Imaging in childhood cancer: A society for pediatric radiology and children's oncology group joint task force report

Abstract

Contemporary medical imaging is a cornerstone of care for children with cancer. As 5-year survival rates for children with cancer exceed 80%, imaging technologies have evolved in parallel to include a wide array of modalities. Here, we overview the risks and benefits associated with commonly used imaging modalities and survey the current landscape of medical imaging for children with cancer. We find evidence-based imaging guidelines to assist in protocol development and to guide decision-making for optimal patient care are often lacking. The substantial variation in protocol-based recommendations for imaging both during and following therapy may hinder optimal clinical research and clinical care for children with cancer.

Surveillance imaging and radiation exposure in the detection of relapsed neuroblastoma

“…In addition, our study and others have supported the importance of providing rationale to limit the use of certain scans in subsets of patients. Recent pediatric oncology specific publications from Radiology societies and COG have highlighted additional issues, such as surveillance‐associated cost and psychological stress, and the need to increase availability of lower dose CT technology . These reports suggest that there is currently little evidence to guide optimal frequency and modality of scans, or to determine when to limit imaging to subgroups depending on tumor locations and/or relapse risk.…”

“…Recent pediatric oncology specific publications from Radiology societies and COG have highlighted additional issues, such as surveillance-associated cost and psychological stress, and the need to increase availability of lower dose CT technology. 36,37 These reports suggest that there is currently little evidence to guide optimal frequency and modality of scans, or to determine when to limit imaging to subgroups depending on tumor locations and/or relapse risk. 22 We also found that in addition to history/symptoms and UCats, MIBG scans detected the majority of recurrences.…”

The role of chest computed tomography (CT) as a surveillance tool in children with high‐risk neuroblastoma

“…There has been considerable debate surrounding the utility of surveillance imaging in patients with pediatric cancer . For high‐risk neuroblastoma, surveillance imaging practices vary among institutions and the use of routine chest CT as an initial staging and surveillance tool is debatable.…”

“…While the implemented changes in imaging protocols have been effective at reducing radiation exposure, clinicians must diligently evaluate the risks and benefits of surveillance imaging. There has been considerable debate surrounding the utility of surveillance imaging in patients with pediatric cancer [30][31][32][33]. For high-risk neuroblastoma, surveillance imaging practices vary among institutions and the use of routine chest CT as an initial staging and surveillance tool is debatable.…”

Pediatric Bone Sarcoma: Diagnostic Performance of 18F-FDG PET/CT Versus Conventional Imaging for Initial Staging and Follow-Up

“…Few studies have investigated the diagnostic performance of FDG PET/CT in children with osteosarcoma and Ewing sarcoma [8][9][10][11]. Presently, FDG PET/CT is not considered a standard examination in the diagnostic algorithm for these patients [12,13]. Nevertheless, in our clinical experience FDG PET/CT accurately depicts metastatic lesions from bone sarcoma both at diagnosis and at the time of relapse.…”