Journal article
How to Provide Gadolinium-Free PET/MR Cancer Staging of Children and Young Adults in Less than 1 h: the Stanford Approach
Molecular imaging and biology, Vol.20(2), pp.324-335
04/01/2018
DOI: 10.1007/s11307-017-1105-7
PMCID: PMC5773418
PMID: 28721605
Abstract
To provide clinically useful gadolinium-free whole-body cancer staging of children and young adults with integrated positron emission tomography/magnetic resonance (PET/MR) imaging in less than 1 h.
In this prospective clinical trial, 20 children and young adults (11-30 years old, 6 male, 14 female) with solid tumors underwent 2-deoxy-2-[F-18]fluoro-d-glucose ([F-18]FDG) PET/MR on a 3T PET/MR scanner after intravenous injection of ferumoxytol (5 mg Fe/kg) and [F-18]FDG (2-3 MBq/kg). Time needed for patient preparation, PET/MR image acquisition, and data processing was compared before (n = 5) and after (n = 15) time-saving interventions, using a Wilcoxon test. The ferumoxytol-enhanced PET/MR images were compared with clinical standard staging tests regarding radiation exposure and tumor staging results, using Fisher's exact tests.
Tailored workflows significantly reduced scan times from 36 to 24 min for head to mid thigh scans (p < 0.001). These streamlined PET/MR scans were obtained with significantly reduced radiation exposure (mean 3.4 mSv) compared to PET/CT with diagnostic CT (mean 13.1 mSv; p = 0.003). Using the iron supplement ferumoxytol "off label" as an MR contrast agent avoided gadolinium chelate administration. The ferumoxytol-enhanced PET/MR scans provided equal or superior tumor staging results compared to clinical standard tests in 17 out of 20 patients. Compared to PET/CT, PET/MR had comparable detection rates for pulmonary nodules with diameters of equal or greater than 5 mm (94 vs. 100 %), yet detected significantly fewer nodules with diameters of less than 5 mm (20 vs 100 %) (p = 0.03). [F-18]FDG-avid nodules were detected with slightly higher sensitivity on the PET of the PET/MR compared to the PET of the PET/CT (59 vs 49 %).
Our streamlined ferumoxytol-enhanced PET/MR protocol provided cancer staging of children and young adults in less than 1 h with equivalent or superior clinical information compared to clinical standard staging tests. The detection of small pulmonary nodules with PET/MR needs to be improved.
Details
- Title: Subtitle
- How to Provide Gadolinium-Free PET/MR Cancer Staging of Children and Young Adults in Less than 1 h: the Stanford Approach
- Creators
- Anne M. Muehe - Lucile Packard Children's HospitalAshok J. Theruvath - Stanford UniversityLillian Lai - Lucile Packard Children's HospitalMaryam Aghighi - Lucile Packard Children's HospitalAndrew Quon - Lucile Packard Children's HospitalSamantha J. Holdsworth - Lucile Packard Children's HospitalJia Wang - Stanford UniversitySandra Luna-Fineman - Lucile Packard Children's HospitalNeyssa Marina - Lucile Packard Children's HospitalRanjana Advani - Stanford MedicineJarrett Rosenberg - Lucile Packard Children's HospitalHeike E. Daldrup-Link - Stanford University
- Resource Type
- Journal article
- Publication Details
- Molecular imaging and biology, Vol.20(2), pp.324-335
- Publisher
- Springer Nature
- DOI
- 10.1007/s11307-017-1105-7
- PMID
- 28721605
- PMCID
- PMC5773418
- ISSN
- 1536-1632
- eISSN
- 1860-2002
- Number of pages
- 12
- Grant note
- R01 HD081123-01A1 / Eunice Kennedy Shriver National Institute of Child Health and Human Development; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD) R01HD081123 / EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH & HUMAN DEVELOPMENT; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
- Language
- English
- Date published
- 04/01/2018
- Academic Unit
- Radiology
- Record Identifier
- 9984318804502771
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