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Early postoperative 18F-FET PET/MRI for pediatric brain and spinal cord tumors

Marner, Lisbeth ; Nysom, Karsten ; Sehested, Astrid ; Borgwardt, Lise ; Mathiasen, René ; Henriksen, Otto Mølby ; Lundemann, Michael ; af Rosenschöld, Per Munck LU orcid ; Thomsen, Carsten and Bøgeskov, Lars , et al. (2019) In Journal of Nuclear Medicine 60(8). p.1053-1058
Abstract

Complete resection is the treatment of choice for most pediatric brain tumors, but early postoperative MRI for detection of residual tumor may be misleading because of MRI signal changes caused by the operation. PET imaging with amino acid tracers in adults increases the diagnostic accuracy for brain tumors, but the literature in pediatric neurooncology is limited. A hybrid PET/MRI system is highly beneficial in children, reducing the number of scanning procedures, and this is to our knowledge the first larger study using PET/MRI in pediatric neurooncology. We evaluated if additional postoperative 18F-fluoro-ethyl-tyrosine (18F-FET) PET in children and adolescents would improve diagnostic accuracy for the detection... (More)

Complete resection is the treatment of choice for most pediatric brain tumors, but early postoperative MRI for detection of residual tumor may be misleading because of MRI signal changes caused by the operation. PET imaging with amino acid tracers in adults increases the diagnostic accuracy for brain tumors, but the literature in pediatric neurooncology is limited. A hybrid PET/MRI system is highly beneficial in children, reducing the number of scanning procedures, and this is to our knowledge the first larger study using PET/MRI in pediatric neurooncology. We evaluated if additional postoperative 18F-fluoro-ethyl-tyrosine (18F-FET) PET in children and adolescents would improve diagnostic accuracy for the detection of residual tumor as compared with MRI alone and would assist clinical management. Methods: Twenty-two patients (7 male; mean age, 9.5 y; range, 0–19 y) were included prospectively and consecutively in the study and had 27 early postoperative 18F-FET PET exams performed preferentially in a hybrid PET/MRI system (NCT03402425). Results: Using follow-up (93%) or reoperation (7%) as the reference standard, PET combined with MRI discriminated tumor from treatment effects with a lesion-based sensitivity/ specificity/accuracy (95% confidence intervals) of 0.73 (0.50–1.00)/ 1.00 (0.74–1.00)/0.87 (0.73–1.00) compared with MRI alone: 0.80 (0.57–1.00)/0.75 (0.53–0.94)/0.77 (0.65–0.90); that is, the specificity for PET/MRI was 1.00 as compared with 0.75 for MRI alone (P 5 0.13). In 11 of 27 cases (41%), results from the 18F-FET PET scans added relevant clinical information, including one scan that directly influenced clinical management because an additional residual tumor site was identified. 18F-FET uptake in reactive changes was frequent (52%), but correct interpretation was possible in all cases. Conclusion: The high specificity for detecting residual tumor suggests that supplementary 18F-FET PET is relevant in cases where reoperation for residual tumor is considered.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
F-fluoro-ethyl-tyrosine, Amino acid analog, Cancer, Children, CNS, Surgery
in
Journal of Nuclear Medicine
volume
60
issue
8
pages
1053 - 1058
publisher
Society of Nuclear Medicine
external identifiers
  • pmid:30683767
  • scopus:85065053564
ISSN
0161-5505
DOI
10.2967/jnumed.118.220293
language
English
LU publication?
no
additional info
Publisher Copyright: COPYRIGHT © 2019 by the Society of Nuclear Medicine and Molecular Imaging.
id
39507fe2-2a6d-4545-8fed-67532c0534e5
date added to LUP
2023-07-19 17:05:08
date last changed
2024-04-19 23:44:36
@article{39507fe2-2a6d-4545-8fed-67532c0534e5,
  abstract     = {{<p>Complete resection is the treatment of choice for most pediatric brain tumors, but early postoperative MRI for detection of residual tumor may be misleading because of MRI signal changes caused by the operation. PET imaging with amino acid tracers in adults increases the diagnostic accuracy for brain tumors, but the literature in pediatric neurooncology is limited. A hybrid PET/MRI system is highly beneficial in children, reducing the number of scanning procedures, and this is to our knowledge the first larger study using PET/MRI in pediatric neurooncology. We evaluated if additional postoperative <sup>18</sup>F-fluoro-ethyl-tyrosine (<sup>18</sup>F-FET) PET in children and adolescents would improve diagnostic accuracy for the detection of residual tumor as compared with MRI alone and would assist clinical management. Methods: Twenty-two patients (7 male; mean age, 9.5 y; range, 0–19 y) were included prospectively and consecutively in the study and had 27 early postoperative <sup>18</sup>F-FET PET exams performed preferentially in a hybrid PET/MRI system (NCT03402425). Results: Using follow-up (93%) or reoperation (7%) as the reference standard, PET combined with MRI discriminated tumor from treatment effects with a lesion-based sensitivity/ specificity/accuracy (95% confidence intervals) of 0.73 (0.50–1.00)/ 1.00 (0.74–1.00)/0.87 (0.73–1.00) compared with MRI alone: 0.80 (0.57–1.00)/0.75 (0.53–0.94)/0.77 (0.65–0.90); that is, the specificity for PET/MRI was 1.00 as compared with 0.75 for MRI alone (P 5 0.13). In 11 of 27 cases (41%), results from the <sup>18</sup>F-FET PET scans added relevant clinical information, including one scan that directly influenced clinical management because an additional residual tumor site was identified. <sup>18</sup>F-FET uptake in reactive changes was frequent (52%), but correct interpretation was possible in all cases. Conclusion: The high specificity for detecting residual tumor suggests that supplementary <sup>18</sup>F-FET PET is relevant in cases where reoperation for residual tumor is considered.</p>}},
  author       = {{Marner, Lisbeth and Nysom, Karsten and Sehested, Astrid and Borgwardt, Lise and Mathiasen, René and Henriksen, Otto Mølby and Lundemann, Michael and af Rosenschöld, Per Munck and Thomsen, Carsten and Bøgeskov, Lars and Skjøth-Rasmussen, Jane and Juhler, Marianne and Kruse, Anders and Broholm, Helle and Scheie, David and Lauritsen, Torsten and Forman, Julie Lyng and Wehner, Peder Skov and Højgaard, Liselotte and Law, Ian}},
  issn         = {{0161-5505}},
  keywords     = {{F-fluoro-ethyl-tyrosine; Amino acid analog; Cancer; Children; CNS; Surgery}},
  language     = {{eng}},
  month        = {{08}},
  number       = {{8}},
  pages        = {{1053--1058}},
  publisher    = {{Society of Nuclear Medicine}},
  series       = {{Journal of Nuclear Medicine}},
  title        = {{Early postoperative <sup>18</sup>F-FET PET/MRI for pediatric brain and spinal cord tumors}},
  url          = {{http://dx.doi.org/10.2967/jnumed.118.220293}},
  doi          = {{10.2967/jnumed.118.220293}},
  volume       = {{60}},
  year         = {{2019}},
}