Top

Published in:

01-08-2014 | Original Paper

Integrated PET/MRI for planning navigated biopsies in pediatric brain tumors

Authors: Matthias Preuss, Peter Werner, Henryk Barthel, Ulf Nestler, Holger Christiansen, Franz Wolfgang Hirsch, Dominik Fritzsch, Karl-Titus Hoffmann, Matthias K. Bernhard, Osama Sabri

Published in: Child's Nervous System | Issue 8/2014

Abstract

Introduction

An integrated PET/MRI scanner has been used in selected cases of pediatric brain tumor patients to obtain additional metabolic information about lesions for preoperative biopsy planning and navigation.

Patients and methods

Four patients, age 9–16 years, received PET/MRI scans employing [¹¹C]methionine positron emission tomography (PET) and contrast-enhanced 3D-MR sequences for neuronavigation. PET and MR sequences have been matched for neurosurgical guidance. An infrared camera-based neuronavigation system was employed with co-registered MR and PET images fused to hybrid images for preoperative planning, stereotactic biopsy planning, and/or intraoperative guidance.

Results

All patients showed hot spots of increased amino acid transport in PET and contrast-enhancing lesions in MRI. In three of the four patients, PET hot spots were congruent with contrast-enhancing areas in MRI. In two patients, frame-based stereotactic biopsies were taken from thalamo-mesencephalic lesions. One patient underwent second-look surgery for the suspicion of recurrent malignant glioma of the posterior fossa. One incidental frontal mass lesion was subtotally resected. No complications occurred. Hybrid imaging was helpful during the procedures to obtain representative histopathologic specimens and for surgical guidance during resection. Co-registered images did match with intraoperative landmarks, tumor borders, and histopathologic specimens.

Conclusion

The integrated PET/MRI scanner offers co-registered multimodal, high-resolution data for neuronavigation with reduced radiation exposure compared to PET/CT scans. One examination session provides all necessary data for neuronavigation and preoperative planning, avoiding additional anesthesia in the small patients. Hybrid multimodality imaging may improve safety and yield additional information when obtaining representative histopathologic specimens of brain tumors.

Bailey DL, Barthel H, Beyer T, Boellaard R, Gückel B, Hellwig D, Herzog H, Pichler BJ, Quick HH, Sabri O, Scheffler K, Schlemmer HP, Schwenzer NF, Wehrl HF (2012) Summary report of the first international workshop on PET/MR imaging, March 19-23, 2012, Tübingen, Germany. Mol Imaging Biol 15(4):361–371CrossRef

Biermann M, Schwarzlmüller T, Fasmer KE, Reitan BC, Johnsen B, Rosendahl K (2013) Is there a role for PET-CT and SPECT-CT in pediatric oncology? Acta Radiol 54(9):1037–1045. doi:10.1258/ar.2012.120616, Epub 2013 Apr 30. ReviewPubMedCrossRef

Hirsch FW, Sattler B, Sorge I, Kurch L, Viehweger A, Ritter L, Werner P, Jochimsen T, Barthel H, Bierbach U, Till H, Sabri O, Kluge R (2013) PET/MR in children. Initial clinical experience in paediatric oncology using an integrated PET/MR scanner. Pediatr Radiol 43(7):860–875. doi:10.1007/s00247-012-2570-4, Epub 2013 Jan 11PubMedCentralPubMedCrossRef

Imani F, Boada FE, Lieberman FS, Davis DK, Deeb EL, Mountz JM (2012) Comparison of proton magnetic resonance spectroscopy with fluorine-18 2-fluoro deoxyglucose positron emission tomography for assessment of brain tumor progression. J Neuroimaging 22(2):184–190PubMedCentralPubMedCrossRef

Jadvar H, Colletti PM (2014) Competitive advantage of PET/MRI. Eur J Radiol 83(1):84–94PubMedCrossRef

Mertens K, Acou M, Van Hauwe J, De Ruyck I, Van den Broecke C, Kalala JP, D’Asseler Y, Goethals I (2013) Validation of 18F-FDG PET at conventional and delayed intervals for the discrimination of high-grade from low-grade gliomas: a stereotactic PET and MRI study. Clin Nucl Med 38(7):495–500. doi:10.1097/RLU.0b013e318292a753 PubMedCrossRef

Pichler BJ, Kolb A, Nägele T, Schlemmer HP (2010) PET/MRI: paving the way for next generation of clinical multimodality imaging applications. J Nucl Med 51:333–336PubMedCrossRef

Pirotte BJ, Lubansu A, Massager N, Wikler D, Van Bogaert P, Levivier M, Brotchi J, Goldman S (2010) Clinical interest of integrating positron emission tomography imaging in the workup of 55 children with incidentally diagnosed brain lesions. J Neurosurg Pediatr 5(5):479–485PubMedCrossRef

Pirotte BJ, Lubansu A, Massager N, Wikler D, Van Bogaert P, Levivier M, Brotchi J, Goldman S (2010) Clinical impact of integrating positron emission tomography during surgery in 85 children with brain tumor. J Neurosurg Pediatr 5(5):486–499PubMedCrossRef

10.

Sattler B, Jochimsen T, Barthel H, Sommerfeld K, Stumpp P, Hoffmann KT, Gutberlet M, Villringer A, Kahn T, Sabri O (2013) Physical and organizational provision for installation, regulatory requirements and implementation of a simultaneous hybrid PET/MR-imaging system in an integrated research and clinical setting. MAGMA 26(1):159–171PubMedCrossRef

11.

Sauter AW, Wehrl HF, Kolb A, Judenhofer MS, Pichler BJ (2010) Combined PET/MR: one step further in multimodality imaging. Trends Mol Med 16:508–515PubMedCrossRef

12.

Thorsen F, Fite B, Mahakian LM, Seo JW, Qin S, Harrison V, Johnson S, Ingham E, Caskey C, Sundstrøm T, Meade TJ, Harter PN, Skaftnesmo KO, Ferrara KW (2013) Multimodal imaging enables early detection and characterization of changes in tumor permeability of brain metastases. J Control Release 172(3):812–822. doi:10.1016/j.jconrel.2013.10.019, Epub 2013 Oct 29PubMedCrossRef

13.

Wehrl HF, Judenhofer MS, Wiehr S, Pichler BJ (2009) Pre-clinical PET/MR: technological advances and new perspectives in biomedical research. Eur J Nucl Med Mol Imaging 36(Suppl 1):56–68CrossRef

14.

Wehrl HF, Schwab J, Hasenbach K, Reischl G, Tabatabai G, Quintanilla-Martinez L, Jiru F, Chughtai K, Kiss A, Cay F, Bukala D, Heeren RM, Pichler BJ, Sauter AW (2013) Multimodal elucidation of choline metabolism in a murine glioma model using magnetic resonance spectroscopy and 11C-choline positron emission tomography. Cancer Res 73(5):1470–1480. doi:10.1158/0008-5472.CAN-12-2532, Epub 2013 Jan 23PubMedCrossRef

Title: Integrated PET/MRI for planning navigated biopsies in pediatric brain tumors
Authors: Matthias Preuss
Peter Werner
Henryk Barthel
Ulf Nestler
Holger Christiansen
Franz Wolfgang Hirsch
Dominik Fritzsch
Karl-Titus Hoffmann
Matthias K. Bernhard
Osama Sabri
Publication date: 01-08-2014
Publisher: Springer Berlin Heidelberg
Published in: Child's Nervous System / Issue 8/2014
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-014-2412-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Integrated PET/MRI for planning navigated biopsies in pediatric brain tumors

Abstract

Introduction

Patients and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Patients and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 8/2014

The pathogenesis of intracranial growing teratoma syndrome: proliferation of tumor cells or formation of multiple expanding cysts? Two case reports and review of the literature

Comparison of posterior fossa decompression with or without duraplasty in children with Type I Chiari malformation

Transorbital penetrating cerebral injury caused by a wooden stick: surgical nuances for removal of a foreign body lodged in cavernous sinus

Cerebral oxygenation and hemodynamic measurements during craniosynostosis surgery with near-infrared spectroscopy

Intraoperative blood loss during decompressive craniectomy for intractable intracranial hypertension after severe traumatic brain injury in children

COL4A1 mutations should not be a contraindication for epilepsy surgery