Patel Akash,  States Lisa

Final Pr. ID: Poster #: EDU-082

With the increased demand and utilization of PET/MRI in oncologic imaging, there is an ever increasing database of non-malignant pathology that has not yet been described on PET/MRI. Furthermore, the pediatric population provides an even more unique breadth of pathology that is often only seen in this age group. It is important to be able to accurately identify these common pathologies so as to not mistake them for malignancy and to prevent unnecessary follow up imaging studies and further invasive diagnostic procedures.

For this educational exhibit we review over 200 clinical pediatric 18F-FDG PET/MRs performed at our institution and highlight the most common and most interesting cases of FDG-avid non-malignant pathology.

Listed below are some of the cases to be included in the poster:
-Benign FDG avid bone tumors including non-ossifying fibromas
-Benign causes of FDG avid lymphadenopathy including cat scratch disease
-Benign causes of FDG avid lung lesions including aspiration pneumonia
-Benign causes of gastro-intestinal FDG uptake including pseudomembranous colitis
-Benign FDG avid infectious pathologies including a liver abscess Read More

Authors:  Patel Akash , States Lisa

Keywords:  PET/MR, PET/MRI, benign

Vasyliv Iryna

Final Pr. ID: Poster #: SCI-067

Chimeric antigen receptor (CAR) T-cell therapy achieves remission in 80–90% of children with relapsed or refractory acute lymphoblastic leukemia (ALL), but only 20% in pediatric patients with solid tumors. Identifying early biomarkers of response could allow timely interventions for non-responders and support the optimization of effective combination therapies. The spleen plays a central role in immune regulation and lymphocyte trafficking, potentially affecting CAR T-cell expansion, persistence, and toxicity risk. The purpose of our study was to explore if pre treatment spleen to liver SUV ratio (SLR) measured on 18FDG PET/MR may correlate with their treatment outcomes. Read More

Authors:  Vasyliv Iryna

Keywords:  Immunotherapy, Outcomes, Hybrid Pet/MRI

Maleki Nazanin,  Amiruddin Raisa,  States Lisa,  Aboian Mariam

Final Pr. ID: Poster #: EDU-075

PET/MRI plays a significant role in Pediatric Oncology, but its implementation in Pediatric Neuro-Oncology has not been well established. PET/MRI addresses a major challenge in pediatrics by providing capability for serial imaging to track disease response to therapy, while minimizing radiation exposure and sedation events. PET/MRI has become a critical imaging modality in the management of pediatric brain neoplasms and metastases, aiding in diagnosis, staging, treatment planning, and follow-up, all while reducing radiation burden, minimizing time spent in the hospital, and reducing the number of sedation events.
At our tertiary center for pediatric care, we have gained extensive experience in utilizing hybrid PET/MRI to manage complex cases referred from multiple institutions. We present a series of cases where hybrid PET/MRI provided critical information for patient management including nasopharyngeal rhabdomyosarcoma, refractory metastatic germ cell tumor, and neuroblastoma. We offer a forward-looking perspective on the current role of FDG PET/MRI and future applications of amino acid PET in improving patient outcomes and its role in distinguishing tumor progression from post-treatment changes. Amino acid PET/MRI use cases were compiled from literature review and demonstrate definitive roles of amino acid PET/MRI in decision making in brain tumor diagnosis, immediate post-surgical assessment, and delayed treatment response assessment.
18F-FDG PET/MRI representative cases from clinical practice:
Case 1.
18 year old male with refractory metastatic germ cell tumor with anterior mediastinal mass and intracranial metastasis
Clinical Problem: Whole body evaluation in addition to detailed analysis of brain metastases in time efficient manner.
Imaging Solution: PET/MRI allowed detailed evaluation of hypermetabolic metastatic disease to the mediastinum and lungs and further detailed delineation of hemorrhagic brain metastases.
Case2.
4 year old boy with history of nasopharyngeal rhabdomyosarcoma with cerebellar metastasis who underwent resection and chemoradiation.
Clincial Problem: How to monitor nasopharyngeal mass after treatment in the setting of extensive postsurgical changes on MRI
Imaging Solution: PET/MRI provides an excellent imaging method for monitoring disease recurrence in the setting of post-treatment changes in nasopharyngeal location. Recurrent tumor was identified as hypermetabolic lesion, while MRI was not definitive. Read More

Authors:  Maleki Nazanin , Amiruddin Raisa , States Lisa , Aboian Mariam

Keywords:  PET-MRI, Pediatric Imaging, Brain Tumors

Davis James,  Servaes Sabah,  Nevo Elad,  States Lisa

Final Pr. ID: Paper #: 139

We aim to evaluate qualitative and quantitative image quality of low-dose PET-MRI in young patients. Read More

Authors:  Davis James , Servaes Sabah , Nevo Elad , States Lisa

Keywords:  PET/MRI, dose reduction

Sanders Vanessa,  Khanna Geetika,  Mhlanga Joyce,  Ponisio Maria

Final Pr. ID: Poster #: SCI-060

To determine if diffusion weighted imaging (DWI) adds value to PET/MRI in pediatric solid tumors. Read More

Authors:  Sanders Vanessa , Khanna Geetika , Mhlanga Joyce , Ponisio Maria

Keywords:  PET/MRI, DWI, Oncology

Chan Alex,  Laughlin Brady,  Latshaw Rachael,  Abid Waqas,  Iaia Alberto,  Moftakhar Parham,  Kandula Vinay,  Nikam Rahul,  Choudhary Arabinda

Final Pr. ID: Poster #: EDU-066

PET/MRI has recently become a clinical realization after overcoming complex hardware and image reconstruction issues. The goal of this educational exhibit is to provide a comprehensive, yet understandable, introduction to these aspects of PET/MRI along with displaying a pictorial assay of different normal and abnormal metabolic findings within the field of Pediatric Neuroradiology.

The first part of this presentation will begin by highlighting the basic hardware components of the PET/CT contrasting with the interactions between the main components of the PET/MRI scanner along with their associated solutions. In general, these issues include how MRI can affect PET in terms of their magnetic field and RF properties and how PET affect MRI due to the scintillator/electronic components.

The second part will begin by discussing some soft tissue and hardware attenuation correction techniques that are currently in use, such as: Segmentation and atlas-based methods along with attenuation map generation and coil localization methods. Additionally, we will show the consequence of field-of-view (FOV) mismatch between the PET and MRI acquisitions and partial volume effects along with their solutions.

The final part will showcase clinical applications of PET/MRI to Pediatric Neuroradiology, featuring imaging protocol details and a pictorial guide of normal distributions and pathologic conditions. Clinical examples range from seizure localization, cortical malformations, manifestations of Phakomatoses, perinatal stroke, tumor recurrence, and Flutriciclamide (¹⁸F-GE180) imaging in the setting of neuroinflammation. Read More

Authors:  Chan Alex , Laughlin Brady , Latshaw Rachael , Abid Waqas , Iaia Alberto , Moftakhar Parham , Kandula Vinay , Nikam Rahul , Choudhary Arabinda

Keywords:  PET/MRI, Physics

Martinez-rios Claudia,  Malkin David,  Vali Reza,  Shammas Amer,  Tijerin Bueno Marta,  Greer Mary-louise,  Doria Andrea

Final Pr. ID: Poster #: EDU-123

Whole-body (WB) magnetic resonance (MR) imaging in children is of special interest because it is radiation free and can be used to evaluate systemic conditions, exploiting the advantage of the superior soft-tissue contrast provided by MR imaging. An important clinical application of whole-body MR imaging in children is its use for screening of oncologic conditions, tumor characterization, and staging. However, the list of non-oncologic applications of WB MRI has recently expanded to include the evaluation of numerous multisystemic conditions.

This is a pictorial review of different oncologic applications of WB MRI including cancer predisposition syndromes, solid neoplasias and lymphomas, as well as of non-oncologic applications of WB MRI including chronic recurrent osteomyelitis (CRMO), enthesitis related arthritis (ERA), vascular malformations and benign tumors. In this review we discuss the advantages and challenges of conventional and functional MRI sequences including the use of diffusion weighted imaging (DWI), color-encoded DWI enhanced with iron supplement Ferumoxytol as blood pool contrast agent, as well as the advantages and disadvantages of the recently introduced WB positron emission tomography (PET)/MRI. Read More

Authors:  Martinez-rios Claudia , Malkin David , Vali Reza , Shammas Amer , Tijerin Bueno Marta , Greer Mary-louise , Doria Andrea

Keywords:  MRI, DWI, STIR, PET/MRI, oncology

Vasyliv Iryna

Final Pr. ID: Poster #: SCI-068

Most pediatric patients with acute lymphoblastic leukemia (ALL) demonstrate tumor remission during the first weeks or months after Chimeric Antigen Receptor (CAR) T-cell therapy. However, 30–60% of patients ultimately relapse, highlighting the need for early, non-invasive risk stratification after treatment. 18FDG PET/MR can assess the bone marrow without biopsy, but its prognostic utility after CAR T-cell therapy remains unexplored. The purpose of the study was to determine if changes in bone marrow metabolic activity on 18F-FDG PET/MR at day 28 after CAR T-cell therapy is associated with five-year survival in children with ALL. Read More

Authors:  Vasyliv Iryna

Keywords:  Hybrid Pet/MRI, Leukemia, Bone Marrow

Antil Neha,  Gatidis Sergios,  Nadel Helen

Final Pr. ID: Poster #: EDU-110

PET/MRI (Positron Emission Tomography–Magnetic Resonance Imaging) is a powerful hybrid imaging modality that has gained increasing clinical relevance in pediatric and neonatal imaging over the past decade. It combines the molecular imaging strengths of PET with the superior soft tissue contrast and functional capabilities of MRI, enabling both whole-body and targeted imaging in a single session. In pediatric imaging, where minimizing radiation exposure is critical and conditions often involve subtle functional or metabolic changes, PET/MRI has emerged as a powerful problem-solving modality. Additional advantage of PET/MRI in pediatric patients is reduction in the number of necessary single examinations and thus reducing the number of sedations and radiation exposure when compared with PET/CT.
PET/MRI has been established as a clinical imaging modality with a wide range of applications across pediatric oncology, neurology, cardiology, infectious/ inflammatory disorders, and rheumatology. It can be utilized for presurgical planning for epilepsy, detection and staging of tumors. Beyond detection and characterization of tumor lesions, PET/MRI is highly effective in providing relevant secondary information about tumor-related or therapy-related complications. Additionally, PET/MRI is helpful diagnostic tool in unusual or challenging clinical situations such as discrepant findings from other diagnostic tests, nonspecific clinical findings, or inconclusive prior imaging findings, especially in children with fever of unknown origin. In such settings, PET/MRI can be used as a problem-solving tool to provide guidance regarding patient management when identifying disease foci or biopsy targets or when ruling out the presence of macroscopic malignancy or active inflammatory processes.
This exhibit demonstrates the unique diagnostic value of hybrid PET/MRI in complex pediatric imaging and to highlight its role as a comprehensive, multiparametric tool in evaluating a wide spectrum of challenging pediatric conditions through clinical cases. The exhibit will be educational for radiologists, nuclear medicine physicians, and pediatric specialists on the strengths, clinical applications, and practical considerations of PET/MRI in children. Read More

Authors:  Antil Neha , Gatidis Sergios , Nadel Helen

Keywords:  Paediatric Nuclear Medicine, Pet/MRI, Oncology

Jayapal Praveen,  Baratto Lucia,  Rashidi Ali,  Daldrup-link Heike

Final Pr. ID: Poster #: EDU-055

Children with cancer typically require a local MRI scan for primary tumor staging, which is often supplemented by a whole-body PET scan for whole-body staging. Over the past decade, PET-CT was the most widely used modality for whole-body staging across the world. Seven years ago, our team pioneered whole-body 18F-FDG PET-MRI of children with cancer as a "one-stop" alternative with 80% reduced radiation exposure and optimized child-tailored fast and efficient Whole-Body PET/MRI protocols. We then replaced all whole-Body PET/CT studies at our Institution with whole-body PET-MRI as the standard of care for our patients and have performed over 800 Pediatric Whole Body PET MRIs in the last three years.

The purpose of this educational exhibit is to provide a comprehensive review of whole-body PET/MRI technique, imaging patterns in common pediatric malignancies.

The first aim is to briefly explain our Institution's protocol for simultaneous PET/MRI acquisitions. Such simultaneous acquisition results in a convenient, faster, and safer approach for local and whole-body staging in one session. Furthermore, it avoids the need for repetitive anesthesia and imaging and also avoids potential ionizing radiation from PET CTs. The excellent contrast resolution in the MRI provides superior diagnostic detail compared to the CT.

The second aim will present PET/MRI case examples, where either the PET component added value to the MRI or the MRI component added value to the PET, thereby confirming the importance of this integrated hybrid imaging technology. We will present PET/MRI case examples of the following pediatric tumors:
1. Lymphomas:
2. Osseous Sarcomas including Osteosarcoma and Ewing Sarcoma
3. Soft-tissue Sarcomas such as Rhabdomyosarcoma, Desmoplastic small round blue cell tumor. Synovial Sarcoma, Fibrosarcoma, Epithelioid Sarcoma, Alveolar Soft part sarcoma, and Liposarcoma
4. Neuroblastoma
5. Neuroendocrine tumors
6. Malignant Peripheral Nerve Sheath Tumor
7. Germ cell tumors
8. Renal tumors
9. Malignant Liver tumors
10. Langerhan Cell Histiocytosis

As a result of this educational presentation, participants will be able to prescribe a PET/MRI exam for children with cancer, implement tumor-specific protocol modifications, and improve their tumor diagnoses' sensitivity, specificity, and accuracy. Read More

Authors:  Jayapal Praveen , Baratto Lucia , Rashidi Ali , Daldrup-link Heike

Keywords:  PET-MRI, PET, 18F-FDG PET-MRI

Lopez-rippe Julian,  Ramanjana Reddy Manasa,  Hamel Eva,  Reid Janet,  States Lisa

Final Pr. ID: Poster #: SCI-014

Hybrid PET-MR is increasingly used in pediatric oncologic and metabolic imaging, yet structured educational resources remain scarce, creating a significant gap in PET-MR competency development. We designed an online case-based platform combining foundational modules (principles, radiopharmaceuticals, protocols, normal variants) with interactive case libraries featuring radiologist-verified findings and teaching points. This study evaluates its feasibility, preliminary learning outcomes, and user perceptions during pediatric nuclear medicine rotations. Read More

Authors:  Lopez-rippe Julian , Ramanjana Reddy Manasa , Hamel Eva , Reid Janet , States Lisa

Keywords:  PET-MRI, Education, Training