systems have been introduced that allow simultaneous performance of ASL and PET, but comparisons of these techniques with stereoelectroencephalography (SEEG) and comparisons among the treatment outcomes of these techniques are still lacking. Here, we investigate the effectiveness of ASL compared with that of SEEG and their outcomes in localizing mesial temporal lobe epilepsy (MTLE) and assess the correlation between simultaneously acquired PET and ASL. Methods Between October 2016 and August 2017, we retrospectively studied 12 patients diagnosed with pure unilateral MTLE. We extracted and quantitatively computed values for ASL and PET in the bilateral hippocampus. SEEG findings and outcome were considered the gold standard of lateralization. Finally, the bilateral asymmetry index (AI) was calculated to assess the correlation between PET and ASL. Results Our results showed that hypoperfusion in the hippocampus detected using ASL matched the SEEG-defined epileptogenic zone in this series of patients. The mean normalized voxel value of ASL in the contralateral hippocampus was 0.97 ± 0.19, while in the ipsilateral hippocampus, it was 0.84 ± 0.14. Meanwhile, significantly decreased perfusion and metabolism were observed in these patients (Wilcoxon, p < 0.05), with a significant positive correlation between the AI values derived from PET and ASL (Pearson's correlation, r = 0.74, p < 0.05). Significance In our SEEG- and outcome-defined patients with MTLE, ASL could provide significant information during presurgical evaluation, with the hypoperfusion detected with ASL reliably lateralizing MTLE. This non-invasive technique may be used as an alternative diagnostic tool for MTLE lateralization. ASL has been increasingly used in presurgical evaluations in epilepsy recent years. Comparisons of ASL and PET with a PET/MR system using SEEG and treatment outcomes as gold-standard are still lacking. Decreased perfusion consistent with hypometabolism and SEEG was observed with ASL. ASL offers an effective non-invasive alternative to PET in evaluation of MTLE.
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Affiliation(s)
- Yi-He Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yang An
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Xiao-Tong Fan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Jie Lu
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; Department of Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Lian-Kun Ren
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Peng-Hu Wei
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Bi-Xiao Cui
- Department of Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Jia-Lin Du
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Chao Lu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Di Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Hua-Qiang Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yong-Zhi Shan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
| | - Guo-Guang Zhao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorder, Beijing 100069, China.
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Queiroz MA, Barbosa FDG, Buchpiguel CA, Cerri GG. Positron emission tomography/magnetic resonance imaging (PET/MRI): An update and initial experience at HC-FMUSP. ACTA ACUST UNITED AC 2018; 64:71-84. [PMID: 29561945 DOI: 10.1590/1806-9282.64.01.71] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 08/17/2017] [Indexed: 01/16/2023]
Abstract
The new technology of PET/MRI is a prototype of hybrid imaging, allowing for the combination of molecular data from PET scanning and morphofunctional information derived from MRI scanning. Recent advances regarding the technical aspects of this device, especially after the development of MRI-compatible silicon photomultipliers of PET, permitted an increase in the diagnostic performance of PET/MRI translated into dose reduction and higher imaging quality. Among several clinical applications, PET/MRI gains ground initially in oncology, where MRI per se plays an essential role in the assessment of primary tumors (which is limited in the case of PET/CT), including prostate, rectal and gynecological tumors. On the other hand, the evaluation of the lungs remains an enigma although new MRI sequences are being designed to overcome this. More clinical indications of PET/MRI are seen in the fields of neurology, cardiology and inflammatory processes, and the use of PET/MRI also opens perspectives for pediatric populations as it involves very low radiation exposure. Our review aimed to highlight the current indications of PET/MRI and discuss the challenges and perspectives of PET/MRI at HC-FMUSP.
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Affiliation(s)
- Marcelo A Queiroz
- Institute of Radiology (InRad), Hospital das Clínicas da Faculdade de Medicina da USP (HC-FMUSP), São Paulo, SP, Brazil.,Service of Medical Imaging, Hospital Sírio-Libanês, São Paulo, SP, Brazil
| | | | - Carlos Alberto Buchpiguel
- Institute of Radiology (InRad), Hospital das Clínicas da Faculdade de Medicina da USP (HC-FMUSP), São Paulo, SP, Brazil.,Service of Medical Imaging, Hospital Sírio-Libanês, São Paulo, SP, Brazil
| | - Giovanni Guido Cerri
- Institute of Radiology (InRad), Hospital das Clínicas da Faculdade de Medicina da USP (HC-FMUSP), São Paulo, SP, Brazil.,Service of Medical Imaging, Hospital Sírio-Libanês, São Paulo, SP, Brazil
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Chan SC, Yeh CH, Yen TC, Ng SH, Chang JTC, Lin CY, Yen-Ming T, Fan KH, Huang BS, Hsu CL, Chang KP, Wang HM, Liao CT. Clinical utility of simultaneous whole-body 18F-FDG PET/MRI as a single-step imaging modality in the staging of primary nasopharyngeal carcinoma. Eur J Nucl Med Mol Imaging 2018; 45:1297-1308. [PMID: 29502310 DOI: 10.1007/s00259-018-3986-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 02/19/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE Both head and neck magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) play a crucial role in the staging of primary nasopharyngeal carcinoma (NPC). In this study, we sought to prospectively investigate the clinical utility of simultaneous whole-body 18F-FDG PET/MRI for primary staging of NPC patients. METHODS We examined 113 patients with histologically confirmed NPC who underwent pretreatment, simultaneous whole-body PET/MRI and PET/CT for primary tumor staging. The images obtained with the different imaging modalities were interpreted independently and compared with each other. RESULTS PET/MRI increased the accuracy of head and neck MRI for assessment of primary tumor extent in four patients via addition of FDG uptake information to increase the conspicuity of morphologically subtle lesions. PET/MR images were more discernible than PET/CT images for mapping tumor extension, especially intracranial invasion. Regarding the N staging assessment, the sensitivity of PET/MRI (99.5%) was higher than that of head and neck MRI (94.2%) and PET/CT (90.9%). PET/MRI was particularly useful for distinguishing retropharyngeal nodal metastasis from adjacent nasopharyngeal tumors. For distant metastasis evaluation, PET/MRI exhibited a similar sensitivity (90% vs. 86.7% vs. 83.3%), but higher positive predictive value (93.1% vs. 78.8% vs. 83.3%) than whole-body MRI and PET/CT, respectively. CONCLUSIONS For tumor staging of NPC, simultaneous whole-body PET/MRI was more accurate than head and neck MRI and PET/CT, and may serve as a single-step staging modality.
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Affiliation(s)
- Sheng-Chieh Chan
- Department of Nuclear Medicine, Linkou Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chih-Hua Yeh
- Department of Diagnostic Radiology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Tzu-Chen Yen
- Department of Nuclear Medicine, Linkou Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Shu-Hang Ng
- Department of Diagnostic Radiology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chien-Yu Lin
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Tsang Yen-Ming
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Kang-Hsing Fan
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Bing-Shen Huang
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Lung Hsu
- Division of Medical Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Kai-Ping Chang
- Department of Otorhinolaryngology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Hung-Ming Wang
- Division of Medical Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chun-Ta Liao
- Department of Otorhinolaryngology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
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Abstract
Molecular imaging (mainly PET and MR imaging) has played important roles in gynecologic oncology. Emerging MR-based technologies, including DWI, CEST, DCE-MR imaging, MRS, and DNP, as well as FDG-PET and many novel PET radiotracers, will continuously improve practices. In combination with radiomics analysis, a new era of decision making in personalized medicine and precisely guided radiation treatment planning or real-time surgical interventions is being entered into, which will directly impact on patient survival. Prospective trials with well-defined endpoints are encouraged to evaluate the multiple facets of these emerging imaging tools in the management of gynecologic malignancies.
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Affiliation(s)
- Gigin Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 5 Fu-Shin Street, Kueishan, Taoyuan 333, Taiwan
| | - Chyong-Huey Lai
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 5 Fu-Shin Street, Kueishan, Taoyuan 333, Taiwan.
| | - Tzu-Chen Yen
- Department of Nuclear Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 5 Fu-Shin Street, Kueishan, Taoyuan 333, Taiwan
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Mikhaylova E, Tabacchini V, Borghi G, Mollet P, D’Hoe E, Schaart DR, Vandenberghe S. Optimization of an ultralow-dose high-resolution pediatric PET scanner design based on monolithic scintillators with dual-sided digital SiPM readout: a simulation study. ACTA ACUST UNITED AC 2017; 62:8402-8418. [DOI: 10.1088/1361-6560/aa8eb2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Gatidis S, Gückel B, la Fougère C, Schmitt J, Schäfer JF. [Simultaneous whole-body PET-MRI in pediatric oncology : More than just reducing radiation?]. Radiologe 2017; 56:622-30. [PMID: 27306199 DOI: 10.1007/s00117-016-0122-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Diagnostic imaging plays an essential role in pediatric oncology with regard to diagnosis, therapy-planning, and the follow-up of solid tumors. The current imaging standard in pediatric oncology includes a variety of radiological and nuclear medicine imaging modalities depending on the specific tumor entity. The introduction of combined simultaneous positron emission tomography (PET) and magnetic resonance imaging (MRI) has opened up new diagnostic options in pediatric oncology. This novel modality combines the excellent anatomical accuracy of MRI with the metabolic information of PET. In initial clinical studies, the technical feasibility and possible diagnostic advantages of combined PET-MRI have been in comparison with alternative imaging techniques. It was shown that a reduction in radiation exposure of up to 70 % is achievable compared with PET-CT. Furthermore, it has been shown that the number of imaging studies necessary can be markedly reduced using combined PET-MRI. Owing to its limited availability, combined PET-MRI is currently not used as a routine procedure. However, this new modality has the potential to become the imaging reference standard in pediatric oncology in the future. This review article summarizes the central aspects of pediatric oncological PET-MRI based on existing literature. Typical pediatric oncological PET-MRI cases are also presented.
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Affiliation(s)
- S Gatidis
- Radiologische Klinik, Diagnostische und Interventionelle Radiologie, Universität Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland.
| | - B Gückel
- Radiologische Klinik, Diagnostische und Interventionelle Radiologie, Universität Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
| | - C la Fougère
- Radiologische Klinik, Nuklearmedizin, Universität Tübingen, Tübingen, Deutschland
| | - J Schmitt
- Abteilung für Präklinische Bildgebung und Radiopharmazie, Werner Siemens Imaging Center, Universität Tübingen, Tübingen, Deutschland
| | - J F Schäfer
- Radiologische Klinik, Diagnostische und Interventionelle Radiologie, Universität Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
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PET/MRI in children. Eur J Radiol 2017; 94:A64-A70. [DOI: 10.1016/j.ejrad.2017.01.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/16/2017] [Accepted: 01/17/2017] [Indexed: 01/30/2023]
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Bagheri MH, Ahlman MA, Lindenberg L, Turkbey B, Lin J, Cahid Civelek A, Malayeri AA, Agarwal PK, Choyke PL, Folio LR, Apolo AB. Advances in medical imaging for the diagnosis and management of common genitourinary cancers. Urol Oncol 2017; 35:473-491. [PMID: 28506596 PMCID: PMC5931389 DOI: 10.1016/j.urolonc.2017.04.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 04/05/2017] [Accepted: 04/15/2017] [Indexed: 01/01/2023]
Abstract
Medical imaging of the 3 most common genitourinary (GU) cancers-prostate adenocarcinoma, renal cell carcinoma, and urothelial carcinoma of the bladder-has evolved significantly during the last decades. The most commonly used imaging modalities for the diagnosis, staging, and follow-up of GU cancers are computed tomography, magnetic resonance imaging (MRI), and positron emission tomography (PET). Multiplanar multidetector computed tomography and multiparametric MRI with diffusion-weighted imaging are the main imaging modalities for renal cell carcinoma and urothelial carcinoma, and although multiparametric MRI is rapidly becoming the main imaging tool in the evaluation of prostate adenocarcinoma, biopsy is still required for diagnosis. Functional and molecular imaging using 18-fluorodeoxyglucose-PET and sodium fluoride-PET are essential for the diagnosis, and especially follow-up, of metastatic GU tumors. This review provides an overview of the latest advances in the imaging of these 3 major GU cancers.
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Affiliation(s)
- Mohammad H Bagheri
- Clinical Image Processing Service, Radiology and Imaging Sciences Department, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Mark A Ahlman
- Nuclear Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD; Radiology and Imaging Sciences Department, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Liza Lindenberg
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Baris Turkbey
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Jeffrey Lin
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Ali Cahid Civelek
- Radiology and Imaging Sciences Department, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Ashkan A Malayeri
- Radiology and Imaging Sciences Department, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Piyush K Agarwal
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Peter L Choyke
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Les R Folio
- Radiology and Imaging Sciences Department, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Andrea B Apolo
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD.
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Abstract
Nuclear medicine has an important role in the management of many cancers in pediatric age group with multiple imaging modalities and radiopharmaceuticals targeting various biological uptake mechanisms. 18-Flourodeoxyglucose is the radiotracer of choice especially in patients with sarcoma and lymphoma. (18)FDG-PET, for sarcoma and lymphomas, is proved to be superior to conventional imaging in staging and therapy response. Although studies are limited in pediatric population, (18)FDG-PET/CT has found its way through international guidelines. Limitations and strengths of PET imaging must be noticed before adapting PET imaging in clinical protocols. Established new response criteria using multiple parameters derived from (18)FDG-PET would increase the accuracy and repeatability of response evaluation. Current data suggest that I-123 metaiodobenzylguanidine (MIBG) remains the tracer of choice in the evaluation of neuroblastoma (NB) because of its high sensitivity, specificity, diagnostic accuracy, and prognostic value. It is valuable in determining the response to therapy, surveillance for disease recurrence, and in selecting patients for I-131 therapy. SPECT/CT improves the diagnostic accuracy and the interpretation confidence of MIBG scans. (18)FDG-PET/CT is an important complementary to MIBG imaging despite its lack of specificity to NB. It is valuable in cases of negative or inconclusive MIBG scans and when MIBG findings underestimate the disease status as determined from clinical and radiological findings. F-18 DOPA is promising tracer that reflects catecholamine metabolism and is both sensitive and specific. F-18 DOPA scintigraphy provides the advantages of PET/CT imaging with early and short imaging times, high spatial resolution, inherent morphologic correlation with CT, and quantitation. Regulatory and production issues currently limit the tracer's availability. PET/CT with Ga-68 DOTA appears to be useful in NB imaging and may have a unique role in selecting patients for peptide receptor radionuclide therapy with somatostatin analogues. C-11 hydroxyephedrine PET/CT is a specific PET tracer for NB, but the C-11 label that requires an on-site cyclotron production and the high physiologic uptake in the liver and kidneys limit its use. I-124 MIBG is useful for I-131 MIBG pretherapeutic dosimetry planning. Its use for diagnostic imaging as well as the use of F-18 labeled MIBG analogues is currently experimental. PET/MR imaging is emerging and is likely to become an important tool in the evaluation. It provides metabolic and superior morphological data in one imaging session, expediting the diagnosis and lowering the radiation exposure. Radioactive iodines not only detect residual tissue and metastatic disease but also are used in the treatment of differentiated thyroid cancer. However, these are not well documented in pediatric age group like adult patients. Use of radioactivity in pediatric population is very important and strictly controlled because of the possibility of secondary malignities; therefore, management of oncological cases requires detailed literature knowledge. This article aims to review the literature on the use of radionuclide imaging and therapy in pediatric population with thyroid cancer, sarcomas, lymphoma, and NB.
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Affiliation(s)
- Pınar Özgen Kiratli
- Department of Nuclear Medicine, Hacettepe University Medical Center, Ankara, Turkey.
| | - Murat Tuncel
- Department of Nuclear Medicine, Hacettepe University Medical Center, Ankara, Turkey
| | - Zvi Bar-Sever
- Department of Nuclear Medicine, Schneider Children's Medical Center, Petah Tikva, Israel
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50
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Lee YZ, Oldan JD, Fordham LA. Pediatric Applications of Hybrid PET/MR Imaging. Magn Reson Imaging Clin N Am 2017; 25:367-375. [DOI: 10.1016/j.mric.2016.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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