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- Title
How to Provide Gadolinium-Free PET/MR Cancer Staging of Children and Young Adults in Less than 1 h: the Stanford Approach.
- Authors
Muehe, Anne M.; Theruvath, Ashok J.; Lai, Lillian; Aghighi, Maryam; Quon, Andrew; Holdsworth, Samantha J.; Wang, Jia; Luna-Fineman, Sandra; Marina, Neyssa; Advani, Ranjana; Rosenberg, Jarrett; Daldrup-Link, Heike E.
- Abstract
<bold>Purpose: </bold>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.<bold>Procedures: </bold>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-[18F]fluoro-D-glucose ([18F]FDG) PET/MR on a 3T PET/MR scanner after intravenous injection of ferumoxytol (5 mg Fe/kg) and [18F]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.<bold>Results: </bold>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). [18F]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 %).<bold>Conclusion: </bold>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.
- Subjects
TUMOR classification; CANCER tomography; MAGNETIC resonance imaging of cancer; POSITRON emission tomography; CHILDHOOD cancer; CANCER in young adults; DIAGNOSIS; CHEMICAL elements; COMPUTED tomography; DIAGNOSTIC imaging; LUNG tumors; MAGNETIC resonance imaging; RESEARCH funding; TUMORS
- Publication
Molecular Imaging & Biology, 2018, Vol 20, Issue 2, p324
- ISSN
1536-1632
- Publication type
journal article
- DOI
10.1007/s11307-017-1105-7