PET/MR Imaging in Pediatric Oncology
PDF

Review

PET/MR Imaging in Pediatric Oncology

Nucl Med Semin 2024;10(3):369-382 DOI: 10.4274/nts.galenos.2024.14633
,
PDF
Permissions

Abstract

Pediatric patients are among the primary patient groups where positron emission tomography/magnetic resonance imaging (PET/MRI) is considered to have significant advantages, due to its ability to reduce radiation dose by up to 70-80%, high soft tissue resolution, and to obtain diagnostic MRI and PET images in a single anesthesia session. Due to the fact that pediatric patients are more sensitive to radiation compared to adults and are exposed to repeated imaging during follow-up, reducing the cumulative radiation dose in these patients through PET/MRI imaging is of great importance. Studies on hybrid PET/MRI in pediatric oncology patients have shown that, in addition to reducing radiation dose, PET/MRI provides diagnostic performance in lesion detection that is at least as good as PET/computed tomography, owing to its high soft tissue resolution. Therefore, when available, PET/MR is supported as the primary PET imaging modality in pediatric oncology. The aim of this review is to present the role of hybrid PET/MR imaging in pediatric oncology diseases in light of the literature.

Keywords: Positron emission tomography/magnetic resonance imaging, hybrid imaging, pediatric tumors

References

1

Giraudo C, Carraro S, Zucchetta P, Cecchin D. Pediatric imaging using PET/MR imaging. Magn Reson Imaging Clin N Am. 2023;31:625-636.

2

Kwatra NS, Lim R, Gee MS, States LJ, Vossough A, Lee EY. PET/MR imaging: current updates on pediatric applications. Magn Reson Imaging Clin N Am. 2019;27:387-407.

3

Chawla SC, Federman N, Zhang D, et al. Estimated cumulative radiation dose from PET/CT in children with malignancies: a 5-year retrospective review. Pediatr Radiol. 2010;40:681-686.

4

Martin O, Schaarschmidt BM, Kirchner J, et al. PET/MRI versus PET/CT for whole-body staging: results from a single-center observational study on 1,003 sequential examinations. J Nucl Med. 2020;61:1131-1136.

5

Zucchetta P, Branchini M, Zorz A, et al. Quantitative analysis of image metrics for reduced and standard dose pediatric 18F-FDG PET/MRI examinations. Br J Radiol. 2019;92:20180438.

6

Aydos U, Balcı E, Ateş SG, Akdemir ÜÖ, Karadeniz C, Atay LÖ. Quantitative and visual analyses of the effect of activity reduction on image metrics and quality in 18F-FDG PET/MRI in pediatric oncology. Turk J Med Sci. 2023;53:289-302.

7

Schäfer JF, Gatidis S, Schmidt H, et al. Simultaneous whole-body PET/MR imaging in comparison to PET/CT in pediatric oncology: initial results. Radiology. 2014;273:220-231.

8

Uslu-Beşli L, Atay Kapucu L, Karadeniz C, et al. 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.

9

Baratto L, Hawk KE, States L, et al. PET/MRI improves management of children with cancer. J Nucl Med. 2021;62:1334-1340.

10

States LJ, Reid JR. Whole-Body PET/MRI Applications in pediatric oncology. AJR Am J Roentgenol. 2020;215:713-725.

11

Catana C. Motion correction options in PET/MRI. Semin Nucl Med. 2015;45:212-223.

12

Cecchin D, Barthel H, Poggiali D, et al. A new integrated dual time-point amyloid PET/MRI data analysis method. Eur J Nucl Med Mol Imaging. 2017;44:2060-2072.

13

Rauscher I, Eiber M, Fürst S, et al. PET/MR imaging in the detection and characterization of pulmonary lesions: technical and diagnostic evaluation in comparison to PET/CT. J Nucl Med. 2014;55:724-729.

14

Wang X, Cui Y, Wang Y, et al. Assessment of lung nodule detection and lung CT screening reporting and data system classification using zero echo time pulmonary MRI. J Magn Reson Imaging. 2024 Apr 11.

15

Gatidis S, Schmidt H, Gücke B, et al. Comprehensive Oncologic imaging in infants and preschool children with substantially reduced radiation exposure using combined simultaneousF-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging: a direct comparison to F-fluorodeoxyglucose positron emission tomography/computed tomography. Invest Radiol. 2016;51:7-14.

16

Hirsch FW, Sattler B, Sorge I, et al. PET/MR in children. Initial clinical experience in paediatric oncology using an integrated PET/MR scanner. Pediatr Radiol. 2013;43:860-875.

17

Ponisio MR, McConathy J, Laforest R, Khanna G. Evaluation of diagnostic performance of whole-body simultaneous PET/MRI in pediatric lymphoma. Pediatr Radiol. 2016;46:1258-1268.

18

Sher AC, Seghers V, Paldino MJ, et al. Assessment of sequential PET/MRI in comparison with PET/CT of pediatric lymphoma: a prospective study. AJR Am J Roentgenol. 2016;206:623-631.

19

Spijkers S, Littooij AS, Nievelstein RAJ. Measurements of cervical lymph nodes in children on computed tomography. Pediatr Radiol. 2020;50:534-542.

20

Muehe AM, Siedek F, Theruvath AJ, et al. Differentiation of benign and malignant lymph nodes in pediatric patients on ferumoxytol-enhanced PET/MRI. Theranostics. 2020;10:3612-3621.

21

Gawande RS, Khurana A, Messing S, et al. Differentiation of normal thymus from anterior mediastinal lymphoma and lymphoma recurrence at pediatric PET/CT. Radiology. 2012;262:613-622.

22

Person A, Janitz E, Thapa M. Pediatric bone marrow: normal and abnormal MRI appearance. Semin Roentgenol. 2021;56:325-337.

23

Daldrup-Link HE, Franzius C, Link TM, et al. Whole-body MR imaging for detection of bone metastases in children and young adults: comparison with skeletal scintigraphy and FDG PET. AJR Am J Roentgenol. 2001;177:229-236.

24

Jadvar H, Connolly LP, Fahey FH, Shulkin BL. PET and PET/CT in pediatric oncology. Semin Nucl Med. 2007;37:316-331.

25

Panigrahy A, Blüml S. Neuroimaging of pediatric brain tumors: from basic to advanced magnetic resonance imaging (MRI). J Child Neurol. 2009;24:1343-1365.

26

Pedersen C, Aboian M, McConathy JE, Daldrup-Link H, Franceschi AM. PET/MRI in pediatric neuroimaging: primer for clinical practice. AJNR Am J Neuroradiol. 2022;43:938-943.

27

Harat M, Rakowska J, Harat M, et al. Combining amino acid PET and MRI imaging increases accuracy to define malignant areas in adult glioma. Nat Commun. 2023;14:4572.

28

Hojjati M, Badve C, Garg V, et al. Role of FDG-PET/MRI, FDG-PET/CT, and dynamic susceptibility contrast perfusion mri in differentiating radiation necrosis from tumor recurrence in glioblastomas. J Neuroimaging. 2018;28:118-125.

29

Pyatigorskaya N, Sgard B, Bertaux M, Yahia-Cherif L, Kas A. Can FDG-PET/MR help to overcome limitations of sequential MRI and PET-FDG for differential diagnosis between recurrence/progression and radionecrosis of high-grade gliomas? J Neuroradiol. 2021;48:189-194.

30

Pyka T, Hiob D, Preibisch C, et al. Diagnosis of glioma recurrence using multiparametric dynamic 18F-fluoroethyl-tyrosine PET-MRI. Eur J Radiol. 2018;103:32-37.

31

Marner L, Lundemann M, Sehested A, et al. Diagnostic accuracy and clinical impact of [18F]FET PET in childhood CNS tumors. Neuro Oncol. 2021;23:2107-2116.

32

Marner L, Nysom K, Sehested A, et al. Early Postoperative 18F-FET PET/MRI for pediatric brain and spinal cord tumors. J Nucl Med. 2019;60:1053-1058.

33

Preuss M, Werner P, Barthel H, et al. Integrated PET/MRI for planning navigated biopsies in pediatric brain tumors. Childs Nerv Syst. 2014;30:1399-1403.

34

Shankar A, Bomanji J, Hyare H. Hybrid PET-MRI imaging in paediatric and TYA brain tumours: clinical applications and challenges. J Pers Med. 2020;10:218.

35

Tsouana E, Stoneham S, Fersht N, et al. Evaluation of treatment response using integrated 18F-labeled choline positron emission tomography/magnetic resonance imaging in adolescents with intracranial non-germinomatous germ cell tumours. Pediatr Blood Cancer. 2015;62:1661-1663.

36

Chun GYC, Sample J, Hubbard AK, Spector LG, Williams LA. Trends in pediatric lymphoma incidence by global region, age and sex from 1988-2012. Cancer Epidemiol. 2021;73:101965.

37

Pfister SM, Reyes-Múgica M, zar AJ, et al. Summary of the inaugural WHO classification of pediatric tumors: transitioning from the optical into the molecular era. Cancer Discov. 2022;12:331-355.

38

Kirchner J, Deuschl C, Schweiger B, et al. Imaging children suffering from lymphoma: an evaluation of different 18F-FDG PET/MRI protocols compared to whole-body DW-MRI. Eur J Nucl Med Mol Imaging. 2017;44:1742-1750.

39

Jannusch K, Morawitz J, Schweiger B, et al. [18F]FDG PET/MRI in children suffering from lymphoma: does MRI contrast media make a difference? Eur Radiol. 2023;33:8366-8375.

40

Giraudo C, Raderer M, Karanikas G, et al. 18F-Fluorodeoxyglucose positron emission tomography/magnetic resonance in lymphoma: comparison with 18F-fluorodeoxyglucose positron emission tomography/computed tomography and with the addition of magnetic resonance diffusion-weighted imaging. Invest Radiol. 2016;51:163-169.

41

Verhagen MV, Menezes LJ, Neriman D, et al. 18F-FDG PET/MRI for Staging and interim response assessment in pediatric and adolescent hodgkin lymphoma: a prospective study with 18F-FDG PET/CT as the reference standard. J Nucl Med. 2021;62:1524-1530.

42

Rashidi A, Baratto L, Theruvath AJ, et al. Diagnostic accuracy of 2-[18F]FDG-PET and whole-body DW-MRI for the detection of bone marrow metastases in children and young adults. Eur Radiol. 2022;32:4967-4979.

43

Dahlsgaard-Wallenius SE, Hildebrandt MG, et al. Hybrid PET/MRI in non-small cell lung cancer (NSCLC) and lung nodules-a literature review. Eur J Nucl Med Mol Imaging. 2021;48:584-91.

44

Morakote W, Baratto L, Ramasamy SK, et al. 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.

45

Arndt CA, Rose PS, Folpe AL, Laack NN, editors. Common musculoskeletal tumors of childhood and adolescence. Mayo Clinic Proceedings; 2012: Elsevier.

46

Guja KE, Behr G, Bedmutha A, Kuhn M, Nadel HR, Pandit-Taskar N. Molecular imaging with PET-CT and PET-MRI in pediatric musculoskeletal diseases. Semin Nucl Med. 2024;54:438-455.

47

Ricard F, Cimarelli S, Deshayes E, Mognetti T, Thiesse P, Giammarile F. Additional benefit of F-18 FDG PET/CT in the staging and follow-up of pediatric rhabdomyosarcoma. Clin Nucl Med. 2011;36:672-627.

48

van Ewijk R, Schoot RA, Sparber-Sauer M, et al. European guideline for imaging in paediatric and adolescent rhabdomyosarcoma - joint statement by the European Paediatric Soft Tissue Sarcoma Study Group, the Cooperative Weichteilsarkom Studiengruppe and the Oncology Task Force of the European Society of Paediatric Radiology. Pediatr Radiol. 2021;51:1940-1951.

49

Pourmehdi Lahiji A, Jackson T, Nejadnik H, et al. Association of tumor [18F]FDG activity and diffusion restriction with clinical outcomes of rhabdomyosarcomas. Mol Imaging Biol. 2019;21:591-598.

50

Zhang X, Chen YL, Lim R, Huang C, Chebib IA, El Fakhri G. Synergistic role of simultaneous PET/MRI-MRS in soft tissue sarcoma metabolism imaging. Magn Reson Imaging. 2016;34:276-279.

51

Padwal J, Baratto L, Chakraborty A, et al. PET/MR of pediatric bone tumors: what the radiologist needs to know. Skeletal Radiol. 2023;52:315-328.

52

Eiber M, Takei T, Souvatzoglou M, et al. Performance of whole-body integrated 18F-FDG PET/MR in comparison to PET/CT for evaluation of malignant bone lesions. J Nucl Med. 2014;55:191-197.

53

Chodyla M, Barbato F, Dirksen U, et al. Utility of Integrated PET/MRI for the primary diagnostic work-up of patients with ewing sarcoma: preliminary results. Diagnostics (Basel). 2022;12:2278.

54

Giraudo C, Fichera G, Stramare R, et al. Radiomic features as biomarkers of soft tissue paediatric sarcomas: preliminary results of a PET/MR study. Radiol Oncol. 2022;56:138-141.

55

Orsatti G, Zucchetta P, Varotto A, et al. Volumetric histograms-based analysis of apparent diffusion coefficients and standard uptake values for the assessment of pediatric sarcoma at staging: preliminary results of a PET/MRI study. Radiol Med. 2021;126:878-885.

56

Maennlin S, Chaika M, Gassenmaier S, et al. Evaluation of functional and metabolic tumor volume using voxel-wise analysis in childhood rhabdomyosarcoma. Pediatr Radiol. 2023;53:438-449.

57

Gadner H, Grois N, Pötschger U, et al. Improved outcome in multisystem Langerhans cell histiocytosis is associated with therapy intensification. Blood. 2008;111:2556-2562.

58

Binkovitz LA, Olshefski RS, Adler BH. Coincidence FDG-PET in the evaluation of Langerhans' cell histiocytosis: preliminary findings. Pediatr Radiol. 2003;33:598-602.

59

Ferrell J, Sharp S, Kumar A, Jordan M, Picarsic J, Nelson A. Discrepancies between F-18-FDG PET/CT findings and conventional imaging in Langerhans cell histiocytosis. Pediatr Blood Cancer. 2021;68:e28891.

60

Sher AC, Orth R, McClain K, Allen C, Hayatghaibi S, Seghers V. PET/MR in the assessment of pediatric histiocytoses: a comparison to PET/CT. Clin Nucl Med. 2017;42:582-588.

61

Wang F, Xu Y. The diagnostic value of 18F-FDG PET/MR in Langerhans histiocytosis in children. J Nuc Med. 2022;63:3129.

62

Baratto L, Nyalakonda R, Theruvath AJ, et al. Comparison of whole-body DW-MRI with 2-[18F]FDG PET for staging and treatment monitoring of children with Langerhans cell histiocytosis. Eur J Nucl Med Mol Imaging. 2023;50:1689-1698.

63

Colon NC, Chung DH. Neuroblastoma. Adv Pediatr. 2011;58:297-311.

64

Vik TA, Pfluger T, Kadota R, et al. (123)I-mIBG scintigraphy in patients with known or suspected neuroblastoma: Results from a prospective multicenter trial. Pediatr Blood Cancer. 2009;52:784-790.

65

Papathanasiou ND, Gaze MN, Sullivan K, et al. 18F-FDG PET/CT and 123I-metaiodobenzylguanidine imaging in high-risk neuroblastoma: diagnostic comparison and survival analysis. J Nucl Med. 2011;52:519-525.

66

Liu J, Li C, Yang X, et al. The diagnostic value of 18F-FDG PET/CT bone marrow uptake pattern in detecting bone marrow involvement in pediatric neuroblastoma patients. Contrast Media Mol Imaging. 2022 Jan 6;2022:7556315.

67

Bar-Sever Z, Keidar Z, Ben-Barak A, et al. The incremental value of 18F-FDG PET/CT in paediatric malignancies. Eur J Nucl Med Mol Imaging. 2007;34:630-637.

68

Soliman H, El-Noueam K, Ettaby A, Fadel S, Abougabal AM. Whole-body three-dimensional short tau inversion recovery and T1-weighted in/opposed phase MRI in the detection of neuroblastoma bone marrow metastasis: comparative study with PET/CT utilising bone marrow biopsy as the reference standard. Clin Radiol. 2023;78:e535-e541.

69

Kong G, Hofman MS, Murray WK, et al. Initial experience with gallium-68 DOTA-octreotate PET/CT and peptide receptor radionuclide therapy for pediatric patients with refractory metastatic neuroblastoma. J Pediatr Hematol Oncol. 2016;38:87-96.

70

Kroiss A, Putzer D, Uprimny C, et al. Functional imaging in phaeochromocytoma and neuroblastoma with 68Ga-DOTA-Tyr 3-octreotide positron emission tomography and 123I-metaiodobenzylguanidine. Eur J Nucl Med Mol Imaging. 2011;38:865-873.

71

Combemale P, Valeyrie-Allanore L, Giammarile F, et al. Utility of 18F-FDG PET with a semi-quantitative index in the detection of sarcomatous transformation in patients with neurofibromatosis type 1. PLoS One. 2014;9:e85954.

72

Reinert CP, Schuhmann MU, Bender B, et al. Comprehensive anatomical and functional imaging in patients with type I neurofibromatosis using simultaneous FDG-PET/MRI. Eur J Nucl Med Mol Imaging. 2019;46:776-787.

73

Voss SD. Functional and anatomical imaging in pediatric oncology: which is best for which tumors. Pediatr Radiol. 2019;49:1534-1544.

74

Evans DGR, Salvador H, Chang VY, et al. Cancer and central nervous system tumor surveillance in pediatric neurofibromatosis 1. Clin Cancer Res. 2017;23:e46-e53.

75

Raad RA, Lala S, Allen JC, et al. Comparison of hybrid 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging and positron emission tomography/computed tomography for evaluation of peripheral nerve sheath tumors in patients with neurofibromatosis type 1. World J Nucl Med. 2018;17:241-248.