Clinical utilization of whole-body PET/MRI in childhood sarcoma
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PICTORIAL ESSAY
Clinical utilization of whole-body PET/MRI in childhood sarcoma Jing Qi 1
Pooja D. Thakrar 1 & Meghen B. Browning 2 & Nghia Vo 1 & Sachin S. Kumbhar 1
&
Received: 15 May 2020 / Revised: 12 August 2020 / Accepted: 27 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Hybrid positron emission tomography (PET)/magnetic resonance imaging (MRI) has emerged as a useful tool that combines the superior tissue contrast of MRI with the targeted functional imaging of PET. In the assessment of sarcomas in children, PET/MRI has the potential to serve as a single point of service, allowing superior anatomical imaging and evaluation of metabolic uptake during one imaging session. In this pictorial essay, we review our preliminary experience with PET/MRI in the evaluation of pediatric sarcoma. The limitations and contraindications of PET/MRI are also discussed. Keywords
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F-fluorodeoxyglucose . Children . Positron emission tomography/magnetic resonance imaging . Sarcoma
Introduction Positron emission tomography (PET) has long been used in oncological imaging for staging, treatment response assessment, end of therapy evaluation and recurrent tumor detection. PET/magnetic resonance imaging (MRI) has previously been shown to have a performance equivalent to PET/computed tomography (CT) for a wide range of malignancies in adults [1–4]. PET/MRI has also been shown to be a reliable and precise diagnostic tool in pediatric oncologic imaging [5–8]. The MRI component of this hybrid imaging modality provides better soft-tissue contrast compared to CT. Moreover, MRI does not expose patients to ionizing radiation. This benefit, while important in all patients, is particularly significant in the pediatric population. There is limited literature available regarding the performance of PET/MRI in pediatric sarcomas. A small number of preliminary studies that included sarcomas among other pediatric malignancies have demonstrated PET/ MRI to be a reliable staging modality with a similar lesion detection rate compared to PET/CT with the added benefit of
* Jing Qi [email protected] 1
Department of Radiology, Children’s Wisconsin and the Medical College of Wisconsin, 9000 W. Wisconsin Ave., MS-721, Milwaukee, WI 53226, USA
2
Department of Pediatric Hematology and Oncology, Children’s Wisconsin and the Medical College of Wisconsin, Milwaukee, WI, USA
less radiation exposure [5, 6]. In addition, the superior softtissue contrast provided by the MRI component can facilitate selection of a biopsy site within the tumor as well as preoperative planning for local resection [6]. Here we seek to discuss our use of PET/MRI to evaluate patients with childhood sarcoma.
PET/MRI imaging technique As PET studies for sarcoma require use of 1 8 Ffluorodeoxyglucose (FDG), a glucose analogue, we instruct our patients to fast for at least 4 h before radiotracer injection. A weight-based dose of FDG (0.1 mCi/kg) is administered intravenously. PET/MRI scanning begins 40 to 90 min after the injection. Our PET/MRI scans
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