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Jin H, Yin Y, Wang H, Cheng W. 18 F-FDG PET/CT in a Case of Clear Cell Sarcoma of the Kidney. Clin Nucl Med 2024; 49:468-469. [PMID: 38377388 DOI: 10.1097/rlu.0000000000005071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
ABSTRACT 18 F-FDG PET/CT was performed in a 1-year-old girl who had a heterogeneous mass in the right abdominal cavity revealed by abdominal ultrasound. A heterogeneous mass with internal necrosis, cystic changes, and hemorrhage in the right kidney, accompanied by a slight increase of FDG uptake, was observed in FDG PET/CT. Malignant renal tumor was considered, and Wilms tumor was preferentially suspected. However, the mass was demonstrated as clear cell sarcoma of the kidney by histopathological examination.
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Affiliation(s)
- Hongfu Jin
- From the Department of Nuclear Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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2
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Fuchs J, Schunn MC, Schäfer JF, Ebinger M, Graf N, Furtwängler R, Warmann SW. Redo nephron-sparing surgery in stage V pediatric renal tumors - A report from the SIOP/GPOH study group for renal tumors. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107265. [PMID: 38035461 DOI: 10.1016/j.ejso.2023.107265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/08/2023] [Indexed: 12/02/2023]
Abstract
PURPOSE Nephron-sparing Surgery (NSS) is the surgical treatment of choice in children with bilateral renal tumors or in syndromatic patients. With an increasing role of this surgical approach, there is also an increased number of tumor relapses after NSS. Aim of this study was to evaluate a second ("Redo-") NSS in children with relapsed renal tumors. MATERIALS AND METHODS We retrospectively analysed patients undergoing Redo-NSS for relapsed kidney tumors between 2009 and 2021 at our institution, which represents a national reference center of the SIOP/GPOH renal tumor study group. RESULTS Nine patients (5 girls, 4 boys) underwent Redo-NSS with resection of 15 lesions. Mean age at surgery was 58 months (12-137), mean operative time for Redo-NSS was 195 min (137-260). R0 resection status was achieved in all children. Two patients had second relapses, one of them was resected via NSS, the other child underwent tumor nephrectomy. Two patients with anaplastic relapses died from combined second relapses. Thus, 7/9 patients are alive without evidence of disease, an impaired renal function was observed in one child. Mean follow-up after Redo-NSS was 35 months (6-49). CONCLUSIONS In renal tumor relapses, Redo-NSS can be performed with satisfactory oncological and functional results. Occurrence of diffuse anaplasia should possibly refrain from this approach. Further evaluation in international multicenter analyses are necessary for a definitive determination of Redo-NSS.
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Affiliation(s)
- Jörg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tuebingen, Germany.
| | - Matthias C Schunn
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tuebingen, Germany
| | - Jürgen F Schäfer
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Germany
| | - Martin Ebinger
- Department of Pediatric Oncology, University Children's Hospital Tuebingen, Germany
| | - Norbert Graf
- Department of Pediatric Oncology & Haematology, Saarland University, Homburg, Germany
| | - Rhoikos Furtwängler
- Department of Pediatric Oncology & Haematology, Saarland University, Homburg, Germany
| | - Steven W Warmann
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tuebingen, Germany
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3
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Prediction of Wilms' Tumor Susceptibility to Preoperative Chemotherapy Using a Novel Computer-Aided Prediction System. Diagnostics (Basel) 2023; 13:diagnostics13030486. [PMID: 36766591 PMCID: PMC9914296 DOI: 10.3390/diagnostics13030486] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 01/01/2023] [Accepted: 01/25/2023] [Indexed: 02/01/2023] Open
Abstract
Wilms' tumor, the most prevalent renal tumor in children, is known for its aggressive prognosis and recurrence. Treatment of Wilms' tumor is multimodal, including surgery, chemotherapy, and occasionally, radiation therapy. Preoperative chemotherapy is used routinely in European studies and in select indications in North American trials. The objective of this study was to build a novel computer-aided prediction system for preoperative chemotherapy response in Wilms' tumors. A total of 63 patients (age range: 6 months-14 years) were included in this study, after receiving their guardians' informed consent. We incorporated contrast-enhanced computed tomography imaging to extract the texture, shape, and functionality-based features from Wilms' tumors before chemotherapy. The proposed system consists of six steps: (i) delineate the tumors' images across the three contrast phases; (ii) characterize the texture of the tumors using first- and second-order textural features; (iii) extract the shape features by applying a parametric spherical harmonics model, sphericity, and elongation; (iv) capture the intensity changes across the contrast phases to describe the tumors' functionality; (v) apply features fusion based on the extracted features; and (vi) determine the final prediction as responsive or non-responsive via a tuned support vector machine classifier. The system achieved an overall accuracy of 95.24%, with 95.65% sensitivity and 94.12% specificity. Using the support vector machine along with the integrated features led to superior results compared with other classification models. This study integrates novel imaging markers with a machine learning classification model to make early predictions about how a Wilms' tumor will respond to preoperative chemotherapy. This can lead to personalized management plans for Wilms' tumors.
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Sepehrizadeh T, Jong I, DeVeer M, Malhotra A. PET/MRI in paediatric disease. Eur J Radiol 2021; 144:109987. [PMID: 34649143 DOI: 10.1016/j.ejrad.2021.109987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 12/17/2022]
Abstract
Nuclear medicine and molecular imaging have a small but growing role in the management of paediatric and neonatal diseases. During the past decade, combined PET/MRI has emerged as a clinically important hybrid imaging modality in paediatric medicine due to diagnostic advantages and reduced radiation exposure compared to alternative techniques. The applications for nuclear medicine, radiopharmaceuticals and combined PET/MRI in paediatric diagnosis is broadly similar to adults, however there are some key differences. There are a variety of clinical applications for PET/MRI imaging in children including, but not limited to, oncology, neurology, cardiovascular, infection and chronic inflammatory diseases, and in renal-urological disorders. In this article, we review the applications of PET/MRI in paediatric and neonatal imaging, its current role, advantages and disadvantages over other hybrid imaging techniques such as PET/CT, and its future applications. Overall, PET/MRI is a powerful imaging technology in diagnostic medicine and paediatric diseases. Higher soft tissue contrasts and lower radiation dose of the MRI makes it the superior technology compared to other conventional techniques such as PET/CT or scintigraphy. However, this relatively new hybrid imaging has also some limitations. MRI based attenuation correction remains a challenge and although methodologies have improved significantly in the last decades, most remain under development.
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Affiliation(s)
| | - Ian Jong
- Department of diagnostic imaging, Monash Health, Melbourne, Australia
| | - Michael DeVeer
- Monash Biomedical Imaging, Monash University, Melbourne, Australia
| | - Atul Malhotra
- Monash Newborn, Monash Children's Hospital, Melbourne, Australia; Department of Paediatrics, Monash University, Melbourne, Australia
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5
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Kousik V, Vaswani BA, Milap M, Ram S. 18Fluorine-fluorodeoxyglucose PET-CT findings in a case of rarely seen metastatic adult extrarenal Wilms' tumor of retroperitoneum presenting as lower limb edema. World J Nucl Med 2021; 20:386-388. [PMID: 35018157 PMCID: PMC8686739 DOI: 10.4103/wjnm.wjnm_53_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 05/24/2021] [Accepted: 06/02/2021] [Indexed: 11/15/2022] Open
Abstract
Wilms’ tumor also called as nephroblastoma is commonly seen extracranial solid tumor involving kidneys in children. Rarely, Wilms’ tumor can arise from ectopic nephrogenic remnants located outside the kidneys. Extrarenal Wilms’ tumor comprises 3% of total Wilms’ tumor with its incidence even less common in adults. We report the staging and restaging fluorodeoxyglucose positron emission tomography-computed tomography findings in a case of locally advanced metastatic extrarenal adult Wilms’ tumor involving the retroperitoneum.
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Affiliation(s)
- Vankadari Kousik
- Department of Nuclear Medicine, Yashoda Hospital, Secunderabad, Telangana, India
| | - Bharat A Vaswani
- Department of Oncology, Yashoda Hospital, Secunderabad, Telangana, India
| | - Milap Milap
- Department of Pathology, Yashoda Hospital, Secunderabad, Telangana, India
| | - Sai Ram
- Department of Nuclear Medicine, Yashoda Hospital, Secunderabad, Telangana, India
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6
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Davis JT, Wagner LM. Imaging of childhood urologic cancers: current approaches and new advances. Transl Androl Urol 2020; 9:2348-2357. [PMID: 33209708 PMCID: PMC7658153 DOI: 10.21037/tau-19-839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Urologic tumors make up approximately 10% of all pediatric cancers, and include a variety of different histologies and imaging considerations. In this review, we discuss standard radiologic approaches for children with tumors arising in the genitourinary system, and identify important ways in which imaging affects the differential diagnosis, preoperative planning, and staging of these tumors. In addition, we provide an update on strategies to reduce the time of imaging, which may obviate the need for sedation in younger patients. Efforts to reduce a patient’s overall radiation exposure and subsequent risk of second malignancy are also detailed, including recent work on surveillance imaging following completion of therapy. Finally, we highlight new techniques such as radiomics that are now being investigated for patients with these malignancies.
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Affiliation(s)
- Joseph T Davis
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Lars M Wagner
- Division of Pediatric Hematology/Oncology, Duke University Medical Center, Durham, NC, USA
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7
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Chambers G, Frood R, Patel C, Scarsbrook A. 18F-FDG PET-CT in paediatric oncology: established and emerging applications. Br J Radiol 2018; 92:20180584. [PMID: 30383441 DOI: 10.1259/bjr.20180584] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Accurate staging and response assessment is vital in the management of childhood malignancies. Fluorine-18 fluorodeoxyglucose positron emission tomography/CT (FDG PET-CT) provides complimentary anatomical and functional information. Oncological applications of FDG PET-CT are not as well-established within the paediatric population compared to adults. This article will comprehensively review established oncological PET-CT applications in paediatric oncology and provide an overview of emerging and future developments in this domain.
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Affiliation(s)
- Greg Chambers
- 1 Department of Nuclear Medicine, Leeds Teaching Hospitals NHS Trust , Leeds , UK
| | - Russell Frood
- 1 Department of Nuclear Medicine, Leeds Teaching Hospitals NHS Trust , Leeds , UK
| | - Chirag Patel
- 1 Department of Nuclear Medicine, Leeds Teaching Hospitals NHS Trust , Leeds , UK
| | - Andrew Scarsbrook
- 1 Department of Nuclear Medicine, Leeds Teaching Hospitals NHS Trust , Leeds , UK.,2 Radiotherapy Research Group, Leeds Institute of Cancer and Pathology, University of Leeds , Leeds , UK
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8
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Sanli Y, Yilmaz E, Subramaniam RM. Precision Medicine and PET-Computed Tomography in Pediatric Malignancies. PET Clin 2017; 12:423-435. [PMID: 28867113 DOI: 10.1016/j.cpet.2017.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Fluorine-18 fluorodeoxyglucose (18F-FDG) PET-computed tomography (CT) plays a significant role in diagnosis, staging, therapy selection, and therapy assessment of multiple pediatric malignancies and facilitating precision medicine delivery in pediatric patients. In patients with Hodgkin lymphoma, interim fludeoxyglucose 18F-FDG PET/CT is highly sensitive and specific for predicting survival and multiple trials with FDG PET/CT-based adaptive therapies are currently ongoing. It is superior to iodine-131 metaiodobenzylguanidine (131I-MIBG) scintigraphy and bone scintigraphy for detecting metastases in neuroblastoma patients and sarcoma patients. It may predict histologic differentiation and neoadjuvant therapy assessment in Wilms tumor.
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Affiliation(s)
- Yasemin Sanli
- Department of Nuclear Medicine, Medical Faculty of Istanbul, Istanbul University, Sehremini, Istanbul 34370, Turkey; Department of Radiology, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA.
| | - Ebru Yilmaz
- Department of Nuclear Medicine, Medical Faculty of Istanbul, Istanbul University, Sehremini, Istanbul 34370, Turkey
| | - Rathan M Subramaniam
- Department of Radiology, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA; Department of Clinical Sciences, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA; Department of Biomedical Engineering, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA; Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA; Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA
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9
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Mendichovszky I, Solar BT, Smeulders N, Easty M, Biassoni L. Nuclear Medicine in Pediatric Nephro-Urology: An Overview. Semin Nucl Med 2017; 47:204-228. [PMID: 28417852 DOI: 10.1053/j.semnuclmed.2016.12.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
In the context of ante-natally diagnosed hydronephrosis, the vast majority of children with a dilated renal pelvis do not need any surgical treatment, as the dilatation resolves spontaneously with time. Slow drainage demonstrated at Tc-99m-mercaptoacetyltriglycine (MAG3) renography does not necessarily mean obstruction. Obstruction is defined as resistance to urinary outflow with urinary stasis at the level of the pelvic-ureteric junction (PUJ) which, if left untreated, will damage the kidney. Unfortunately this definition is retrospective and not clinically helpful. Therefore, the identification of the kidney at risk of losing function in an asymptomatic patient is a major research goal. In the context of renovascular hypertension a DMSA scan can be useful before and after revascularisation procedures (angioplasty or surgery) to assess for gain in kidney function. Renal calculi are increasingly frequent in children. Whilst the vast majority of patients with renal stones do not need functional imaging, DMSA scans with SPECT and a low dose limited CT can be very helpful in the case of complex renal calculi. Congenital renal anomalies such as duplex kidneys, horseshoe kidneys, crossed-fused kidneys and multi-cystic dysplastic kidneys greatly benefit from functional imaging to identify regional parenchymal function, thus directing further management. Positron emission tomography (PET) is being actively tested in genito-urinary malignancies. Encouraging initial reports suggest that F-18-fluorodeoxyglucose (FDG) PET is more sensitive than CT in the assessment of lymph nodal metastases in patients with genito-urinary sarcomas; an increased sensitivity in comparison to isotope bone scans for skeletal metastatic disease has also been reported. Further evaluation is necessary, especially with the promising advent of PET/MRI scanners. Nuclear Medicine in paediatric nephro-urology has stood the test of time and is opening up to new exciting developments.
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Affiliation(s)
- Iosif Mendichovszky
- Department of Radiology, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK
| | | | - Naima Smeulders
- Department of Urology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Marina Easty
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Lorenzo Biassoni
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
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10
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Chung EM, Graeber AR, Conran RM. Renal Tumors of Childhood: Radiologic-Pathologic Correlation Part 1. The 1st Decade: From the Radiologic Pathology Archives. Radiographics 2017; 36:499-522. [PMID: 26963460 DOI: 10.1148/rg.2016150230] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Wilms tumor is the second most common pediatric solid tumor and by far the most common renal tumor of infants and young children. As most tumors are large at presentation and are treated with nephrectomy, the role of imaging is primarily in preoperative planning and evaluation for metastatic disease. However, with treatment protocols increasingly involving use of preoperative (neoadjuvant) chemotherapy (the standard in Europe) and consideration of nephron-sparing surgery, the role of imaging is evolving to include providing initial disease staging information and a presumptive diagnosis to guide therapy. Differential diagnostic considerations include lesions that are clinically benign and others that require more intensive therapy than is used to treat Wilms tumor. In part 1 of this article, the unique histologic spectrum of renal neoplasms of infants and young children is reviewed with emphasis on radiologic-pathologic correlation. Part 2 will focus on renal tumors of older children and adolescents.
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Affiliation(s)
- Ellen M Chung
- From the Department of Radiology and Radiological Sciences (E.M.C.), F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences (A.R.G.), 4301 Jones Bridge Rd, Bethesda, MD 20814; Pediatric Radiology Section, American Institute for Radiologic Pathology, Silver Spring, Md (E.M.C.); and Department of Pathology, Eastern Virginia Medical School, Norfolk, Va (R.M.C.)
| | - Adam R Graeber
- From the Department of Radiology and Radiological Sciences (E.M.C.), F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences (A.R.G.), 4301 Jones Bridge Rd, Bethesda, MD 20814; Pediatric Radiology Section, American Institute for Radiologic Pathology, Silver Spring, Md (E.M.C.); and Department of Pathology, Eastern Virginia Medical School, Norfolk, Va (R.M.C.)
| | - Richard M Conran
- From the Department of Radiology and Radiological Sciences (E.M.C.), F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences (A.R.G.), 4301 Jones Bridge Rd, Bethesda, MD 20814; Pediatric Radiology Section, American Institute for Radiologic Pathology, Silver Spring, Md (E.M.C.); and Department of Pathology, Eastern Virginia Medical School, Norfolk, Va (R.M.C.)
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11
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Wu J, Zhu Q, Zhu W, Chen W. CT and MRI imaging features and long-term follow-up of adult Wilms' tumor. Acta Radiol 2016; 57:894-900. [PMID: 26452976 DOI: 10.1177/0284185115608658] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 08/24/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Only few previous case reports have been found focusing on the imaging findings of adult Wilms' tumor (WT). PURPOSE To characterize multislice computed tomography (MSCT), magnetic resonance imaging (MRI) characteristics, and follow-up results of adult WT. MATERIAL AND METHODS Sixteen patients with WT were studied retrospectively. MSCT and MRI were undertaken to investigate the tumor characteristics. RESULTS Tumors (mean diameter, 13.1 ± 4.5 cm) exhibited an expansible appearance and disrupted the reniform contour (16/16), cystic components (16/16), curvilinear calcification (1/16), poorly marginated (2/16), hemorrhage (16/16), displacement of renal pelvis or calyx (13/16), and had lymph node or distal metastases (5/16). Attenuation of WT was less or equal compared to renal parenchyma on unenhanced CT (P > 0.05), while tumor enhancement after administration of a contrast agent was lower than that of normal renal parenchyma (P < 0.05). WT was isointense on T1-weighted (T1W) imaging, isointense or hypointense on T2-weighted (T2W) imaging. Tumor enhancement was less than normal renal cortex in all phases (P < 0.05). The number of tumor stages (grades I, II, III, and IV) was two, three, six, and five cases, respectively. Follow-up time was in the range of 19-123 months; six patients died within 3 years, six patients died within 5 years after the initial diagnosis, with the remaining patients still alive. CONCLUSION Adult WT tends to be a large tumor, isointense or hypointense on T2W imaging with enhancement less than normal renal parenchyma in all phases. The long-term follow-up results demonstrated the poor prognosis of the tumor.
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Affiliation(s)
- Jingtao Wu
- Department of Medical Imaging, Subei People’s Hospital, Medical School of Yangzhou University, Yangzhou, PR China
| | - Qingqiang Zhu
- Department of Medical Imaging, Subei People’s Hospital, Medical School of Yangzhou University, Yangzhou, PR China
| | - Wenrong Zhu
- Department of Medical Imaging, Subei People’s Hospital, Medical School of Yangzhou University, Yangzhou, PR China
| | - Wenxin Chen
- Department of Medical Imaging, Subei People’s Hospital, Medical School of Yangzhou University, Yangzhou, PR China
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Use of 18F-FDG-PET-CT for Assessment of Response to Neoadjuvant Chemotherapy in Children With Wilms Tumor. J Pediatr Hematol Oncol 2015; 37:396-401. [PMID: 25749587 DOI: 10.1097/mph.0000000000000323] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to evaluate the predictive value of fluorine-18-fluorodeoxyglucose positron emission tomography with computed tomography (F-FDG-PET-CT) in the assessment of histologic response to neoadjuvant chemotherapy in children with Wilms tumors (WTs). MATERIALS AND METHODS We prospectively registered 12 patients with WTs who were treated with 2 cycles of neoadjuvant chemotherapy and surgery. All patients underwent sequential F-FDG-PET-CT before (PET-CT1) and after (PET-CT2) neoadjuvant chemotherapy. Maximum standardized uptake value (SUVmax) was measured on PET-CT1 (SUV1) and PET-CT2 (SUV2). The percentage change in SUVmax (SUVmax reduction) was calculated. After surgery the effects of neoadjuvant chemotherapy were graded histopathologically: ≥90% necrosis indicated a good response and <90% necrosis was considered a poor response. The correlation between SUVmax reduction and histologic response was estimated using the Spearman correlation coefficient. RESULTS Among the 12 patients who underwent PET-CT before and after chemotherapy, SUVmax reduction was significantly different between the good response group and the poor response group (P=0.035). A significant, in terms of P value, correlation was found between pathologic response and SUVmax reduction (r=0.700; 95% confidence interval, 0.060-0.935; P=0.011). A threshold of 66% reduction in SUVmax was identified, with which partition, there were 8 good histologic responders (≥66% decrease in SUVmax) and 4 poor responders. The histologic complete response rate of the good responders was 87.5%, whereas that of poor responders was 0%. SUV1≥7 and SUV2≥2.4 were both considered to be with high risk of recurrence. In patients with SUV1≥7, 4/5 cases relapsed and 4/6 patients with SUV2≥2.4 relapsed. CONCLUSIONS As there seems to be a good correlation of changes in SUVmax and histologic response, PET-CT has the potential of predicting the response to neoadjuvant chemotherapy in children with WT. SUV1 and SUV2 by themselves might be a good prognosticator of the clinical outcome of WT pediatric patients treated with International Society of Pediatric Oncology protocols, although the reduction rate of SUVmax is much less powerful for prognosis.
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Uslu L, Donig J, Link M, Rosenberg J, Quon A, Daldrup-Link HE. Value of 18F-FDG PET and PET/CT for evaluation of pediatric malignancies. J Nucl Med 2015; 56:274-86. [PMID: 25572088 DOI: 10.2967/jnumed.114.146290] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Successful management of solid tumors in children requires imaging tests for accurate disease detection, characterization, and treatment monitoring. Technologic developments aim toward the creation of integrated imaging approaches that provide a comprehensive diagnosis with a single visit. These integrated diagnostic tests not only are convenient for young patients but also save direct and indirect health-care costs by streamlining procedures, minimizing hospitalizations, and minimizing lost school or work time for children and their parents. (18)F-FDG PET/CT is a highly sensitive and specific imaging modality for whole-body evaluation of pediatric malignancies. However, recent concerns about ionizing radiation exposure have led to a search for alternative imaging methods, such as whole-body MR imaging and PET/MR. As we develop new approaches for tumor staging, it is important to understand current benchmarks. This review article will synthesize the current literature on (18)F-FDG PET/CT for tumor staging in children, summarizing questions that have been solved and providing an outlook on unsolved avenues.
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Affiliation(s)
- Lebriz Uslu
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, California; and
| | - Jessica Donig
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, California; and
| | - Michael Link
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Jarrett Rosenberg
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, California; and
| | - Andrew Quon
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, California; and
| | - Heike E Daldrup-Link
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, California; and
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14
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Freebody J, Wegner EA, Rossleigh MA. 2-deoxy-2-( 18F)fluoro-D-glucose positron emission tomography/computed tomography imaging in paediatric oncology. World J Radiol 2014; 6:741-755. [PMID: 25349660 PMCID: PMC4209422 DOI: 10.4329/wjr.v6.i10.741] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 03/05/2014] [Accepted: 09/17/2014] [Indexed: 02/06/2023] Open
Abstract
Positron emission tomography (PET) is a minimally invasive technique which has been well validated for the diagnosis, staging, monitoring of response to therapy, and disease surveillance of adult oncology patients. Traditionally the value of PET and PET/computed tomography (CT) hybrid imaging has been less clearly defined for paediatric oncology. However recent evidence has emerged regarding the diagnostic utility of these modalities, and they are becoming increasingly important tools in the evaluation and monitoring of children with known or suspected malignant disease. Important indications for 2-deoxy-2-(18F)fluoro-D-glucose (FDG) PET in paediatric oncology include lymphoma, brain tumours, sarcoma, neuroblastoma, Langerhans cell histiocytosis, urogenital tumours and neurofibromatosis type I. This article aims to review current evidence for the use of FDG PET and PET/CT in these indications. Attention will also be given to technical and logistical issues, the description of common imaging pitfalls, and dosimetric concerns as they relate to paediatric oncology.
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15
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Baldisserotto M. Wilms' tumor: is computed tomography specific to detect lymph node metastasis? Radiol Bras 2014. [DOI: 10.1590/s0100-39842014000100002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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16
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Flores LG, Yeh HH, Soghomonyan S, Young D, Bankson J, Hu Q, Alauddin M, Huff V, Gelovani JG. Monitoring therapy with MEK inhibitor U0126 in a novel Wilms tumor model in Wt1 knockout Igf2 transgenic mice using 18F-FDG PET with dual-contrast enhanced CT and MRI: early metabolic response without inhibition of tumor growth. Mol Imaging Biol 2013; 15:175-85. [PMID: 22875335 PMCID: PMC3591528 DOI: 10.1007/s11307-012-0588-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE The understanding of the role of genetic alterations in Wilms tumor development could be greatly advanced using a genetically engineered mouse models that can replicate the development and progression of this disease in human patients and can be monitored using non-invasive structural and molecular imaging optimized for renal tumors. PROCEDURES Repetitive dual-contrast computed tomography (CT; intravenous and intraperitoneal contrast), T2-weighted magnetic resonance imaging (MRI), and delayed 2-deoxy-2-[(18)F]fluoro-D-glucose ((18)F-FDG) positron emission tomography (PET) were utilized for characterization of Igf2 biallelic expression/Wt1 knockout mouse model of Wilms tumor. For CT imaging, Ioversol 678 mg/ml in 200 μl was administered i.p. followed by 100 μl injected intravenously at 20 and 15 min prior to imaging, respectively. Static PET imaging studies were acquired at 1, 2, and 3 h after i.v. administration of (18)F-FDG (400 μCi). Coronal and sagittal T1-weighted images (TE/TR 8.5/620 ms) were acquired before and immediately after i.v. injection of 0.4 ml/kg gadopentetate dimeglumine followed by T2-weighted images (TE/TR 60/300 ms). Tumor tissue samples were characterized by histopathology and immunohistochemistry for Glut1, FASN, Ki67, and CD34. In addition, six Wt1-Igf2 mice were treated with a mitogen-activated protein kinase (MEK) inhibitor U0126 (50 μmol/kg i.p.) every 4 days for 6 weeks. (18)F-FDG PET/CT imaging was repeated at different days after initiation of therapy with U0126. The percent change of initial tumor volume and SUV was compared to non-treated historic control animals. RESULTS Overall, the best tumor-to-adjacent kidney contrast as well as soft tissue contrast for other abdominal organs was achieved using T2-weighted MRI. Delayed (18)F-FDG PET (3-h post (18)F-FDG administration) and dual-contrast CT (intravenous and intraperitoneal contrast) provided a more accurate anatomic and metabolic characterization of Wilms tumors in Wt1-Igf2 mice during early development and progression of renal tumors. Over the 8-month period, 46 Wt1-Igf2 mice and 8 littermate control mice were studied. Renal tumors were identified in 54.3 % of Wt1-Igf2 mice between post-natal 50-100 days. In 35.6 % of Wt1-Igf2 mice, tumors were localized in the right kidney; in 24 %, in the left kidney, while 40.4 % of Wt1-Igf2 mice had bilateral kidney tumors. Metastatic lesions were identified in 15.4 % of Wt1-Igf2 mice. Increased levels of Glut1 and IGF1R expression, high Ki67 labeling index, and a dense network of CD34+ microvessels in renal tumors was consistent with increased (18)F-FDG accumulation. Treatment with a MEK 1/2 inhibitor U0126 did not cause the inhibition of tumor growth as compared to untreated animals. However, after the first three to four doses (~2 weeks of treatment), a decrease in (18)F-FDG SUV was observed, as compared to pre-treatment levels (p < 0.05, paired Student t test), which constitutes a metabolic response. Six weeks later, despite continuing therapy, the (18)F-FDG SUV increased again to previous levels. CONCLUSIONS The optimized dual contrast PET/CT imaging with early post i.v. and i.p. contrast CT and 3 h delayed PET imaging after (18)F-FDG administration provides a sensitive and reliable method for detecting early tumor lesions in this endogenous mouse model of Wilms tumor and for monitoring their growth in response to targeted therapies. Therapy with MEK inhibitor U0126 produces only a transient inhibition of tumor glycolytic activity but does not inhibit tumor growth, which is due to continuing IGF2-induced signaling from IGF1R through the PI3K-AKT-mTOR pathway.
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Affiliation(s)
- Leo G Flores
- Department of Experimental Diagnostic Imaging, UT MD Anderson Cancer Center, Houston, TX, USA
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Provenzi M, Saettini F, Conter V, Chinaglia D, Vai P, Bruno A, Cavalleri L, Foglia C, Giraldi E, Collini P, Spreafico F. Is there a role for FDG-PET for the assessment of treatment efficacy in Wilms' tumor? A case report and literature review. Pediatr Hematol Oncol 2013; 30:633-9. [PMID: 24050763 DOI: 10.3109/08880018.2013.832446] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The role of FDG-PET in Wilms' tumor has not been well established. The aim of this report is to describe the role of FDG-PET to assess chemotherapy efficacy and to show potential correlations between different Standardized Uptake Values (SUVs) and histopathological features in a patient with persisting metastatic disease. CASE DESCRIPTION A 3-year-old boy was diagnosed with Wilms' tumor without anaplasia. The patient underwent treatment as according to the AIEOP-TW-2003 protocol, for stage III tumors. Therapy was discontinued with no evidence of disease, yet 9 months later thorax metastases were found. Although second and third line treatments were administered, conventional imaging demonstrated stable disease. Metronomic chemotherapy as well was employed for 44 months and FDG-PET was annually performed basing on responsible local physician choice trying to better describe the disease status. Four months after fourth line treatment was stopped, the patient manifested clinical symptoms; lesions began to increase their metabolic activity inhomogeneously. Therapy was hence restarted and SUVs decreased. Metastasectomies were then performed and histology revealed a correlation between viable disease shown by higher FDG-PET uptake and viable tumor areas. CONCLUSIONS Our case discussion demonstrates that FDG-PET is potentially valuable in Wilms' tumor correlating SUV values and histological features of the tumor after chemotherapy. This case suggests that FDG-PET is a valid tool to assess chemotherapy response in relapsed Wilms' tumor even in case of no evidence of significant dimensional changes under conventional imaging.
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Affiliation(s)
- M Provenzi
- 1Department of Pediatrics, Ospedale Papa Giovanni XXIII, Bergamo, Italy
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Abstract
Hybrid PET/magnetic resonance (MR) imaging, which combines the excellent anatomic information and functional MR imaging parameters with the metabolic and molecular information obtained with PET, may be superior to PET/computed tomography or MR imaging alone for a wide range of disease conditions. This review highlights potential clinical applications in neurologic, cardiovascular, and musculoskeletal disease conditions, with special attention to applications in oncologic imaging.
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Abstract
The commonest urogenital tumours in childhood are Wilms tumour of the kidney and rhabdomyosarcoma in the pelvis. We review these tumours along with other primary renal tumours and less common ovarian and testicular tumours in childhood. Current clinical concepts, relevant staging investigations and imaging features are described.
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Affiliation(s)
- S Swinson
- Department of Radiology, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK
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20
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Abstract
The use of PET/PET-CT is a rapidly growing area of imaging and research in the care of children. Until recently, diagnostic imaging methods have provided either anatomical or functional assessment. The development of fused imaging modalities, such as PET-CT or PET-MRI, now provides the opportunity for simultaneously providing both anatomical and functional or physiological assessment. This review will discuss current established uses of PET-CT, possible uses and potential research investigations in the use of this modality in the pediatric population. The focus of this paper will be its use in children being treated for non-central nervous system and non-cardiac disorders.
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F-18 FDG PET/CT imaging of metastatic extrarenal Wilms tumor arising in the inguinal canal. Clin Nucl Med 2011; 36:475-8. [PMID: 21552031 DOI: 10.1097/rlu.0b013e31820ade92] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Extrarenal Wilms tumor (ERWT) is rare, and has been reported sporadically in the literatures. ERWT can arise anywhere from the renal bed to the testes; reported locations of ERWTs include the retroperitoneum, inguinal canal, endocervix, uterus, epididymis, and sigmoid mesocolon. We report the F-18 FDG PET/CT imaging findings of an ERWT arising from the inguinal canal in a 9-year-old boy. F-18 FDG accumulated in the metastatic lesions of the lung and mediastinal lymph nodes, as well as the primary ERWT. After chemotherapy, a follow-up PET/CT showed complete metabolic remission. F-18 FDG PET/CT is useful in detecting primary and metastatic ERWTs and in evaluating treatment response.
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Pilot study of F18-Fluorodeoxyglucose Positron Emission Tomography/computerised tomography in Wilms’ tumour: Correlation with conventional imaging, pathology and immunohistochemistry. Eur J Cancer 2011; 47:389-96. [DOI: 10.1016/j.ejca.2010.09.039] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 09/27/2010] [Indexed: 11/23/2022]
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Portwine C, Marriott C, Barr RD. PET imaging for pediatric oncology: an assessment of the evidence. Pediatr Blood Cancer 2010; 55:1048-61. [PMID: 20979168 DOI: 10.1002/pbc.22747] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Positron emission tomography (PET) has shown potential benefits when used in therapeutic clinical trials for children with cancer. However, existing trials are limited in scope with small numbers of patients and varied observations, making accurate conclusions about the usefulness of PET scanning impossible. This review examines PET and its applications in pediatric oncology. While evidence is limited, there appears to be a basis for rigorous evaluation of this imaging modality before widespread application without validation from clinical trials.
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Affiliation(s)
- Carol Portwine
- Division of Pediatric Hematology/Oncology, McMaster University, Hamilton, Ontario, Canada.
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Abstract
PURPOSE OF REVIEW To review the 2008-2009 literature on pediatric genitourinary tumors and highlight the most significant publications. RECENT FINDINGS New techniques such as gene expression profiling, PET, nephron-sparing surgery, and stem cell transplantation are being incorporated into contemporary treatments for pediatric patients with genitourinary tumors. The WTX gene is the most commonly mutated gene in Wilms tumor, and its product enhances Wilms tumor gene 1-mediated transcription. Germline WTX mutations cause an X-linked sclerosing bone dysplasia but do not appear to predispose to Wilms tumor formation. Protocadherin gene clusters on chromosome 5q31 may act as tumor suppressors. In rhabdomyosarcoma, ILK and platelet-derived growth factor receptor-A join the paired box gene 7 and 3-forkhead box O1 fusions as potential therapeutic targets, and muscle-specific microRNAs offer promise as adjuvant therapy. Despite the high cure rate of Wilms tumor, long-term survivors remain at risk of death from various causes. SUMMARY In general, the prognosis for patients with pediatric genitourinary tumors is favorable. The elucidation of the molecular abnormalities in these tumors is determining risk stratification, treatment strategies, and candidates for new drug development.
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Smets AM, de Kraker J. Malignant tumours of the kidney: imaging strategy. Pediatr Radiol 2010; 40:1010-8. [PMID: 20432020 PMCID: PMC2861760 DOI: 10.1007/s00247-010-1584-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Accepted: 01/30/2010] [Indexed: 11/25/2022]
Abstract
Primitive malignant renal tumours comprise 6% of all childhood cancers. Wilms tumour (WT) or nephroblastoma is the most frequent type accounting for more than 90%. Imaging alone cannot differentiate between these tumours with certainty but it plays an important role in screening, diagnostic workup, assessment of therapy response, preoperative evaluation and follow-up. The outcome of WT after therapy is excellent with an overall survival around 90%. In tumours such as those where the outcome is extremely good, focus can be shifted to a risk-based stratification to maintain excellent outcome in children with low risk tumours while improving quality of life and decreasing toxicity and costs. This review will discuss the imaging issues for WT from the European perspective and briefly discuss the characteristics of other malignant renal tumours occurring in children and new imaging techniques with potential in this matter.
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Affiliation(s)
- Anne M Smets
- Department of Radiology G1, Academic Medical Center, PO Box 22700, Amsterdam 1100 DE, The Netherlands.
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Moinul Hossain AKM, Shulkin BL, Gelfand MJ, Bashir H, Daw NC, Sharp SE, Nadel HR, Dome JS. FDG positron emission tomography/computed tomography studies of Wilms' tumor. Eur J Nucl Med Mol Imaging 2010; 37:1300-8. [PMID: 20204356 DOI: 10.1007/s00259-010-1396-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Accepted: 01/15/2010] [Indexed: 01/03/2023]
Abstract
PURPOSE The purpose of this analysis was to evaluate the utility of FDG PET/CT scanning in patients with Wilms' tumors. METHODS A total of 58 scans were performed in 27 patients (14 male, 13 female; ages: 1.9-23 years, median: 7 years) with proven Wilms' tumor. Twenty-six patients (56 scans) were studied at the time of suspected relapse, progressive disease, persistent disease, or for monitoring of therapy. RESULTS In the 27 patients with Wilms' tumor, 34 scans showed areas of abnormal uptake consistent with metabolically active tumors. Of the patients, 8 (24 scans) had pulmonary metastases larger than 10 mm in diameter, 10 (12 scans) had hepatic metastases, 11 (11 scans) had regional nodal involvement, 3 (3 scans) had bone metastases, 1 (1 scan) had chest wall involvement, 2 (2 scans) had pancreatic metastasis, and 5 (5 scans) had abdominal and pelvic soft tissue involvement. Two of eight patients with lung metastases had variable uptakes. Lung lesions 10 mm or smaller were not consistently visualized on PET scans. One patient with a liver metastasis showed no uptake on PET scan after treatment (size decreased from 45 to 15 mm). CONCLUSION Most Wilms' tumors concentrate FDG. However, small pulmonary metastases may be better visualized with CT. FDG PET/CT appears useful for defining the extent of involvement and assessing the response to treatment.
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Affiliation(s)
- A K M Moinul Hossain
- Nuclear Imaging Division, Department of Radiological Sciences, MS #220, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105-3678, USA
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