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Guimarães JB, da Cruz IAN, Ahlawat S, Ormond Filho AG, Nico MAC, Lederman HM, Fayad LM. The Role of Whole-Body MRI in Pediatric Musculoskeletal Oncology: Current Concepts and Clinical Applications. J Magn Reson Imaging 2024; 59:1886-1901. [PMID: 34145692 DOI: 10.1002/jmri.27787] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 06/04/2021] [Accepted: 06/04/2021] [Indexed: 01/23/2023] Open
Abstract
Whole-body magnetic resonance imaging (WB-MRI) has gained importance in the field of musculoskeletal oncology over the last decades, consisting in a one-stop imaging method that allows a wide coverage assessment of both bone and soft tissue involvement. WB-MRI is valuable for diagnosis, staging, and follow-up in many oncologic diseases and is especially advantageous for the pediatric population since it avoids redundant examinations and exposure to ionizing radiation in patients who often undergo long-term surveillance. Its clinical application has been studied in many pediatric neoplasms, such as cancer predisposition syndromes, Langerhans cell histiocytosis, lymphoma, sarcomas, and neuroblastoma. The addition of diffusion-weighted sequences allows functional evaluation of neoplastic lesions, which is helpful in the assessment of viable tumor and response to treatment after neoadjuvant or adjuvant therapy. WB-MRI is an excellent alternative to fluorodeoxyglucose-positron emission tomography/computed tomography in oncologic children, with comparable accuracy and the convenience of being radiation-free, fast to perform, and available at a similar cost. The development of new techniques and protocols makes WB-MRI increasingly faster, safer, and more accessible, and it is important for referring physicians and radiologists to recognize the role of this imaging method in pediatric oncology. LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Júlio Brandão Guimarães
- Diagnostic Imaging Center, Pediatric Oncology Institute, Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), São Paulo, Brazil
- Department of Radiology, Fleury Group, São Paulo, Brazil
- Department of Radiology, Federal University of São Paulo, São Paulo, Brazil
| | | | - Shivani Ahlawat
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland, USA
| | - Alípio Gomes Ormond Filho
- Diagnostic Imaging Center, Pediatric Oncology Institute, Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), São Paulo, Brazil
| | - Marcelo Astolfi Caetano Nico
- Diagnostic Imaging Center, Pediatric Oncology Institute, Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), São Paulo, Brazil
| | - Henrique Manoel Lederman
- Diagnostic Imaging Center, Pediatric Oncology Institute, Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), São Paulo, Brazil
- Department of Radiology, Federal University of São Paulo, São Paulo, Brazil
| | - Laura Marie Fayad
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland, USA
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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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Spadafora M, Sannino P, Mansi L, Mainolfi C, Capasso R, Di Giorgio E, Fiordoro S, Imbimbo S, Masone F, Evangelista L. Algorithm for Reducing Overall Biological Detriment Caused by PET/CT: an Age-Based Study. Nucl Med Mol Imaging 2023; 57:137-144. [PMID: 37181801 PMCID: PMC10172419 DOI: 10.1007/s13139-023-00788-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 01/16/2023] [Accepted: 01/28/2023] [Indexed: 02/09/2023] Open
Abstract
Purpose This study is to use a simple algorithm based on patient's age to reduce the overall biological detriment associated with PET/CT. Materials and Methods A total of 421 consecutive patients (mean age 64 ± 14 years) undergoing PET for various clinical indications were enrolled. For each scan, effective dose (ED in mSv) and additional cancer risk (ACR) were computed both in a reference condition (REF) and after applying an original algorithm (ALGO). The ALGO modified the mean dose of FDG and the PET scan time parameters; indeed, a lower dose and a longer scan time were reported in the younger, while a higher dose and a shorter scan time in the older patients. Moreover, patients were classified by age bracket (18-29, 30-60, and 61-90 years). Results The ED was 4.57 ± 0.92 mSv in the REF condition. The ACR were 0.020 ± 0.016 and 0.0187 ± 0.013, respectively, in REF and ALGO. The ACR for the REF and ALGO conditions were significantly reduced in males and females, although it was more evident in the latter gender (all p < 0.0001). Finally, the ACR significantly reduced from the REF condition to ALGO in all three age brackets (all p < 0.0001). Conclusion Implementation of ALGO protocols in PET can reduce the overall ACR, mainly in young and female patients.
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Affiliation(s)
| | | | - Luigi Mansi
- CIRPS, Interuniversity Research Center for Sustainability, Rome, Italy
- IOS–Medicina Futura, Acerra, Naples, Italy
| | - Ciro Mainolfi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | | | | | | | | | - Laura Evangelista
- Nuclear Medicine Unit, Department of Medicine (DIMED), University of Padua, Via Giustiniani 2, 35128 Padua, Italy
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Adams LC, Jayapal P, Ramasamy SK, Morakote W, Yeom K, Baratto L, Daldrup-Link HE. Ferumoxytol-Enhanced MRI in Children and Young Adults: State of the Art. AJR Am J Roentgenol 2023; 220:590-603. [PMID: 36197052 PMCID: PMC10038879 DOI: 10.2214/ajr.22.28453] [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] [Indexed: 11/18/2022]
Abstract
Ferumoxytol is an ultrasmall iron oxide nanoparticle that was originally approved by the FDA in 2009 for IV treatment of iron deficiency in adults with chronic kidney disease. Subsequently, its off-label use as an MRI contrast agent increased in clinical practice, particularly in pediatric patients in North America. Unlike conventional MRI contrast agents that are based on the rare earth metal gadolinium (gadolinium-based contrast agents), ferumoxytol is biodegradable and carries no potential risk of nephrogenic systemic fibrosis. At FDA-approved doses, ferumoxytol shows no long-term tissue retention in patients with intact iron metabolism. Ferumoxytol provides unique MRI properties, including long-lasting vascular retention (facilitating high-quality vascular imaging) and retention in reticuloendothelial system tissues, thereby supporting a variety of applications beyond those possible with gadolinium-based contrast agents (GBCAs). This Clinical Perspective describes clinical and early translational applications of ferumoxytol-enhanced MRI in children and young adults through off-label use in a variety of settings, including vascular, cardiac, and cancer imaging, drawing on the institutional experience of the authors. In addition, we describe current advances in pre-clinical and clinical research using ferumoxytol in cellular and molecular imaging as well as the use of ferumoxytol as a novel potential cancer therapeutic agent.
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Affiliation(s)
- Lisa C. Adams
- 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
| | - Praveen Jayapal
- 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
| | - Shakthi Kumaran Ramasamy
- 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
| | - Wipawee Morakote
- 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
| | - Kristen Yeom
- 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
| | - 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
| | - 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
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Padwal J, Baratto L, Chakraborty A, Hawk K, Spunt S, Avedian R, Daldrup-Link HE. PET/MR of pediatric bone tumors: what the radiologist needs to know. Skeletal Radiol 2023; 52:315-328. [PMID: 35804163 PMCID: PMC9826799 DOI: 10.1007/s00256-022-04113-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/11/2022] [Accepted: 06/29/2022] [Indexed: 02/02/2023]
Abstract
Integrated 2-deoxy-2-[fluorine-18]fluoro-D-glucose (18F-FDG) positron emission tomography (PET)/magnetic resonance (MR) imaging can provide "one stop" local tumor and whole-body staging in one session, thereby streamlining imaging evaluations and avoiding duplicate anesthesia in young children. 18F-FDG PET/MR scans have the benefit of lower radiation, superior soft tissue contrast, and increased patient convenience compared to 18F-FDG PET/computerized tomography scans. This article reviews the 18F-FDG PET/MR imaging technique, reporting requirements, and imaging characteristics of the most common pediatric bone tumors, including osteosarcoma, Ewing sarcoma, primary bone lymphoma, bone and bone marrow metastases, and Langerhans cell histiocytosis.
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Affiliation(s)
- Jennifer Padwal
- Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Lucia Baratto
- Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Amit Chakraborty
- Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Kristina Hawk
- Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Sheri Spunt
- Department of Pediatrics, Stanford University, 725 Welch Rd., Rm. 1665, Stanford, CA, 94305-5614, USA
| | - Raffi Avedian
- Department of Surgery, Division of Pediatric Orthopedic Surgery, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, 94305, USA
| | - Heike E Daldrup-Link
- Department of Radiology, Stanford University, Stanford, CA, 94305, USA.
- Cancer Imaging Program, Stanford Cancer Institute, Stanford, USA.
- Department of Pediatrics, Stanford University, 725 Welch Rd., Rm. 1665, Stanford, CA, 94305-5614, USA.
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García Cañamaque L, Field CA, Furtado FS, Plaza DE Las Heras I, Husseini JS, Balza R, Jarraya M, Catalano OA, Mitjavila Casanovas M. Contribution of positron emission tomography/magnetic resonance imaging in musculoskeletal malignancies. 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... 2022; 66:3-14. [PMID: 34881853 DOI: 10.23736/s1824-4785.21.03432-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Positron emission tomography/computed tomography (PET/CT) is a promising hybrid imaging technique for evaluating musculoskeletal malignancies. Both technologies, independently are useful for evaluating this type of tumors. PET/MR has great potential combining metabolic and functional imaging PET with soft tissue contrast and multiparametric sequences of MR. In this paper we review the existing literature and discuss the different protocols, new available radiotracers to conclude with the scarce evidence available the most useful/probable indications of the PET MR for the for musculoskeletal malignancies.
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Affiliation(s)
- Lina García Cañamaque
- Department of Nuclear Medicine, Madrid Sanchinarro University Hospital, Madrid, Spain -
| | - Caroline A Field
- Department of Nuclear Medicine, Madrid Sanchinarro University Hospital, Madrid, Spain
| | - Felipe S Furtado
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Jad S Husseini
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Rene Balza
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Mohamed Jarraya
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Onofrio A Catalano
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
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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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Daldrup-Link HE, Theruvath AJ, Rashidi A, Iv M, Majzner RG, Spunt SL, Goodman S, Moseley M. How to stop using gadolinium chelates for magnetic resonance imaging: clinical-translational experiences with ferumoxytol. Pediatr Radiol 2022; 52:354-366. [PMID: 34046709 PMCID: PMC8626538 DOI: 10.1007/s00247-021-05098-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/01/2021] [Accepted: 04/28/2021] [Indexed: 12/17/2022]
Abstract
Gadolinium chelates have been used as standard contrast agents for clinical MRI for several decades. However, several investigators recently reported that rare Earth metals such as gadolinium are deposited in the brain for months or years. This is particularly concerning for children, whose developing brain is more vulnerable to exogenous toxins compared to adults. Therefore, a search is under way for alternative MR imaging biomarkers. The United States Food and Drug Administration (FDA)-approved iron supplement ferumoxytol can solve this unmet clinical need: ferumoxytol consists of iron oxide nanoparticles that can be detected with MRI and provide significant T1- and T2-signal enhancement of vessels and soft tissues. Several investigators including our research group have started to use ferumoxytol off-label as a new contrast agent for MRI. This article reviews the existing literature on the biodistribution of ferumoxytol in children and compares the diagnostic accuracy of ferumoxytol- and gadolinium-chelate-enhanced MRI. Iron oxide nanoparticles represent a promising new class of contrast agents for pediatric MRI that can be metabolized and are not deposited in the brain.
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Affiliation(s)
- Heike E. Daldrup-Link
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Stanford University
- Department of Pediatrics, Division of Hematology/Oncology, Stanford University
| | - Ashok J. Theruvath
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Stanford University
| | - Ali Rashidi
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Stanford University
| | - Michael Iv
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Stanford University
| | - Robbie G. Majzner
- Department of Pediatrics, Division of Hematology/Oncology, Stanford University
| | - Sheri L. Spunt
- Department of Pediatrics, Division of Hematology/Oncology, Stanford University
| | | | - Michael Moseley
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Stanford University
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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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10
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Mundy DC, Goldberg JL. Nanoparticles as Cell Tracking Agents in Human Ocular Cell Transplantation Therapy. CURRENT OPHTHALMOLOGY REPORTS 2021. [DOI: 10.1007/s40135-021-00275-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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11
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Abstract
PET/MR imaging is in routine clinical use and is at least as effective as PET/CT for oncologic and neurologic studies with advantages with certain PET radiopharmaceuticals and applications. In addition, whole body PET/MR imaging substantially reduces radiation dosages compared with PET/CT which is particularly relevant to pediatric and young adult population. For cancer imaging, assessment of hepatic, pelvic, and soft-tissue malignancies may benefit from PET/MR imaging. For neurologic imaging, volumetric brain MR imaging can detect regional volume loss relevant to cognitive impairment and epilepsy. In addition, the single-bed position acquisition enables dynamic brain PET imaging without extending the total study length which has the potential to enhance the diagnostic information from PET.
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Affiliation(s)
- Farshad Moradi
- Department of Radiology, Stanford University, 300 Pasteur Drive, H2200, Stanford, CA 94305, USA.
| | - Andrei Iagaru
- Department of Radiology, Stanford University, 300 Pasteur Drive, H2200, Stanford, CA 94305, USA
| | - Jonathan McConathy
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, JT 773, Birmingham, AL 35249, USA
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12
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Muehe AM, Yerneni K, Theruvath AJ, Thakor AS, Pribnow A, Avedian R, Steffner R, Rosenberg J, Hawk KE, Daldrup-Link HE. Ferumoxytol Does Not Impact Standardized Uptake Values on PET/MR Scans. Mol Imaging Biol 2021; 22:722-729. [PMID: 31325083 DOI: 10.1007/s11307-019-01409-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Tumor response assessments on positron emission tomography (PET)/magnetic resonance imaging (MRI) scans require correct quantification of radiotracer uptake in tumors and normal organs. Historically, MRI scans have been enhanced with gadolinium (Gd)-based contrast agents, which are now controversial due to brain deposition. Recently, ferumoxytol nanoparticles have been identified as an alternative to Gd-based contrast agents because they provide strong tissue enhancement on MR images but are not deposited in the brain. However, it is not known if the strong T1- and T2-contrast obtained with iron oxide nanoparticles such as ferumoxytol could affect MR-based attenuation correction of PET data. The purpose of our study was to investigate if ferumoxytol administration prior to a 2-deoxy-2-[18F]fluoro-D-glucose [18F]FDG PET/MR scan would change standardized uptake values (SUV) of normal organs. PROCEDURES Thirty pediatric patients (6-18 years) with malignant tumors underwent [18F]FDG-PET/MR scans (dose 3 MBq/kg). Fifteen patients received an intravenous ferumoxytol injection (5 mg Fe/kg) prior to the [18F]FDG-PET/MR scans (group 1). Fifteen additional age- and sex-matched patients received unenhanced [18F]FDG-PET/MR scans (group 2). For attenuation correction of PET data, we used a Dixon-based gradient echo sequence (TR 4.2 ms, TE 1.1, 2.3 ms, FA 5), which accounted for soft tissue, lung, fat, and background air. We used a mixed linear effects model to compare the tissue MRI enhancement, quantified as the signal-to-noise ratio (SNR), as well as tissue radiotracer signal, quantified as SUVmean and SUVmax, between group 1 and group 2. Alpha was assumed at 0.05. RESULTS The MRI enhancement of the blood and solid extra-cerebral organs, quantified as SNR, was significantly higher on ferumoxytol-enhanced MRI scans compared to unenhanced scans (p < 0.001). However, SUVmean and SUVmax values, corrected based on the patients' body weight or body surface area, were not significantly different between the two groups (p > 0.05). CONCLUSION Ferumoxytol administration prior to a [18F]FDG PET/MR scan did not change standardized uptake values (SUV) of solid extra-cerebral organs. This is important, because it allows injection of ferumoxytol contrast prior to a PET/MRI procedure and, thereby, significantly accelerates image acquisition times.
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Affiliation(s)
- Anne M Muehe
- Department of Radiology, Pediatric Molecular Imaging Program, Stanford University, 725 Welch Road, Stanford, CA, 94304, USA
| | - Ketan Yerneni
- Department of Radiology, Pediatric Molecular Imaging Program, Stanford University, 725 Welch Road, Stanford, CA, 94304, USA
| | - Ashok J Theruvath
- Department of Radiology, Pediatric Molecular Imaging Program, Stanford University, 725 Welch Road, Stanford, CA, 94304, USA.,Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Avnesh S Thakor
- Department of Radiology, Pediatric Molecular Imaging Program, Stanford University, 725 Welch Road, Stanford, CA, 94304, USA
| | - Allison Pribnow
- Department of Pediatrics, Division of Hematology/Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Raffi Avedian
- Department of Orthopedic Surgery, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA
| | - Robert Steffner
- Department of Orthopedic Surgery, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA
| | - Jarrett Rosenberg
- Department of Radiology, Pediatric Molecular Imaging Program, Stanford University, 725 Welch Road, Stanford, CA, 94304, USA
| | - Kristina E Hawk
- Department of Radiology, Pediatric Molecular Imaging Program, Stanford University, 725 Welch Road, Stanford, CA, 94304, USA
| | - Heike E Daldrup-Link
- Department of Radiology, Pediatric Molecular Imaging Program, Stanford University, 725 Welch Road, Stanford, CA, 94304, USA. .,Department of Pediatrics, Division of Hematology/Oncology, Stanford University School of Medicine, Stanford, CA, USA.
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13
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Husseini JS, Amorim BJ, Torrado-Carvajal A, Prabhu V, Groshar D, Umutlu L, Herrmann K, Cañamaque LG, Garzón JRG, Palmer WE, Heidari P, Shih TTF, Sosna J, Matushita C, Cerci J, Queiroz M, Muglia VF, Nogueira-Barbosa MH, Borra RJH, Kwee TC, Glaudemans AWJM, Evangelista L, Salvatore M, Cuocolo A, Soricelli A, Herold C, Laghi A, Mayerhoefer M, Mahmood U, Catana C, Daldrup-Link HE, Rosen B, Catalano OA. An international expert opinion statement on the utility of PET/MR for imaging of skeletal metastases. Eur J Nucl Med Mol Imaging 2021; 48:1522-1537. [PMID: 33619599 PMCID: PMC8240455 DOI: 10.1007/s00259-021-05198-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/10/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND MR is an important imaging modality for evaluating musculoskeletal malignancies owing to its high soft tissue contrast and its ability to acquire multiparametric information. PET provides quantitative molecular and physiologic information and is a critical tool in the diagnosis and staging of several malignancies. PET/MR, which can take advantage of its constituent modalities, is uniquely suited for evaluating skeletal metastases. We reviewed the current evidence of PET/MR in assessing for skeletal metastases and provided recommendations for its use. METHODS We searched for the peer reviewed literature related to the usage of PET/MR in the settings of osseous metastases. In addition, expert opinions, practices, and protocols of major research institutions performing research on PET/MR of skeletal metastases were considered. RESULTS Peer-reviewed published literature was included. Nuclear medicine and radiology experts, including those from 13 major PET/MR centers, shared the gained expertise on PET/MR use for evaluating skeletal metastases and contributed to a consensus expert opinion statement. [18F]-FDG and non [18F]-FDG PET/MR may provide key advantages over PET/CT in the evaluation for osseous metastases in several primary malignancies. CONCLUSION PET/MR should be considered for staging of malignancies where there is a high likelihood of osseous metastatic disease based on the characteristics of the primary malignancy, hight clinical suspicious and in case, where the presence of osseous metastases will have an impact on patient management. Appropriate choice of tumor-specific radiopharmaceuticals, as well as stringent adherence to PET and MR protocols, should be employed.
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Affiliation(s)
- Jad S Husseini
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Bárbara Juarez Amorim
- Division of Nuclear Medicine, Department of Radiology, School of Medical Sciences,, State University of Campinas, Campinas, Brazil
| | - Angel Torrado-Carvajal
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
- Medical Image Analysis and Biometry Laboratory, Universidad Rey Juan Carlos, Madrid, Spain
| | - Vinay Prabhu
- Department of Radiology, NYU Langone Health, New York, NY, USA
| | - David Groshar
- Department of Nuclear Medicine, Assuta Medical Center, Tel Aviv, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Lina García Cañamaque
- Department of Nuclear Medicine, Hospital Universitario Madrid Sanchinarro, Madrid, Spain
| | | | - William E Palmer
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Pedram Heidari
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Tiffany Ting-Fang Shih
- Department of Radiology and Medical Imaging, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan
| | - Jacob Sosna
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Cristina Matushita
- Department of Nuclear Medicine, Hospital São Lucas of Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Juliano Cerci
- Department of Nuclear Medicine, Quanta Diagnóstico Nuclear, Curitiba, Brazil
| | - Marcelo Queiroz
- Department of Radiology and Oncology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Valdair Francisco Muglia
- Department of Medical Images, Radiation Therapy and Oncohematology, Ribeirao Preto Medical School, Hospital Clinicas, University of São Paulo, Ribeirão Prêto, Brazil
| | - Marcello H Nogueira-Barbosa
- Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School. University of São Paulo (USP), Ribeirão Prêto, Brazil
| | - Ronald J H Borra
- Medical Imaging Center, University Medical Center Groningen, Groningen, The Netherlands
| | - Thomas C Kwee
- Medical Imaging Center, University Medical Center Groningen, Groningen, The Netherlands
| | - Andor W J M Glaudemans
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | - Laura Evangelista
- Department of Clinical and Experimental Medicine, University of Padova, Padua, Italy
| | - Marco Salvatore
- Department of Radiology and Nuclear Medicine, Università Suor Orsola Benincasa di Napoli, Naples, Italy
- Department of Radiology and Nuclear Medicine, Institute for Hospitalization and Healthcare (IRCCS) SDN, Istituto di Ricerca, Naples, Italy
| | - Alberto Cuocolo
- Department of Radiology and Nuclear Medicine, Institute for Hospitalization and Healthcare (IRCCS) SDN, Istituto di Ricerca, Naples, Italy
- Department of Advanced Biomedical Science, University of Naples Federico II, Naples, Italy
| | - Andrea Soricelli
- Department of Radiology and Nuclear Medicine, Institute for Hospitalization and Healthcare (IRCCS) SDN, Istituto di Ricerca, Naples, Italy
- Department of Movement and Wellness Sciences, Parthenope University of Naples, Naples, Italy
| | - Christian Herold
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Andrea Laghi
- Department of Radiology, University of Rome "La Sapienza", Rome, Italy
| | - Marius Mayerhoefer
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Umar Mahmood
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Ciprian Catana
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Bruce Rosen
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Onofrio A Catalano
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
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14
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Wang YRJ, Baratto L, Hawk KE, Theruvath AJ, Pribnow A, Thakor AS, Gatidis S, Lu R, Gummidipundi SE, Garcia-Diaz J, Rubin D, Daldrup-Link HE. Artificial intelligence enables whole-body positron emission tomography scans with minimal radiation exposure. Eur J Nucl Med Mol Imaging 2021; 48:2771-2781. [PMID: 33527176 DOI: 10.1007/s00259-021-05197-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/10/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE To generate diagnostic 18F-FDG PET images of pediatric cancer patients from ultra-low-dose 18F-FDG PET input images, using a novel artificial intelligence (AI) algorithm. METHODS We used whole-body 18F-FDG-PET/MRI scans of 33 children and young adults with lymphoma (3-30 years) to develop a convolutional neural network (CNN), which combines inputs from simulated 6.25% ultra-low-dose 18F-FDG PET scans and simultaneously acquired MRI scans to produce a standard-dose 18F-FDG PET scan. The image quality of ultra-low-dose PET scans, AI-augmented PET scans, and clinical standard PET scans was evaluated by traditional metrics in computer vision and by expert radiologists and nuclear medicine physicians, using Wilcoxon signed-rank tests and weighted kappa statistics. RESULTS The peak signal-to-noise ratio and structural similarity index were significantly higher, and the normalized root-mean-square error was significantly lower on the AI-reconstructed PET images compared to simulated 6.25% dose images (p < 0.001). Compared to the ground-truth standard-dose PET, SUVmax values of tumors and reference tissues were significantly higher on the simulated 6.25% ultra-low-dose PET scans as a result of image noise. After the CNN augmentation, the SUVmax values were recovered to values similar to the standard-dose PET. Quantitative measures of the readers' diagnostic confidence demonstrated significantly higher agreement between standard clinical scans and AI-reconstructed PET scans (kappa = 0.942) than 6.25% dose scans (kappa = 0.650). CONCLUSIONS Our CNN model could generate simulated clinical standard 18F-FDG PET images from ultra-low-dose inputs, while maintaining clinically relevant information in terms of diagnostic accuracy and quantitative SUV measurements.
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Affiliation(s)
- Yan-Ran Joyce Wang
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, 725 Welch Road, CA, 94304, Stanford, USA
| | - Lucia Baratto
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, 725 Welch Road, CA, 94304, Stanford, USA
| | - K Elizabeth Hawk
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, 725 Welch Road, CA, 94304, Stanford, USA
| | - Ashok J Theruvath
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, 725 Welch Road, CA, 94304, Stanford, USA
| | - Allison Pribnow
- Department of Pediatrics, Pediatric Oncology, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, 94304, USA
| | - Avnesh S Thakor
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, 725 Welch Road, CA, 94304, Stanford, USA
| | - Sergios Gatidis
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Rong Lu
- Quantitative Sciences Unit, School of Medicine, Stanford University, Stanford, CA, 94304, USA
| | - Santosh E Gummidipundi
- Quantitative Sciences Unit, School of Medicine, Stanford University, Stanford, CA, 94304, USA
| | - Jordi Garcia-Diaz
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, 725 Welch Road, CA, 94304, Stanford, USA
| | - Daniel Rubin
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, 725 Welch Road, CA, 94304, Stanford, USA. .,Department of Pediatrics, Pediatric Oncology, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, 94304, USA.
| | - Heike E Daldrup-Link
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, 725 Welch Road, CA, 94304, Stanford, USA. .,Department of Pediatrics, Pediatric Oncology, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, 94304, USA.
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15
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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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16
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Abstract
Oncologic imaging has been a major focus of clinical research on PET/MR over the last 10 years. Studies so far have shown that PET/MR with 18F-Fluorodeoxyglucose (FDG) overall provides a similar accuracy for tumor staging as FDG PET/CT. The effective radiation dose of whole-body FDG PET/MR is more than 50% lower than for FDG PET/CT, making PET/MR particularly attractive for imaging of children. However, the longer acquisition times and higher costs have so far limited broader clinical use of PET/MR technology for whole-body staging. With the currently available technology, PET/MR appears more promising for locoregional staging of diseases for which MR is the anatomical imaging modality of choice. These include brain tumors, head and neck cancers, gynecologic malignancies, and prostate cancer. For instance, PET imaging with ligands of prostate-specific membrane antigen, combined with multi-parametric MR, appears promising for detection of prostate cancer and differentiation from benign prostate pathologies as well as for detection of local recurrences. The combination of functional parameters from MR, such as apparent diffusion coefficients, and molecular parameters from PET, such as receptor densities or metabolic rates, is feasible in clinical studies, but clinical applications for this multimodal and multi-parametric imaging approach still need to be defined.
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17
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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 PMCID: PMC7325702 DOI: 10.1148/radiol.2020192508] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/24/2020] [Accepted: 03/03/2020] [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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Theruvath AJ, Aghighi M, Iv M, Nejadnik H, Lavezo J, Pisani LJ, Daldrup-Link HE. Brain iron deposition after Ferumoxytol-enhanced MRI: A study of Porcine Brains. Nanotheranostics 2020; 4:195-200. [PMID: 32637297 PMCID: PMC7332795 DOI: 10.7150/ntno.46356] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/31/2020] [Indexed: 12/14/2022] Open
Abstract
Recent evidence of gadolinium deposition in the brain has raised safety concerns. Iron oxide nanoparticles are re-emerging as promising alternative MR contrast agents, because the iron core can be metabolized. However, long-term follow up studies of the brain after intravenous iron oxide administration have not been reported thus far. In this study, we investigated, if intravenously administered ferumoxytol nanoparticles are deposited in porcine brains. Methods: In an animal care and use committee-approved prospective case-control study, ten Göttingen minipigs received either intravenous ferumoxytol injections at a dose of 5 mg Fe/kg (n=4) or remained untreated (n=6). Nine to twelve months later, pigs were sacrificed and the brains of all pigs underwent ex vivo MRI at 7T with T2 and T2*-weighted sequences. MRI scans were evaluated by measuring R2* values (R2*=1000/T2*) of the bilateral caudate nucleus, lentiform nucleus, thalamus, dentate nucleus, and choroid plexus. Pig brains were sectioned and stained with Prussian blue and evaluated for iron deposition using a semiquantitative scoring system. Data of ferumoxytol exposed and unexposed groups were compared with an unpaired t-test and a Mann-Whitney U test. Results: T2 and T2* signal of the different brain regions was not visually different between ferumoxytol exposed and unexposed controls. There were no significant differences in R2* values of the different brain regions in the ferumoxytol exposed group compared to controls (p>0.05). Prussian blue stains of the same brain regions, scored according to a semiquantitative score, were not significantly different either between the ferumoxytol exposed group and unexposed controls (p>0.05). Conclusions: Our study shows that intravenous ferumoxytol doses of 5-10 mg Fe/kg do not lead to iron deposition in the brain of pigs. We suggest iron oxide nanoparticles as a promising alternative for gadolinium-enhanced MRI.
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Affiliation(s)
- Ashok Joseph Theruvath
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, CA, USA.,Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Maryam Aghighi
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, CA, USA
| | - Michael Iv
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, CA, USA
| | - Hossein Nejadnik
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, CA, USA
| | - Jonathan Lavezo
- Department of Pathology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Laura Jean Pisani
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, CA, USA
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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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Rogers HJ, Verhagen MV, Shelmerdine SC, Clark CA, Hales PW. An alternative approach to contrast-enhanced imaging: diffusion-weighted imaging and T 1-weighted imaging identifies and quantifies necrosis in Wilms tumour. Eur Radiol 2019; 29:4141-4149. [PMID: 30560365 PMCID: PMC6610268 DOI: 10.1007/s00330-018-5907-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/26/2018] [Accepted: 11/22/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Volume of necrosis in Wilms tumour is informative of chemotherapy response. Contrast-enhanced T1-weighted MRI (T1w) provides a measure of necrosis using gadolinium. This study aimed to develop a non-invasive method of identifying non-enhancing (necrotic) tissue in Wilms tumour. METHODS In this single centre, retrospective study, post-chemotherapy MRI data from 34 Wilms tumour patients were reviewed (March 2012-March 2017). Cases with multiple b value diffusion-weighted imaging (DWI) and T1w imaging pre- and post-gadolinium were included. Fractional T1 enhancement maps were generated from the gadolinium T1w data. Multiple linear regression determined whether fitted parameters from a mono-exponential model (ADC) and bi-exponential model (IVIM - intravoxel incoherent motion) (D, D*, f) could predict fractional T1 enhancement in Wilms tumours, using normalised pre-gadolinium T1w (T1wnorm) signal as an additional predictor. Measured and predicted fractional enhancement values were compared using the Bland-Altman plot. An optimum threshold for separating necrotic and viable tissue using fractional T1 enhancement was established using ROC. RESULTS ADC and D (diffusion coefficient) provided the strongest predictors of fractional T1 enhancement in tumour tissue (p < 0.001). Using the ADC-T1wnorm model (adjusted R2 = 0.4), little bias (mean difference = - 0.093, 95% confidence interval = [- 0.52, 0.34]) was shown between predicted and measured values of fractional enhancement and analysed via the Bland-Altman plot. The optimal threshold for differentiating viable and necrotic tissue was 33% fractional T1 enhancement (based on measured values, AUC = 0.93; sensitivity = 85%; specificity = 90%). CONCLUSIONS Combining ADC and T1w imaging predicts enhancement in Wilms tumours and reliably identifies and measures necrotic tissue without gadolinium. KEY POINTS • Alternative method to identify necrotic tissue in Wilms tumour without using contrast agents but rather using diffusion and T 1 weighted MRI. • A method is presented to visualise and quantify necrotic tissue in Wilms tumour without contrast. • The proposed method has the potential to reduce costs and burden to Wilms tumour patients who undergo longitudinal follow-up imaging as contrast agents are not used.
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Affiliation(s)
- Harriet J Rogers
- Developmental Imaging and Biophysics Section, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.
| | - Martijn V Verhagen
- Department of Radiology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, WC1N 3JH, UK
| | - Susan C Shelmerdine
- Department of Radiology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, WC1N 3JH, UK
| | - Christopher A Clark
- Developmental Imaging and Biophysics Section, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | - Patrick W Hales
- Developmental Imaging and Biophysics Section, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
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Berzaczy D, Fueger B, Hoeller C, Haug AR, Staudenherz A, Berzaczy G, Weber M, Mayerhoefer ME. Whole-Body [18F]FDG-PET/MRI vs. [18F]FDG-PET/CT in Malignant Melanoma. Mol Imaging Biol 2019; 22:739-744. [DOI: 10.1007/s11307-019-01413-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Theruvath AJ, Nejadnik H, Lenkov O, Yerneni K, Li K, Kuntz L, Wolterman C, Tuebel J, Burgkart R, Liang T, Felt S, Daldrup-Link HE. Tracking Stem Cell Implants in Cartilage Defects of Minipigs by Using Ferumoxytol-enhanced MRI. Radiology 2019; 292:129-137. [PMID: 31063081 DOI: 10.1148/radiol.2019182176] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Cartilage repair outcomes of matrix-associated stem cell implants (MASIs) in patients have been highly variable. Conventional MRI cannot help distinguish between grafts that will and grafts that will not repair the underlying cartilage defect until many months after the repair. Purpose To determine if ferumoxytol nanoparticle labeling could be used to depict successful or failed MASIs compared with conventional MRI in a large-animal model. Materials and Methods Between January 2016 and December 2017, 10 Göttingen minipigs (n = 5 male; n = 5 female; mean age, 6 months ± 5.1; age range, 4-20 months) received implants of unlabeled (n = 12) or ferumoxytol-labeled (n = 20) viable and apoptotic MASIs in cartilage defects of the distal femur. All MASIs were serially imaged with MRI on a 3.0-T imaging unit at week 1 and weeks 2, 4, 8, 12, and 24, with calculation of T2 relaxation times. Cartilage regeneration outcomes were assessed by using the MR observation of cartilage repair tissue (MOCART) score (scale, 0-100), the Pineda score, and histopathologic quantification of collagen 2 production in the cartilage defect. Findings were compared by using the unpaired Wilcoxon rank sum test, a linear regression model, the Fisher exact test, and Pearson correlation. Results Ferumoxytol-labeled MASIs showed significant T2 shortening (22.2 msec ± 3.2 vs 27.9 msec ± 1.8; P < .001) and no difference in cartilage repair outcomes compared with unlabeled control MASIs (P > .05). At week 2 after implantation, ferumoxytol-labeled apoptotic MASIs showed a loss of iron signal and higher T2 relaxation times compared with ferumoxytol-labeled viable MASIs (26.6 msec ± 4.9 vs 20.8 msec ± 5.3; P = .001). Standard MRI showed incomplete cartilage defect repair of apoptotic MASIs at 24 weeks. Iron signal loss at 2 weeks correlated with incomplete cartilage repair, diagnosed at histopathologic examination at 12-24 weeks. Conclusion Ferumoxytol nanoparticle labeling can accelerate the diagnosis of successful and failed matrix-associated stem cell implants at MRI in a large-animal model. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Sneag and Potter in this issue.
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Affiliation(s)
- Ashok J Theruvath
- From the Department of Radiology and Molecular Imaging Program at Stanford (MIPS) (A.J.T., H.N., O.L., K.Y., K.L., L.K., C.W., T.L., H.E.D.), Department of Comparative Medicine (S.F.), and Department of Pediatrics (H.E.D.), Stanford University School of Medicine, 725 Welch Rd, Room 1665, Stanford, CA 94305-5654; Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany (A.J.T.); and Department of Orthopedics and Sportorthopedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (L.K., J.T., R.B.)
| | - Hossein Nejadnik
- From the Department of Radiology and Molecular Imaging Program at Stanford (MIPS) (A.J.T., H.N., O.L., K.Y., K.L., L.K., C.W., T.L., H.E.D.), Department of Comparative Medicine (S.F.), and Department of Pediatrics (H.E.D.), Stanford University School of Medicine, 725 Welch Rd, Room 1665, Stanford, CA 94305-5654; Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany (A.J.T.); and Department of Orthopedics and Sportorthopedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (L.K., J.T., R.B.)
| | - Olga Lenkov
- From the Department of Radiology and Molecular Imaging Program at Stanford (MIPS) (A.J.T., H.N., O.L., K.Y., K.L., L.K., C.W., T.L., H.E.D.), Department of Comparative Medicine (S.F.), and Department of Pediatrics (H.E.D.), Stanford University School of Medicine, 725 Welch Rd, Room 1665, Stanford, CA 94305-5654; Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany (A.J.T.); and Department of Orthopedics and Sportorthopedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (L.K., J.T., R.B.)
| | - Ketan Yerneni
- From the Department of Radiology and Molecular Imaging Program at Stanford (MIPS) (A.J.T., H.N., O.L., K.Y., K.L., L.K., C.W., T.L., H.E.D.), Department of Comparative Medicine (S.F.), and Department of Pediatrics (H.E.D.), Stanford University School of Medicine, 725 Welch Rd, Room 1665, Stanford, CA 94305-5654; Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany (A.J.T.); and Department of Orthopedics and Sportorthopedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (L.K., J.T., R.B.)
| | - Kai Li
- From the Department of Radiology and Molecular Imaging Program at Stanford (MIPS) (A.J.T., H.N., O.L., K.Y., K.L., L.K., C.W., T.L., H.E.D.), Department of Comparative Medicine (S.F.), and Department of Pediatrics (H.E.D.), Stanford University School of Medicine, 725 Welch Rd, Room 1665, Stanford, CA 94305-5654; Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany (A.J.T.); and Department of Orthopedics and Sportorthopedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (L.K., J.T., R.B.)
| | - Lara Kuntz
- From the Department of Radiology and Molecular Imaging Program at Stanford (MIPS) (A.J.T., H.N., O.L., K.Y., K.L., L.K., C.W., T.L., H.E.D.), Department of Comparative Medicine (S.F.), and Department of Pediatrics (H.E.D.), Stanford University School of Medicine, 725 Welch Rd, Room 1665, Stanford, CA 94305-5654; Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany (A.J.T.); and Department of Orthopedics and Sportorthopedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (L.K., J.T., R.B.)
| | - Cody Wolterman
- From the Department of Radiology and Molecular Imaging Program at Stanford (MIPS) (A.J.T., H.N., O.L., K.Y., K.L., L.K., C.W., T.L., H.E.D.), Department of Comparative Medicine (S.F.), and Department of Pediatrics (H.E.D.), Stanford University School of Medicine, 725 Welch Rd, Room 1665, Stanford, CA 94305-5654; Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany (A.J.T.); and Department of Orthopedics and Sportorthopedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (L.K., J.T., R.B.)
| | - Jutta Tuebel
- From the Department of Radiology and Molecular Imaging Program at Stanford (MIPS) (A.J.T., H.N., O.L., K.Y., K.L., L.K., C.W., T.L., H.E.D.), Department of Comparative Medicine (S.F.), and Department of Pediatrics (H.E.D.), Stanford University School of Medicine, 725 Welch Rd, Room 1665, Stanford, CA 94305-5654; Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany (A.J.T.); and Department of Orthopedics and Sportorthopedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (L.K., J.T., R.B.)
| | - Rainer Burgkart
- From the Department of Radiology and Molecular Imaging Program at Stanford (MIPS) (A.J.T., H.N., O.L., K.Y., K.L., L.K., C.W., T.L., H.E.D.), Department of Comparative Medicine (S.F.), and Department of Pediatrics (H.E.D.), Stanford University School of Medicine, 725 Welch Rd, Room 1665, Stanford, CA 94305-5654; Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany (A.J.T.); and Department of Orthopedics and Sportorthopedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (L.K., J.T., R.B.)
| | - Tie Liang
- From the Department of Radiology and Molecular Imaging Program at Stanford (MIPS) (A.J.T., H.N., O.L., K.Y., K.L., L.K., C.W., T.L., H.E.D.), Department of Comparative Medicine (S.F.), and Department of Pediatrics (H.E.D.), Stanford University School of Medicine, 725 Welch Rd, Room 1665, Stanford, CA 94305-5654; Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany (A.J.T.); and Department of Orthopedics and Sportorthopedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (L.K., J.T., R.B.)
| | - Stephen Felt
- From the Department of Radiology and Molecular Imaging Program at Stanford (MIPS) (A.J.T., H.N., O.L., K.Y., K.L., L.K., C.W., T.L., H.E.D.), Department of Comparative Medicine (S.F.), and Department of Pediatrics (H.E.D.), Stanford University School of Medicine, 725 Welch Rd, Room 1665, Stanford, CA 94305-5654; Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany (A.J.T.); and Department of Orthopedics and Sportorthopedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (L.K., J.T., R.B.)
| | - Heike E Daldrup-Link
- From the Department of Radiology and Molecular Imaging Program at Stanford (MIPS) (A.J.T., H.N., O.L., K.Y., K.L., L.K., C.W., T.L., H.E.D.), Department of Comparative Medicine (S.F.), and Department of Pediatrics (H.E.D.), Stanford University School of Medicine, 725 Welch Rd, Room 1665, Stanford, CA 94305-5654; Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany (A.J.T.); and Department of Orthopedics and Sportorthopedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (L.K., J.T., R.B.)
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23
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Rodríguez-Nogales C, González-Fernández Y, Aldaz A, Couvreur P, Blanco-Prieto MJ. Nanomedicines for Pediatric Cancers. ACS NANO 2018; 12:7482-7496. [PMID: 30071163 DOI: 10.1021/acsnano.8b03684] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Chemotherapy protocols for childhood cancers are still problematic due to the high toxicity associated with chemotherapeutic agents and incorrect dosing regimens extrapolated from adults. Nanotechnology has demonstrated significant ability to reduce toxicity of anticancer compounds. Improvement in the therapeutic index of cytostatic drugs makes this strategy an alternative to common chemotherapy in adults. However, the lack of nanomedicines specifically for pediatric cancer care raises a medical conundrum. This review highlights the current state and progress of nanomedicine in pediatric cancer and discusses the real clinical challenges and opportunities.
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Affiliation(s)
- Carlos Rodríguez-Nogales
- Pharmacy and Pharmaceutical Technology Department , University of Navarra , Pamplona 31008 , Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA) , Pamplona 31008 , Spain
| | | | - Azucena Aldaz
- Department of Pharmacy , Clínica Universidad de Navarra , Pamplona 31008 , Spain
| | - Patrick Couvreur
- Institut Galien Paris-Sud, UMR CNRS 8612, Université Paris-Sud, Université Paris-Saclay, Châtenay-Malabry Cedex 92296 , France
| | - María J Blanco-Prieto
- Pharmacy and Pharmaceutical Technology Department , University of Navarra , Pamplona 31008 , Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA) , Pamplona 31008 , Spain
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24
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Pareek A, Muehe AM, Theruvath AJ, Gulaka PK, Spunt SL, Daldrup-Link HE. Whole-body PET/MRI of Pediatric Patients: The Details That Matter. J Vis Exp 2017. [PMID: 29286486 DOI: 10.3791/57128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Integrated PET/MRI is a hybrid imaging technique enabling clinicians to acquire diagnostic images for tumor assessment and treatment monitoring with both high soft tissue contrast and added metabolic information. Integrated PET/MRI has shown to be valuable in the clinical setting and has many promising future applications. The protocol presented here will provide step-by-step instructions for the acquisition of whole-body 2-deoxy-2-(18F)fluoro-D-glucose (18F-FDG) PET/MRI data in children with cancer. It also provides instructions on how to combine a whole-body staging scan with a local tumor scan for evaluation of the primary tumor. The focus of this protocol is to be both comprehensive and time-efficient, which are two ubiquitous needs for clinical applications. This protocol was originally developed for children above 6 years, or old enough to comply with breath-hold instructions, but can also be applied to patients under general anesthesia. Similarly, this protocol can be modified to fit institutional preferences in terms of choice of MRI pulse sequences for both the whole-body scan and local tumor assessment.
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Affiliation(s)
- Anuj Pareek
- Department of Radiology, Pediatric Molecular Imaging Program at Stanford (PEDS-MIPS), Stanford University
| | - Anne M Muehe
- Department of Radiology, Pediatric Molecular Imaging Program at Stanford (PEDS-MIPS), Stanford University
| | - Ashok J Theruvath
- Department of Radiology, Pediatric Molecular Imaging Program at Stanford (PEDS-MIPS), Stanford University
| | - Praveen K Gulaka
- Department of Radiology, Pediatric Molecular Imaging Program at Stanford (PEDS-MIPS), Stanford University
| | | | - Heike E Daldrup-Link
- Department of Radiology, Pediatric Molecular Imaging Program at Stanford (PEDS-MIPS), Stanford University;
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25
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Abstract
PURPOSE To review how PET/MR technology could add value for pediatric cancer patients. RECENT FINDINGS Since many primary tumors in children are evaluated with MRI and metastases are detected with PET/CT, integrated PET/MR can be a time-efficient and convenient solution for pediatric cancer staging. 18F-FDG PET/MR can assess primary tumors and the whole body in one imaging session, avoid repetitive anesthesia and reduce radiation exposure compared to 18F-FDG PET/CT. This article lists 10 action points, which might improve the clinical value of PET/MR for children with cancer. However, even if PET/MR proves valuable, it cannot enter mainstream applications if it is not accessible to the majority of pediatric cancer patients. Therefore, innovations are needed to make PET/MR scanners affordable and increase patient throughput. SUMMARY PET/MR offers opportunities for more efficient, accurate and safe diagnoses of pediatric cancer patients. The impact on patient management and outcomes has to be substantiated by large-scale prospective clinical trials.
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Affiliation(s)
- Heike Daldrup-Link
- Department of Radiology, Lucile Packard Children's Hospital, and Pediatric Molecular Imaging Program (@PedsMIPS) in the Molecular Imaging Program at Stanford (MIPS), Stanford University
- Department of Pediatrics, Stanford University
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