Lisbeth Marner1, Karsten Nysom2, Astrid Sehested2, Lise Borgwardt3, René Mathiasen2, Otto Mølby Henriksen3, Michael Lundemann3, Per Munck Af Rosenschöld4, Carsten Thomsen5,6, Lars Bøgeskov7, Jane Skjøth-Rasmussen7, Marianne Juhler7, Anders Kruse8, Helle Broholm9, David Scheie9, Torsten Lauritsen10, Julie Lyng Forman11, Peder Skov Wehner12, Liselotte Højgaard3, Ian Law3. 1. Department of Clinical Physiology, Nuclear Medicine, and PET, Copenhagen University Hospital, Rigshospitalet, Denmark lisbeth.marner.01@regionh.dk. 2. Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Denmark. 3. Department of Clinical Physiology, Nuclear Medicine, and PET, Copenhagen University Hospital, Rigshospitalet, Denmark. 4. Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark. 5. Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Denmark. 6. Department of Radiology, Zealand University Hospital, Køge, Denmark. 7. Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Denmark. 8. Department of Orthopaedic Surgery, Copenhagen University Hospital, Rigshospitalet, Denmark. 9. Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Denmark. 10. Department of Anaesthesiology, Copenhagen University Hospital, Rigshospitalet, Denmark. 11. Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; and. 12. Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.
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 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 = 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.
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 = 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.
Authors: Lisbeth Marner; Michael Lundemann; Astrid Sehested; Karsten Nysom; Lise Borgwardt; René Mathiasen; Peder S Wehner; Otto M Henriksen; Carsten Thomsen; Jane Skjøth-Rasmussen; Helle Broholm; Olga Østrup; Julie L Forman; Liselotte Højgaard; Ian Law Journal: Neuro Oncol Date: 2021-12-01 Impact factor: 12.300
Authors: Jakob M Slipsager; Andreas H Ellegaard; Stefan L Glimberg; Rasmus R Paulsen; M Dylan Tisdall; Paul Wighton; André van der Kouwe; Lisbeth Marner; Otto M Henriksen; Ian Law; Oline V Olesen Journal: PLoS One Date: 2019-04-19 Impact factor: 3.240
Authors: Arnoldo Piccardo; Nathalie L Albert; Lise Borgwardt; Frederic H Fahey; Darren Hargrave; Norbert Galldiks; Nina Jehanno; Lars Kurch; Ian Law; Ruth Lim; Egesta Lopci; Lisbeth Marner; Giovanni Morana; Tina Young Poussaint; Victor J Seghers; Barry L Shulkin; Katherine E Warren; Tatjana Traub-Weidinger; Pietro Zucchetta Journal: Eur J Nucl Med Mol Imaging Date: 2022-05-10 Impact factor: 10.057
Authors: Cornelia Brendle; Caroline Maier; Benjamin Bender; Jens Schittenhelm; Frank Paulsen; Mirjam Renovanz; Constantin Roder; Salvador Castaneda-Vega; Ghazaleh Tabatabai; Ulrike Ernemann; Christian la Fougère Journal: J Nucl Med Date: 2021-08-05 Impact factor: 10.057