Clinical utility of nuclear imaging in the evaluation of pediatric adrenal neoplasms

Abstract

Adrenal neoplasms rarely occur in children. They can be diagnosed in the presence of endocrine, metabolic or neurological problems, an abdominal mass, more rarely an adrenal incidentaloma, or in the context of an adrenal mass discovered in the evaluation of childhood cancer including hematologic malignancy. According to standard medical practice, pediatric malignancies are almost always evaluated by 18F-fluorodeoxyglucose positron emission tomography with computed tomography ([18F]FDG PET/CT). Nuclear imaging using specific radiotracers is also an important tool for diagnosing and staging neuroblastoma, pheochromocytoma, hormone hypersecretion, or indeterminate adrenal masses. The Hippocratic oath “primum non nocere” encourages limitation of radiation in children per the ALARA concept (as low as reasonably achievable) but should not lead to the under-use of nuclear imaging because of the potential risk of inaccurate diagnosis or underestimation of the extent of disease. As in adults, nuclear imaging in children should be performed in conjunction with hormone evaluation and morphological imaging.

Editorial: Pediatric adrenal neoplasms

“…Finally, advances in molecular imaging have also contributed substantially to improved stratification of pediatric patients with adrenal neoplasms. As described by Fargette et al ( 1 ) 123 I - MIBG and 68 Ga-DOTATATE PET/CT functional imaging are today routinely used for the staging of patients with neuroblastoma and PPGL respectively, whereas 18 F-FDG PET/CT has been effectively applied for the preoperative stratification of pediatric patients with ACC.…”