PET/MRI Improves Management of Children with Cancer

Abstract

Learning Objectives: On successful completion of this activity, participants should be able to describe (1) why integrated 18 F-FDG PET/MR can be a time-efficient, convenient, and safe approach for the management of children with cancer; (2) the advantages of integrated 18 F-FDG PET/MR in the evaluation of children with cancer and predisposition syndromes such as lymphoma, sarcoma, and neurofibromatosis 1; and (3) future research directions for the use of integrated 18 F-FDG PET/MR in children with cancer.Financial Disclosure: This study was supported by a grant from the National Institute of Child Health and Human Development (NICHD, R01HD081123) and the Sarcoma Foundation. The authors of this article have indicated no other relevant relationships that could be perceived as a real or apparent conflict of interest.CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. For CE credit, SAM, and other credit types, participants can access this activity through the SNMMI website (http://www.snmmilearningcenter.org) through October 2024.Integrated PET/MRI has shown significant clinical value for staging and restaging of children with cancer by providing functional and anatomic tumor evaluation with a 1-stop imaging test and with up to 80% reduced radiation exposure compared with 18 F-FDG PET/ CT. This article reviews clinical applications of 18 F-FDG PET/MRI that are relevant for pediatric oncology, with particular attention to the value of PET/MRI for patient management. Early adopters from 4 different institutions share their insights about specific advantages of PET/MRI technology for the assessment of young children with cancer. We discuss how whole-body PET/MRI can be of value in the evaluation of certain anatomic regions, such as soft tissues and bone marrow, as well as specific PET/MRI interpretation hallmarks in pediatric patients. We highlight how whole-body PET/MRI can improve the clinical management of children with lymphoma, sarcoma, and neurofibromatosis, by reducing the number of radiologic examinations needed (and consequently the radiation exposure), without losing diagnostic accuracy. We examine how PET/MRI can help in differentiating malignant tumors versus infectious or inflammatory diseases. Future research directions toward the use of PET/MRI for treatment evaluation of patients undergoing immunotherapy and assessment of different theranostic agents are also briefly explored. Lessons learned from applications in children might also be extended to evaluations of adult patients.

Imaging of pediatric pulmonary tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper

“…1 ⁸F‐FDG PET/CT is well established in the primary evaluation and staging of certain adult and pediatric malignancies and is superior to CT alone for the assessment of bone marrow involvement 16 . 1 ⁸F‐FDG PET/MRI also demonstrates high sensivity for bone marrow infiltration 22 . We recommend 1 ⁸F‐FDG PET/CT or PET/MRI to be considered as an alternative to radionuclide bone scintigraphy in select cases (Grade D, SOR 1.67, very strong recommendation).…”

“…16 18 F-FDG PET/MRI also demonstrates high sensivity for bone marrow infiltration. 22 We recommend 18 F-FDG PET/CT or PET/MRI to be considered as an alternative to radionuclide bone scintigraphy in select cases (Grade D, SOR 1.67, very strong recommendation).…”

Perspective Chapter: Bone Tumors – How to Make a Diagnosis?

“…As a disadvantage, there is still no diagnostic advantage in performing the staging of the patient by PET/ MRI in relation to conventional exams [30,31], it presents several results similar to PET-CT [32] and still has limitations for the evaluation of nodules. Lungs smaller than 5 mm in size, and chest CT is still superior in this regard [32,33]. PET-MRI can even be used for radiotherapy planning and detection of tissue damage by chemotherapy.…”

Diagnostische Performanz der PET/MRT für die Detektion von Lebermetastasen

“…Gemessen an diesen Erwartungen kann der bisherige Erfolg der PET/MR im klinischen Kontext als gemischt bezeichnet werden. Für bestimmte Anwendungen, dazu gehören etwa kinderradiologische und neuroradiologische Fragestellungen, gibt es mittlerweile einen guten Konsens zum klinischen Nutzen der Methode [1,2].…”