PET Clinics Vol 3 Issue 03 / 2009 Pediatric PET Imaging by: Elsevier
PET Clinics Vol 3 Issue 03 / 2009 Pediatric PET Imaging (164 Pages Journal)
Contents
Preface xi
Hongming Zhuang and Abass Alavi
Patient Preparation and Performance of PET/CT Scans in Pediatric Patients 473
Michael J. Gelfand and Susan E. Sharp
Appropriate patient preparation is necessary for high-quality PET and PET/CT imaging
in children and adolescents. Standard adult protocols and techniques will sometimes
give suboptimal results, so attention to specific pediatric protocols is
important. Additionally, attempts should be made to limit radiation doses, as pediatric
patients are more sensitive to the effects of radiation. Administered [F-18]2-fluoro-
2-deoxyglucose activities may be reduced using weight based protocols, and
CT parameters should be reduced to appropriate pediatric levels, with low-dose localization
settings used when diagnostic-quality CT images are not needed. Complicating
factors, such as patient motion and brown adipose-tissue uptake, are more
commonly encountered in pediatric patients, and appropriate measures should be
taken to limit their impact on imaging.
PET in theAssessment of Pediatric Brain Development and Developmental Disorders 487
Ajay Kumar and Harry T. Chugani
This article discusses and reviews the role and contribution of PET in understanding
the structural and functional changes that occur during brain development, and how
these changes relate to behavioral and cognitive development in the infant and child.
Data regarding various aspects of brain development, such as glucose metabolism,
protein synthesis, and maturation and development of neurotransmitter systems will
help in understanding the pathogenesis and neurologic basis of various developmental
and neurologic disorders. This may help in following disease evolution and progression,
planning and development of various therapeutic interventions, timing these interventions
and monitoring their responses, and rendering long-term prognostication.
Clinical Application of PET in Pediatric Brain Tumors 517
Wei Chen
While rare in adults, central nervous system tumor is the most common solid tumor in
childhood and is the leading cause of cancer death in children. Childhood brain tumors
are different fromthose in adults in epidemiology, histologic features, and responses to
treatment. Gliomas make up over one-half of all childhood brain tumors. Clinical application
of PET imaging in brain tumors has demonstrated that it is helpful in tumor grading,
establishing prognosis, defining targets for biopsy, and planning resection. This
article emphasizes PET applications in childhood brain tumors, focusing on mainly gliomas
with regard to tumor-grading and prognosis, distinguishing tumor recurrence
from radiation necrosis, and PET guided diagnosis and treatment.
The Use of PET in the Evaluation of Tumors in Children with Neurofibromatosis Type 1 531
Michael J. Fisher
Neurofibromatosis type 1 (NF1) is one of the most common tumor predisposition
disorders. The role of PET for distinguishing tumor from non-malignant processes, Pediatric PET Imaging
detecting and grading tumors, evaluating tumor margins, predicting prognosis, directing
biopsy, planning treatment, and evaluating response to therapy has been established
for a wide variety of benign and malignant tumors. Children with NF1 are
particularly at risk for the development of tumors of the peripheral and central nervous
system, such as neurofibromas, malignant peripheral nerve sheath tumors,
and low-grade astrocytomas of the optic pathway and other brain regions. This article
reviews the role of PET in the management of these NF1-associated tumors of
childhood.
PET/CT in the Evaluation of Neuroblastoma 551
Susan E. Sharp,Michael J. Gelfand, and Barry L. Shulkin
I-123metaiodobenzylguanidine (MIBG) is the most commonly used functional imaging
agent in patients with neuroblastoma, but use of [F-18]- FDG PET is increasing.
MIBG is useful for defining the extent of disease at diagnosis, following response
to treatment, and localizing residual and recurrent disease. In early-stage disease,
FDG is often better concentrated in tumor sites than MIBG. In all stages, disease extent
in the chest, abdomen, and pelvis and local metastases may be better delineated
by FDG. In advanced-stage disease, MIBG is superior for following the
treatment response of metastatic tumor in the marrow and bone. Several C-11
and F-18labeled tracers may be equal to or superior to I-123-MIBG if supply problems
can be resolved.
PET and PET/CT in Pediatric Sarcomas 563
M. Beth McCarville
Because of the rarity of pediatric bone and soft tissue malignancies, it is difficult to
validate the role of emerging imaging technologies in their management. The growing
body of literature regarding the use of PET and PET/CT in children supports the
continued investigation of this modality in the management of pediatric sarcomas.
This article reviews the current literature regarding FDGPET imaging in the management
of pediatric sarcomas and presents important pitfalls in PET/CT imaging of
these patients that the author, her colleagues, and others have encountered.
Fluorine-18 DOPA-PET and PET/CT Imaging in Congenital Hyperinsulinism 577
Mohamed Houseni, Wichana Chamroonrat, Hongming Zhuang,MiGuel Hernandez-Pampolini,
and Abass Alavi
Congenital hyperinsulinism is the principle cause of hypoglycemia during infancy but
successful treatment is difficult and persistent hypoglycemia carries the risk of
neurologic damage. Focal and diffuse abnormalities are the common forms of
hyperinsulinism. Identification and localization of focal hyperinsulinism can be cured
by partial pancreatectomy. It has been shown that affected pancreatic areas utilize
LDOPA in a higher rate than normal pancreatic tissue and, thus, labeling L-DOPA
with fluorine-18 (FDOPA) allows functional mapping of hyperinsulinism using PET.
This article presents a fundamental overview of the genetics background, pathology,
management, and the role of FDOPA-PET imaging in hyperinsulinism.
Pediatric Cardiac PET Imaging 587
Amol Takalkar,MiGuel Hernandez-Pampaloni, Gang Cheng, Hongming Zhuang, and Abass Alavi
Cardiac PET imaging can play a significant role in assessing and managing children
with congenital and acquired heart disorders but remains largely underused for
multiple reasons, not related to the accuracy or usefulness of the modality. Current
work focusing on evaluation of cardiac innervation, cardiac receptor function and
noninvasive cardiac gene therapy assessment with PET imaging has tremendous
potential to revolutionize cardiac evaluation. Awareness and widespread availability
of PET systems is expected to increase use of cardiac PET applications in the pediatric
population. The advent of integrated PET/CT systems with advanced CT technology
and the possible integrated PET/MR imaging systems opens even more
promising future possibilities for cardiac evaluation in a one-stop approach.
The Role of PET/CT in the Monitoring and Diagnosis of Pediatric Inflammatory Bowel Disease 597
Roland Hustinx and Edouard Louis
Ulcerative colitis and Crohns disease are chronic immune-mediated inflammatory
diseases that affect the digestive tract. Major progresses have been made in our
comprehension the underlying molecular substrate of these diseases, and therapeutic
algorithms have greatly changed over the past decade. In this article, we review
the various methods for monitoring the activity of inflammatory bowel disease, with
a particular emphasis on [F-18]2-fluoro-2-deoxyglucose PET and PET/CT imaging.
Applications of PET/CT in Pediatric Patients with Fever of Unknown Origin 605
Mohamed Houseni, Wichana Chamroonrat, Sabah Servaes, Abass Alavi, and Hongming Zhuang
Fever of unknown origin (FUO) is a challenging problem. In children, FUO is critical,
as it may hide a life threatening disease. One of the main difficulties in managing patients
with FUO is the absence of a universal diagnostic approach. There are many
impending causes for FUO. Most cases are attributable to atypical presentations of
common diseases. The key to establishing the diagnosis is through comprehensive
clinical data and targeted investigations. Despite all efforts, the underlying cause remains
undiagnosed in many cases. PET/CT is a powerful modality that has been
proven to be useful in many common causes that could emerge as FUO. This article
reviews the utility of PET/CT imaging in children with FUO.
FDG PET and PET/CT in the Management of Pediatric Lymphoma Patients 621
Gang Cheng, Sabah Servaes, Abass Alavi, and Hongming Zhuang
Fluorodeoxyglucose (FDG) PET has an ever-increasing role in the management of
Hodgkins and non-Hodgkins lymphomas, which has been demonstrated in numerous
studies in the adult population. In children and adolescents, however, only a limited
number of studies have investigated the role of FDG PET in lymphoma. This
article reviews the currently available literature on the clinical application of FDG
PET in the management of childhood lymphoma. The authors believe that FDG
PET (and especially PET/CT) is a valuable imaging modality in the initial diagnosis,
response assessment, and post-therapy residual evaluation of Hodgkins and
FDG-avid non-Hodgkins lymphomas in children and adolescents, and will have
a significant impact on the clinical management of pediatric lymphoma.
Index
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