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Skeletal Radiology
Published in: Skeletal Radiology 3/2023

09-07-2022 | Langerhans Cell Histiocytosis | Review Article

PET/MR of pediatric bone tumors: what the radiologist needs to know

Authors: Jennifer Padwal, Lucia Baratto, Amit Chakraborty, Kristina Hawk, Sheri Spunt, Raffi Avedian, Heike E. Daldrup-Link

Published in: Skeletal Radiology | Issue 3/2023

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Abstract

Integrated 2-deoxy-2-[fluorine-18]fluoro-d-glucose (18F-FDG) positron emission tomography (PET)/magnetic resonance (MR) imaging can provide “one stop” local tumor and whole-body staging in one session, thereby streamlining imaging evaluations and avoiding duplicate anesthesia in young children. 18F-FDG PET/MR scans have the benefit of lower radiation, superior soft tissue contrast, and increased patient convenience compared to 18F-FDG PET/computerized tomography scans. This article reviews the 18F-FDG PET/MR imaging technique, reporting requirements, and imaging characteristics of the most common pediatric bone tumors, including osteosarcoma, Ewing sarcoma, primary bone lymphoma, bone and bone marrow metastases, and Langerhans cell histiocytosis.
Literature
1.
Hardin AP, Hackell JM, Simon GR, Boudreau ADA, Baker CN, Barden GA, et al. Age limit of pediatrics. Pediatrics. 2017;140:3–5.CrossRef
2.
Schäfer JF, Gatidis S, Schmidt H, Gückel B, Bezrukov I, Pfannenberg CA, et al. Simultaneous whole-body PET/MR imaging in comparison to PET/CT in pediatric oncology: initial results Radiology. Radiol Soc N Am Inc. 2014;273:220–31.
3.
Lyons K, Seghers V, Sorensen JIL, Zhang W, Paldino MJ, Krishnamurthy R, et al. Comparison of standardized uptake values in normal structures between PET/CT and PET/MRI in a tertiary pediatric hospital: a prospective study. AJR Am J Roentgenol. 2015;205:1094–101.CrossRef
4.
Buchbender C, Heusner TA, Lauenstein TC, Bockisch A, Antoch G. Oncologic PET/MRI, part 2: bone tumors, soft-tissue tumors, melanoma, and lymphoma. J Nucl Med. 2012;53:1244–52.CrossRef
5.
Rashidi A, Baratto L, Theruvath AJ, Greene EB, Hawk KE, Lu R, et al. Diagnostic accuracy of 2-[18F]FDG-PET and whole-body DW-MRI for the detection of bone marrow metastases in children and young adults. Eur Radiol. 2022;32(7):4967–4979.
6.
Jeon M, Halbert M, Stephen ZR, Zhang M. Iron oxide nanoparticles as T1 contrast agents for magnetic resonance imaging: fundamentals, challenges, applications, and prospectives. Adv Mater. 2021;33:1–18.CrossRef
7.
Avasthi A, Caro C, Pozo-Torres E, Leal MP, García-Martín ML. Magnetic nanoparticles as MRI contrast agents. Top Curr Chem. 2020;378:40.CrossRef
8.
Stephen ZR, Kievit FM, Zhang M. Magnetite nanoparticles for medical MR imaging. Mater Today. 2011;14:330–8.CrossRef
9.
Yoo HJ, Lee JS, Lee JM. Integrated whole body MR/PET: where are we? Korean J Radiol. 2015;16:32.CrossRef
10.
Pareek A, Muehe AM, Theruvath AJ, Gulaka PK, Spunt SL, Daldrup-Link HE. Whole-body PET/MRI of pediatric patients: the details that matter. J Vis Exp. 2017;130:57128.
11.
Ramalho M, AlObaidy M, Catalano OA, Guimaraes AR, Salvatore M, Semelk RC. MR-PET of the body: early experience and insights. Eur J Radiol Open. 2014;1:28–39.CrossRef
12.
States LJ, Reid JR. Whole-body PET/MRI applications in pediatric oncology. AJR Am J Roentgenol. 2020;215:713–25.CrossRef
13.
Ehman EC, Johnson GB, Villanueva-Meyer JE, Cha S, Leynes AP, Larson PEZ, et al. PET/MRI: where might it replace PET/CT? J Magn Reson Imaging. 2017;46:1247–62.CrossRef
14.
Mannheim JG, Schmid AM, Schwenck J, Katiyar P, Herfert K, Pichler BJ, et al. PET/MRI hybrid systems. Semin Nucl Med. 2018;48:332–47.CrossRef
15.
Geiger J, Zeimpekis KG, Jung A, Moeller A, Kellenberger CJ. Clinical application of ultrashort echo-time MRI for lung pathologies in children. Clin Radiol. 2021;76:708.e9-708.e17.CrossRef
16.
Aghighi M, Boe J, Rosenberg J, Von ER, Gawande RS, Petit P, et al. Three-dimensional radiologic assessment of chemotherapy response in Ewing sarcoma can be used to predict clinical outcome. Radiology. 2016;280:905–15.CrossRef
17.
Oprea-Lager DE, Cysouw MCF, Boellaard R, Deroose CM, de Geus-Oei LF, Lopci E, et al. Bone metastases are measurable: the role of whole-body MRI and positron emission tomography. Front Oncol. 2021;11:4948.CrossRef
18.
Nishino M, Jagannathan JP, Ramaiya NH, VanDenAbbeele AD. Revised RECIST guideline version 1.1: what oncologists want to know and what radiologists need to know. AJR Am J Roentgenol. 2010;195:281–9.CrossRef
19.
Mirabello L, Troisi RJ, Savage SA. International osteosarcoma incidence patterns in children and adolescents, middle ages and elderly persons. Int J cancer. 2009;125:229–34.CrossRef
20.
Brenner W, Bohuslavizki KH, Eary JF. PET imaging of osteosarcoma. J Nucl Med. 2003;44:930–42.
21.
Murphey MD, Robbin MR, McRae GA, Flemming DJ, Temple HT, Kransdorf MJ. The many faces of osteosarcoma. Radiographics. 1997;17:1205–31.CrossRef
22.
Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer Statistics, 2021. CA Cancer J Clin. 2021;71:7–33.CrossRef
23.
Bielack SS, Kempf-Bielack B, Delling G, Exner GU, Flege S, Helmke K, et al. Prognostic factors in high-grade osteosarcoma of the extremities or trunk: an analysis of 1,702 patients treated on Neoadjuvant Cooperative Osteosarcoma Study Group Protocols. J Clin Oncol. 2002;20:776–90.CrossRef
24.
Haveman LM, Ranft A, vdBerg H, Smets A, Kruseova J, Ladenstein R, et al. The relation of radiological tumor volume response to histological response and outcome in patients with localized Ewing Sarcoma. Cancer Med. 2019;8:1086–94.CrossRef
25.
Yarmish G, Klein MJ, Landa J, Lefkowitz RA, Hwang S. Imaging characteristics of primary osteosarcoma: nonconventional subtypes. Radiographics. 2010;30:1653–72.CrossRef
26.
Yoshida A. Osteosarcoma: old and new challenges. Surg Pathol Clin. 2021;14:567–83.CrossRef
27.
Daldrup-Link HE. How PET/MR can add value for children with cancer. Curr Radiol Rep. 2017;5.
28.
Yedururi S, Morani AC, Gladish GW, Vallabhaneni S, Anderson PM, Hughes D, et al. Cardiovascular involvement by osteosarcoma: an analysis of 20 patients. Pediatr Radiol. 2016;46:21–33.CrossRef
29.
Murphey MD, Wan Jaovisidha S, Temple HT, Gannon FH, Jelinek JS, Malawer MM. Telangiectatic osteosarcoma: radiologic-pathologic comparison. Radiology. 2003;229:545–53.CrossRef
30.
Discepola F, Powell TI, Nahal A. Telangiectatic osteosarcoma: radiologic and pathologic findings. Radiographics. 2009;29:380–3.CrossRef
31.
Murphey MD, Jelinek JS, Temple HT, Flemming DJ, Gannon FH. Imaging of periosteal osteosarcoma: radiologic-pathologic comparison. Radiology. 2004;233:129–38.CrossRef
32.
Harper K, Sathiadoss P, Saifuddin A, Sheikh A. A review of imaging of surface sarcomas of bone. Skeletal Radiol. 2021;50:9–28.CrossRef
33.
Kumar VS, Barwar N, Khan SA. Surface osteosarcomas: diagnosis, treatment and outcome. Indian J Orthop. 2014;48:255–61.CrossRef
34.
Ayerza MA, Farfalli GL, Aponte-Tinao L, Luis MD. Does increased rate of limb-sparing surgery affect survival in osteosarcoma? Clin Orthop Relat Res. 2010;468:2854–9.CrossRef
35.
Quan GMY, Slavin JL, Schlicht SM, Smith PJ, Powell GJ, Choong PFM. Osteosarcoma near joints: assessment and implications. J Surg Oncol. 2005;91:159–66.CrossRef
36.
Schima W, Amann G, Stiglbauer R, Windhager R, Kramer J, Nicolakis M, et al. Preoperative staging of osteosarcoma: efficacy of MR imaging in detecting joint involvement. AJR Am J Roentgenol. 1994;163:1171–5.CrossRef
37.
Eaton BR, Schwarz R, Vatner R, Yeh B, Claude L, Indelicato DJ, et al.2021 Osteosarcoma. Pediatr Blood Cancer. 68.
38.
Navalkele P, Jones SM, Jones JK, Salazar JD, Toy PC, Iyer RV, et al. Osteosarcoma tumor thrombus: a case report with a review of the literature. Texas Hear Inst J. 2013;40:75–8.
39.
Liang H, Guo W, Yang R, Tang X, Yan T, Ji T, et al. Radiological characteristics and predisposing factors of venous tumor thrombus in pelvic osteosarcoma: a mono-institutional retrospective study of 115 cases. Wiley Online Libr. 2018;7:4903–13.
40.
Nguyen JC, Baghdadi S, Pogoriler J, Guariento A, Rajapakse CS, Arkader A.2022 Pediatric osteosarcoma: correlation of imaging findings with histopathologic features, treatment, and outcome. Radiographics. 210171.
41.
Muehe AM, Theruvath AJ, Lai L, Aghighi M, Quon A, Holdsworth SJ, et al. How to provide gadolinium-free PET/MR cancer staging of children and young adults in less than 1 h: the Stanford approach. Mol imaging Biol. 2018;20:324–35.CrossRef
42.
Kara PO, Sezer Y, Koc ZP, Yilmaz EB, Citak EC, Ozcan P, et al.2018 Role of FDG PET-CT in distinction of benign thrombus and tumor thrombus in oncological patients. Biomed J Sci &Tech Res. 2.
43.
Enneking WF, Kagan A. “Skip” metastases in osteosarcoma. Cancer. 1975;36:2192–205.CrossRef
44.
Jiya TU, Wuisman PIJM. Long-term follow-up of 15 patients with non-metastatic Ewing’s sarcoma and a skip lesion. Acta Orthop. 2005;76:899–903.CrossRef
45.
Sajadi KR, Heck RK, Neel MD, Rao BN, Daw N, Rodriguez-Galindo C, et al. The incidence and prognosis of osteosarcoma skip metastases. Clin Orthop Relat Res. 2004;426:92–6.CrossRef
46.
Kager L, Zoubek A, Kastner U, Kempf-Bielack B, Potratz J, Kotz R, et al. Skip metastases in osteosarcoma: experience of the Cooperative Osteosarcoma Study Group. J Clin Oncol. 2006;24:1535–41.CrossRef
47.
San-Julian M, Diaz-de-Rada P, Noain E, Sierrasesumaga L. Bone metastases from osteosarcoma. Int Orthop. 2003;27:117–20.CrossRef
48.
Quartuccio N, Fox J, Kuk D, Wexler LH, Baldari S, Cistaro A, et al. Pediatric bone sarcoma: diagnostic performance of 18F-FDG PET/CT versus conventional imaging for initial staging and follow-up. AJR Am J Roentgenol. 2015;204:153–60.CrossRef
49.
Faisham WI, Mat Saad AZ, Alsaigh LN, Nor Azman MZ, Kamarul Imran M, Biswal BM, et al. Prognostic factors and survival rate of osteosarcoma: a single-institution study. Asia Pac J Clin Oncol. 2017;13:e104–10.CrossRef
50.
Bajpai J, Gamnagatti S, Kumar R, Sreenivas V, Sharma MC, Khan SA, et al. Role of MRI in osteosarcoma for evaluation and prediction of chemotherapy response: correlation with histological necrosis. Pediatr Radiol. 2011;41:441–50.CrossRef
51.
Hanafy E, Al Jabri A, Gadelkarim G, Dasaq A, Nazim F, Al PM. Tumor histopathological response to neoadjuvant chemotherapy in childhood solid malignancies: is it still impressive? J Investig Med. 2018;66:289–97.CrossRef
52.
Davis JC, Daw NC, Navid F, Billups CA, Wu J, Bahrami A, et al. 18 F-FDG uptake during early adjuvant chemotherapy predicts histologic response in pediatric and young adult patients with osteosarcoma. J Nucl Med. 2018;59:25–30.CrossRef
53.
Dou X, Yan H, Wang R. Treatment of an Askin tumor: a case report and review of the literature. Oncol Lett. 2013;6:985–9.CrossRef
54.
Grünewald TGP, Cidre-Aranaz F, Surdez D, Tomazou EM, De Álava E, Kovar H, et al.2018 Ewing sarcoma. Nat Rev Dis Prim. 4.
55.
Choi JH, Ro JY. The 2020 WHO classification of tumors of soft tissue: selected changes and new entities. Adv Anat Pathol. 2021;28:44–58.CrossRef
56.
Gaspar N, Hawkins DS, Dirksen U, Lewis IJ, Ferrari S, Le Deley MC, et al. Ewing sarcoma: current management and future approaches through collaboration. J Clin Oncol. 2015;33:3036–46.CrossRef
57.
Rodríguez-Galindo C, Navid F, Liu T, Billups CA, Rao BN, Krasin MJ. Prognostic factors for local and distant control in Ewing sarcoma family of tumors. Ann Oncol. 2008;19:814–20.CrossRef
58.
Guimarães JB, Rigo L, Lewin F, Emerick A. The importance of PET/CT in the evaluation of patients with Ewing tumors. Radiol Bras. 2015;48:175–80.CrossRef
59.
Bestic JM, Peterson JJ, Bancroft LW. Pediatric FDG PET/CT: Physiologic uptake, normal variants, and benign conditions. Radiographics. 2009;29:1487–500.CrossRef
60.
Salem U, Amini B, Chuang HH, Daw NC, Wei W, Haygood TM, et al. 18 F-FDG PET/CT as an indicator of survival in Ewing sarcoma of bone. J Cancer. 2017;8:2892–8.CrossRef
61.
Jamet B, Carlier T, Campion L, Bompas E, Girault S, Borrely F, et al. Initial FDG-PET/CT predicts survival in adults Ewing sarcoma family of tumors. Oncotarget. 2017;8:77050–60.CrossRef
62.
Muehe AM, Siedek F, Theruvath AJ, Seekins J, Spunt SL, Pribnow A, et al. Differentiation of benign and malignant lymph nodes in pediatric patients on ferumoxytol-enhanced PET/MRI. Theranostics. 2020;10:3612–21.CrossRef
63.
Völker T, Denecke T, Steffen I, Misch D, Schönberger S, Plotkin M, et al. Positron emission tomography for staging of pediatric sarcoma patients: results of a prospective multicenter trial. J Clin Oncol. 2007;25:5435–41.CrossRef
64.
Javery O, Krajewski K, O’Regan K, Kis B, Giardino A, Jagannathan J, et al.2011 A to Z of extraskeletal Ewing sarcoma family of tumors in adults: imaging features of primary disease, metastatic patterns, and treatment responses. AJR Am J Roentgenol. 197.
65.
Theruvath AJ, Siedek F, Muehe AM, Garcia-Diaz J, Kirchner J, Martin O, et al. Therapy response assessment of pediatric tumors with whole-body diffusion-weighted MRI and FDG PET/MRI. Radiology. 2020;296:143–51.CrossRef
66.
Franzius C, Sciuk J, Schmidt CB, Jürgens H, Schober O. Evaluation of chemotherapy response in primary bone tumors with F-18 FDG positron emission tomography compared with histologically assessed tumor necrosis. Clin Nucl Med. 2000;25:874–81.CrossRef
67.
Hawkins DS, Schuetze SM, Butrynski JE, Rajendran JG, Vernon CB, Conrad EU, et al. [18F]Fluorodeoxyglucose positron emission tomography predicts outcome for Ewing sarcoma family of tumors. J Clin Oncol. 2005;23:8828–34.CrossRef
68.
Bindal P, Desai A, Delasos L, Mulay S, Vredenburgh J. Primary bone lymphoma: a case series and review of literature. Case Rep Hematol. 2020;2020:1–6.CrossRef
69.
Milks KS, McLean TW, Anthony EY. Imaging of primary pediatric lymphoma of bone. Pediatr Radiol. 2016;46:1150–7.CrossRef
70.
Zhou HY, Gao F, Bu B, Fu Z, Sun XJ, Huang CS, et al. Primary bone lymphoma: a case report and review of the literature. Oncol Lett. 2014;8:1551–6.CrossRef
71.
Kaddu-Mulindwa D, Altmann B, Held G, Angel S, Stilgenbauer S, Thurner L, et al. FDG PET/CT to detect bone marrow involvement in the initial staging of patients with aggressive non-Hodgkin lymphoma: results from the prospective, multicenter PETAL and OPTIMAL>60 trials. Eur J Nucl Med Mol Imaging. 2021;48:3550–9.CrossRef
72.
Liu Y. The role of 18F-FDG PET/CT in staging and restaging primary bone lymphoma. Nucl Med Commun. 2017;38:319–24.CrossRef
73.
Friedman DL, Chen L, Wolden S, Buxton A, McCarten K, FitzGerald TJ, et al. Dose-intensive response-based chemotherapy and radiation therapy for children and adolescents with newly diagnosed intermediate-risk hodgkin lymphoma: a report from the Children’s Oncology Group Study AHOD0031. J Clin Oncol. 2014;32:3651–8.CrossRef
74.
Chan BY, Gill KG, Rebsamen SL, Nguyen JC. MR imaging of pediatric bone marrow. Radiographics. 2016;36:1911–30.CrossRef
75.
Sharp SE, Shulkin BL, Gelfand MJ, Salisbury S, Furman WL. 123 I-MIBG scintigraphy and 18 F-FDG PET in neuroblastoma. J Nucl Med. 2009;50:1237–43.CrossRef
76.
Atkin KL, Ditchfield MR. The role of whole-body MRI in pediatric oncology. J Pediatr Hematol Oncol. 2014;36:342–52.CrossRef
77.
Shulkin BL, Hutchinson RJ, Castle VP, Yanik GA, Shapiro B, Sisson JC. Neuroblastoma: Positron emission tomography with 2-[fluorine-18]-fluoro-2-deoxy-D-glucose compared with metaiodobenzylguanidine scintigraphy. Radiology. 1996;199:743–50.CrossRef
78.
Thacker NH, Abla O. Pediatric Langerhans cell histiocytosis: state of the science and future directions. Clin Adv Hematol Oncol. 2019;17:122–31.
79.
Makras P, Samara C, Antoniou M, Zetos A, Papadogias D, Nikolakopoulou Z, et al. Evolving radiological features of hypothalamo-pituitary lesions in adult patients with Langerhans cell histiocytosis (LCH). Neuroradiology. 2006;48:37–44.CrossRef
80.
Sher AC, Orth R, McClain K, Allen C, Hayatghaibi S, Seghers V. PET/MR in the assessment of pediatric histiocytoses: a comparison to PET/CT. Clin Nucl Med. 2017;42:582–8.CrossRef
81.
Váradi Z, Bánusz R, Csomor J, Kállay K, Varga E, Kertész G, et al. Effective BRAF inhibitor vemurafenib therapy in a 2-year-old patient with sequentially diagnosed Langerhans cell histiocytosis and Erdheim-Chester disease. Onco Targets Ther. 2017;10:521–6.CrossRef
82.
Guimarães MD, Noschang J, Teixeira SR, Santos MK, Lederman HM, Tostes V, et al.2017 Whole-body MRI in pediatric patients with cancer. Cancer Imaging. 17.
83.
Phillips M, Allen C, Gerson P, McClain K. Comparison of FDG-PET scans to conventional radiography and bone scans in management of Langerhans cell histiocytosis. Pediatr Blood Cancer. 2009;52:97–101.CrossRef
Metadata
Title
PET/MR of pediatric bone tumors: what the radiologist needs to know
Authors
Jennifer Padwal
Lucia Baratto
Amit Chakraborty
Kristina Hawk
Sheri Spunt
Raffi Avedian
Heike E. Daldrup-Link
Publication date
09-07-2022
Publisher
Springer Berlin Heidelberg
Published in
Skeletal Radiology / Issue 3/2023
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-022-04113-6

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