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April G, De Bruycker JJ, Decaluwe H, Haddad E, Lambert R, Turpin S. Evaluation of physiological Waldeyer's ring, mediastinal blood pool, thymic, bone marrow, splenic and hepatic activity with 18F-FDG PET/CT: exploration of normal range among pediatric patients. Ann Nucl Med 2022; 36:661-673. [PMID: 35643969 DOI: 10.1007/s12149-022-01748-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/27/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION While 18F-FDG PET/CT pediatrics applications have increased in number and indications, few studies have addressed normal maximum standardized uptake values (SUVmax) of referral organs in children. The purpose of this study is to assess these in a cohort of pediatric patients. MATERIAL AND METHODS 285 18F-FDG PET/CT scans in 229 patients were reviewed. SUVmax were assessed for mediastinal blood pool (MBP), thymus (T), liver (L), spleen (S), bone marrow (BM) and Waldeyer's Ring (Wald). L/MBP and S/L ratios were calculated. Same day complete blood counts (CBC) were available for 132 studies and compared to BM and S. Means, standard deviations and correlation coefficients with age, weight and body surface area (BSA) were calculated. RESULTS Weak correlation with age, weight or BSA was found for Wald. Strong correlations with weight/BSA more than with age were demonstrated for MBP, L and BM and moderate for S and T. After initial decrease between age 0 and 2, thymic activity peaked at age 11 years then involuted. No correlation was found between CBC ad BM or S. In 28 studies, L was less or equal to MBP. In 74 S was superior to L. CONCLUSIONS Referral organs 18F-FDG uptake varies in children more in relation with weight and BSA than with age for key referral organs, such as L, S and MBP. In a significant number of studies, L activity may impede evaluation of treatment response in comparison with MBP or inflammation/infection evaluation in comparison with S.
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Affiliation(s)
- Geneviève April
- Medical Imaging Department-Division of Nuclear Medicine, Laval University, CHU de Québec, Hôtel-Dieu, 11 Côte du Palais, Québec, QC, G1R 2J6, Canada
| | - Jean Jacques De Bruycker
- Pediatrics Department Allergy, Immunology and Rheumatology Division, University of Montreal, CHU Ste-Justine, 3175 Chemin de la Côte-Sainte-Catherine Montreal, Montreal, QC, H3T 1C5, Canada
| | - Hélène Decaluwe
- Pediatrics Department Allergy, Immunology and Rheumatology Division, University of Montreal, CHU Ste-Justine, 3175 Chemin de la Côte-Sainte-Catherine Montreal, Montreal, QC, H3T 1C5, Canada
| | - Elie Haddad
- Pediatrics Department Allergy, Immunology and Rheumatology Division, University of Montreal, CHU Ste-Justine, 3175 Chemin de la Côte-Sainte-Catherine Montreal, Montreal, QC, H3T 1C5, Canada
| | - Raymond Lambert
- Medical Imaging Department-Division of Nuclear Medicine, University of Montreal, CHU Ste-Justine, 3175 Chemin de la Côte-Sainte-Catherine Montreal, Montreal, QC, H3T 1C5, Canada
| | - Sophie Turpin
- Medical Imaging Department-Division of Nuclear Medicine, University of Montreal, CHU Ste-Justine, 3175 Chemin de la Côte-Sainte-Catherine Montreal, Montreal, QC, H3T 1C5, Canada.
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Gil TY, Lee DK, Lee JM, Yoo ES, Ryu KH. Clinical experience with (18)F-fluorodeoxyglucose positron emission tomography and (123)I-metaiodobenzylguanine scintigraphy in pediatric neuroblastoma: complementary roles in follow-up of patients. KOREAN JOURNAL OF PEDIATRICS 2014; 57:278-86. [PMID: 25076973 PMCID: PMC4115069 DOI: 10.3345/kjp.2014.57.6.278] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 04/16/2014] [Accepted: 05/16/2014] [Indexed: 12/04/2022]
Abstract
Purpose To evaluate the potential utility of 123I-metaiodobenzylguanine (123I-MIBG) scintigraphy and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) for the detection of primary and metastatic lesions in pediatric neuroblastoma (NBL) patients, and to determine whether 18F-FDG PET is as beneficial as 123I-MIBG imaging. Methods We selected 8 NBL patients with significant residual mass after operation and who had paired 123I-MIBG and 18F-FDG PET images that were obtained during the follow-up. We retrospectively reviewed the clinical charts and the findings of 45 paired scans. Results Both scans correlated relatively well with the disease status as determined by standard imaging modalities during follow-up; the overall concordance rates were 32/45 (71.1%) for primary tumor sites and 33/45 (73.3%) for bone-bone marrow (BM) metastatic sites. In detecting primary tumor sites, 123I-MIBG might be superior to 18F-FDG PET. The sensitivity of 123I-MIBG and 18F-FDG PET were 96.7% and 70.9%, respectively, and their specificity were 85.7% and 92.8%, respectively. 18F-FDG PET failed to detect 9 true NBL lesions in 45 follow-up scans (false negative rate, 29%) with positive 123I-MIBG. For bone-BM metastatic sites, the sensitivity of 123I-MIBG and 18F-FDG PET were 72.7% and 81.8%, respectively, and the specificity were 79.1% and 100%, respectively. 123I-MIBG scan showed higher false positivity (20.8%) than 18F-FDG PET (0%). Conclusion 123I-MIBG is superior for delineating primary tumor sites, and 18F-FDG PET could aid in discriminating inconclusive findings on bony metastatic NBL. Both scans can be complementarily used to clearly determine discrepancies or inconclusive findings on primary or bone-BM metastatic NBL during follow-up.
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Affiliation(s)
- Tae Young Gil
- Department of Pediatrics, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Do Kyung Lee
- Department of Pediatrics, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Jung Min Lee
- Department of Pediatrics, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Eun Sun Yoo
- Department of Pediatrics, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Kyung-Ha Ryu
- Department of Pediatrics, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
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(18)F-FDG PET as a single imaging modality in pediatric neuroblastoma: comparison with abdomen CT and bone scintigraphy. Ann Nucl Med 2014; 28:304-13. [PMID: 24481823 DOI: 10.1007/s12149-014-0813-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 01/13/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the diagnostic performance of (18)F-fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET) as a single imaging agent in neuroblastoma in comparison with other imaging modalities. METHODS A total of 30 patients with pathologically proven neuroblastoma who underwent FDG PET for staging were enrolled. Diagnostic performance of FDG PET and abdomen CT was compared in detecting soft tissue lesions. FDG PET and bone scintigraphy (BS) were compared in bone metastases. Maximal standardized uptake value (SUVmax) of primary or recurrent lesions was calculated for quantitative analysis. RESULTS Tumor FDG uptake was detected in 29 of 30 patients with primary neuroblastoma. On initial FDG PET, SUVmax of primary lesions were lower in early stage (I-II) than in late stage (III-IV) (3.03 vs. 5.45, respectively, p = 0.019). FDG PET was superior to CT scan in detecting distant lymph nodes (23 vs. 18 from 23 lymph nodes). FDG PET showed higher accuracy to identify bone metastases than BS both on patient-based analyses (100 vs. 94.4 % in sensitivity, 100 vs. 77.8 % in specificity), and on lesion-based analyses (FDG PET: 203 lesions, BS: 86 lesions). Sensitivity and specificity of FDG PET to detect recurrence were 87.5 % and 93.8, respectively. CONCLUSION FDG PET was superior to CT in detecting distant LN metastasis and to BS in detecting skeletal metastasis in neuroblastoma. BS might be eliminated in the evaluation of neuroblastoma when FDG PET is performed.
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El-Salam M, Reda S, Lotfi S, Refaat T, El-Abd E. Imaging Techniques in Cancer Diagnosis. Cancer Biomark 2014:19-38. [DOI: 10.1201/b16389-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Value of FDG-PET/CT Examinations in Different Cancers of Children, Focusing on Lymphomas. Pathol Oncol Res 2013; 20:139-43. [DOI: 10.1007/s12253-013-9676-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Accepted: 07/18/2013] [Indexed: 12/17/2022]
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Mueller WP, Coppenrath E, Pfluger T. Nuclear medicine and multimodality imaging of pediatric neuroblastoma. Pediatr Radiol 2013; 43:418-27. [PMID: 23151727 DOI: 10.1007/s00247-012-2512-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 06/22/2012] [Accepted: 06/23/2012] [Indexed: 12/20/2022]
Abstract
Neuroblastoma is an embryonic tumor of the peripheral sympathetic nervous system and is metastatic or high risk for relapse in nearly 50% of cases. Therefore, exact staging with radiological and nuclear medicine imaging methods is crucial for defining the adequate therapeutic choice. Tumor cells express the norepinephrine transporter, which makes metaiodobenzylguanidine (MIBG), an analogue of norepinephrine, an ideal tumor specific agent for imaging. MIBG imaging has several disadvantages, such as limited spatial resolution, limited sensitivity in small lesions and the need for two or even more acquisition sessions. Most of these limitations can be overcome with positron emission tomography (PET) using [F-18]2-fluoro-2-deoxyglucose [FDG]. Furthermore, new tracers, such as fluorodopa or somatostatin receptor agonists, have been tested for imaging neuroblastoma recently. However, MIBG scintigraphy and PET alone are not sufficient for operative or biopsy planning. In this regard, a combination with morphological imaging is indispensable. This article will discuss strategies for primary and follow-up diagnosis in neuroblastoma using different nuclear medicine and radiological imaging methods as well as multimodality imaging.
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Affiliation(s)
- Wolfgang Peter Mueller
- Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Ziemssenstr. 1, 80336, Munich, Germany.
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Abstract
The use of PET/PET-CT is a rapidly growing area of imaging and research in the care of children. Until recently, diagnostic imaging methods have provided either anatomical or functional assessment. The development of fused imaging modalities, such as PET-CT or PET-MRI, now provides the opportunity for simultaneously providing both anatomical and functional or physiological assessment. This review will discuss current established uses of PET-CT, possible uses and potential research investigations in the use of this modality in the pediatric population. The focus of this paper will be its use in children being treated for non-central nervous system and non-cardiac disorders.
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Lopci E, Burnelli R, Ambrosini V, Nanni C, Castellucci P, Biassoni L, Rubello D, Fanti S. (18)F-FDG PET in Pediatric Lymphomas: A Comparison with Conventional Imaging. Cancer Biother Radiopharm 2010; 23:681-90. [PMID: 19111053 DOI: 10.1089/cbr.2008.0519] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study reports on our experience with 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in pediatric patients affected by Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL). We studied 20 pediatric subjects (12 males, 8 females; mean age, 10 years; range, 6 months to 14 years) with malignant lymphoma (9 HD, 11 NHL) for a 4-year period of time. Overall, 45 PET scans were performed: 7 at disease presentation and 38 for evaluation of response to therapy or follow-up study. All PET results were compared with conventional imaging (CI), mainly computed tomography (CT) and/or magnetic resonance imaging (MRI), and supported by clinical follow-up and/or histologic data. In 18 of 20 patients, PET findings correctly identified the status of disease. Two (2) subjects (respectively, 1 HD and 1 NHL, both at follow-up) resulted falsely positive: 1 due to prominent thymic uptake, and the other due to nonspecific inflammation. Of 45 scans, PET findings were consistent with clinical follow-up and other CI data in 43 cases (16 true-positive and 27 true-negative results) and resulted falsely positive in the remaining 2 scans. On a lesion-by-lesion basis (overall, 153 lesions: 84 nodal and 69 extranodal), we found a concordance between CI and PET findings in 25 nodal (29.8%) and in 22 extranodal sites (32%). PET was more accurate than CI, as it identified active disease in 1 patient negative at CI and excluded relapse in 6 patients with inconclusive CI and in 2 patients with a falsely positive CI. Overall, PET sensitivity and specificity was 100% and 93% versus 94% sensitivity and 72.4% specificity for CI. This comparative study shows FDG PET to be more accurate than CI in evaluating children with lymphoma. Our data also confirms that (18)F-FDG PET may show false-positive findings.
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Affiliation(s)
- Egesta Lopci
- Department of Nuclear Medicine, Policlinico "S. Orsola-Malpighi," Bologna, Italy
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Taggart DR, Han MM, Quach A, Groshen S, Ye W, Villablanca JG, Jackson HA, Mari Aparici C, Carlson D, Maris J, Hawkins R, Matthay KK. Comparison of iodine-123 metaiodobenzylguanidine (MIBG) scan and [18F]fluorodeoxyglucose positron emission tomography to evaluate response after iodine-131 MIBG therapy for relapsed neuroblastoma. J Clin Oncol 2009; 27:5343-9. [PMID: 19805691 DOI: 10.1200/jco.2008.20.5732] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Children with relapsed neuroblastoma have poor survival. It is crucial to have a reliable method for evaluating functional response to new therapies. In this study, we compared two functional imaging modalities for neuroblastoma: metaiodobenzylguanidine (MIBG) scan for uptake by the norepinephrine transporter and [(18)F]fluorodeoxyglucose positron emission tomography (FDG-PET) uptake for glucose metabolic activity. PATIENTS AND METHODS Patients enrolled onto a phase I study of sequential infusion of iodine-131 ((131)I) MIBG (NANT-2000-01) were eligible for inclusion if they had concomitant FDG-PET and MIBG scans. (131)I-MIBG therapy was administered on days 0 and 14. For each patient, we compared all lesions identified on concomitant FDG-PET and MIBG scans and gave scans a semiquantitative score. RESULTS The overall concordance of positive lesions on concomitant MIBG and FDG-PET scans was 39.6% when examining the 139 unique anatomic lesions. MIBG imaging was significantly more sensitive than FDG-PET overall and for the detection of bone lesions (P < .001). There was a trend for increased sensitivity of FDG-PET for detection of soft tissue lesions. Both modalities showed similar improvement in number of lesions identified from day 0 to day 56 scan and in semiquantitative scores that correlated with overall response. FDG-PET scans became completely negative more often than MIBG scans after treatment. CONCLUSION MIBG scan is significantly more sensitive for individual lesion detection in relapsed neuroblastoma than FDG-PET, though FDG-PET can sometimes play a complementary role, particularly in soft tissue lesions. Complete response by FDG-PET metabolic evaluation did not always correlate with complete response by MIBG uptake.
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Affiliation(s)
- Denah R Taggart
- Department of Pediatrics and Nuclear Medicine, University of California, San Francisco, CA 94143-0106, USA
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Lee EY. Evaluation of non-vascular mediastinal masses in infants and children: an evidence-based practical approach. Pediatr Radiol 2009; 39 Suppl 2:S184-90. [PMID: 19308383 DOI: 10.1007/s00247-008-1108-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Edward Y Lee
- Department of Radiology, Children's Hospital Boston and Harvard Medical School, 300 Longwood Ave., Boston, MA 02115, USA.
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18F-FDG PET in Pediatric Lymphomas: A Comparison with Conventional Imaging. Cancer Biother Radiopharm 2008. [DOI: 10.1089/cbr.2007.0519] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Colavolpe C, Guedj E, Cammilleri S, Taïeb D, Mundler O, Coze C. Utility of FDG-PET/CT in the follow-up of neuroblastoma which became MIBG-negative. Pediatr Blood Cancer 2008; 51:828-31. [PMID: 18680162 DOI: 10.1002/pbc.21594] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We report on the case of a 10-month-old female infant with a metastatic neuroblastoma which became MIBG-negative at time of relapse. We discuss the different hypothesis associated with this particular outcome, and the potential utility of FDG-PET as an alternative to follow up the residual disease at this stage.
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Affiliation(s)
- Cécile Colavolpe
- Department of Nuclear Medicine, University Hospital Centre, Timone, Marseille, France.
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Schuetze SM, Baker LH, Benjamin RS, Canetta R. Selection of response criteria for clinical trials of sarcoma treatment. Oncologist 2008; 13 Suppl 2:32-40. [PMID: 18434637 DOI: 10.1634/theoncologist.13-s2-32] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Soft tissue sarcomas are a heterogeneous group of malignancies arising from mesenchymal tissues. A large number of new therapies are being evaluated in patients with sarcomas, and consensus criteria defining treatment responses are essential for comparison of results from studies completed by different research groups. The 1979 World Health Organization (WHO) handbook set forth operationally defined criteria for response evaluation in solid tumors that were updated in 2000 with the publication of the Response Evaluation Criteria in Solid Tumors (RECIST). There have been significant advances in tumor imaging, however, that are not reflected in the RECIST. For example, computed tomography (CT) slice thickness has been reduced from 10 mm to < or =2.5 mm, allowing for more reproducible and accurate measurement of smaller lesions. Combination of imaging techniques, such as positron emission tomography with fluorine-18-fluorodeoxyglucose (18FDG-PET) and CT can provide investigators and clinicians with both anatomical and functional information regarding tumors, and there is now a large body of evidence demonstrating the effectiveness of PET/CT and other newer imaging methods for the detection and staging of tumors as well as early determination of responses to therapy. The application of newer imaging methods has the potential to decrease both the sample sizes required for, and duration of, clinical trials by providing an early indication of therapeutic response that is well correlated with clinical outcomes, such as time to tumor progression or overall survival. The results summarized in this review support the conclusion that the RECIST and the WHO criteria for evaluation of response in solid tumors need to be modernized. In addition, there is a current need for prospective trials to compare new response criteria with established endpoints and to validate imaging-based response rates as surrogate endpoints for clinical trials of new agents for sarcoma and other solid tumors.
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Affiliation(s)
- Scott M Schuetze
- Department of Internal Medicine, Division of Hematology/Oncology, 1500 E. Medical Center Drive, C409 MIB, Ann Arbor, Michigan 48109-5843, USA. scotschu@umich
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Abstract
18F-fluorodeoxyglucose positron emission tomography (FDG-PET) and FDG-PET/computed tomography (CT) are becoming increasingly important imaging tools in the noninvasive evaluation and monitoring of children with known or suspected malignant diseases. In this review, we discuss the preparation of children undergoing PET studies and review radiation dosimetry and its implications for family and caregivers. We review the normal distribution of 18F-fluorodeoxyglucose (FDG) in children, common variations of the normal distribution, and various artifacts that may arise. We show that most tumors in children accumulate and retain FDG, allowing high-quality images of their distribution and pathophysiology. We explore the use of FDG-PET in the study of children with the more common malignancies, such as brain neoplasms and lymphomas, and the less-common tumors, including neuroblastomas, bone and soft-tissue sarcomas, Wilms' tumors, and hepatoblastomas. For comparison, other PET tracers are included because they have been applied in pediatric oncology. Multiple multicenter trials are underway that use FDG-PET in the management of children with neoplastic disease; these studies should give us greater insight into the impact FDG-PET can make in their care. PET is emerging as an important diagnostic imaging tool in the evaluation of pediatric cancers. The recent advent of dual-modality PET-computed tomography (PET/CT) imaging systems has added unprecedented diagnostic capability by revealing the precise anatomical localization of metabolic information and metabolic characterization of normal and abnormal structures. The use of CT transmission scanning for attenuation correction has shortened the total acquisition time, which is an especially desirable attribute in pediatric imaging. Moreover, expansion of the regional distribution of the most common PET radiotracer, FDG, and the introduction of mobile PET units have greatly increased access to this powerful diagnostic imaging technology. Here, we review the clinical applications of PET and PET/CT in pediatric oncology. General considerations in patient preparation and radiation dosimetry will be discussed.
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Affiliation(s)
- Hossein Jadvar
- Division of Nuclear Medicine, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, and Children's Hospital Boston, MA, USA
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