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

Meeting name: SPR 2022 Annual Meeting & Postgraduate Course , 2022

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

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

Medical Imaging has a crucial role in the diagnosis and management of pediatric cancer patients by providing information about tumor location and quantitative measures of tumor size and metabolic activity at baseline as well as during and after therapy. The standard imaging plan for staging and re-staging of pediatric malignancies includes a high-resolution MRI or CT scan of the local tumor and whole body staging for the detection of metastases on CT, MRI and/or PET scans. Children with lymphomas, sarcomas, germ cell tumors and a few other tumor types are referred to whole body 18F-FDG PET scanning, either coupled with CT or MRI. Artificial intelligence (AI) algorithms can facilitate staging and re-staging of cancers in children by providing 1) rapid detection and delineation of tumoral lesions, 2) automated measurements of tumoral size and metabolic activity, 3) relating tumor measurements to internal standard such as liver and blood pool, 4) assigning a score according to tumor-specific staging systems. Detecting tumors on a whole-body scan is a challenging task, especially in children whose organs undergo changes in size and composition with increasing age. Moreover, the tumors in children can arise from almost anywhere in the body, from head to toe. With successful applications on object detection, AI methods are promising for automatic tumor detection from whole-body scans as well. In this tutorial, we will introduce a few popular AI methods for such purpose. These methods include U-Net, Vision Transformers (ViT), and the hybrid of the above methods such as O-Net Transformer or TransUNet. Read More

Meeting name: SPR 2023 Annual Meeting & Postgraduate Course , 2023

Authors: Sarrami Amir Hossein, Wang Hongzhi, Baratto Lucia, Syeda-mahmood Tanveer, Daldrup-link Heike

Keywords: Hybrid Imaging, Artificial Intelligence, Cancer

Metastasized osteosarcoma has a poor prognosis with a two-year event free survival rate of 15-20%, highlighting the need for the advancement of efficacious therapeutics. Chimeric antigen receptor (CAR) T-cell therapy is emerging as a potent strategy for eliminating tumors by harnessing the immune system. Despite this, trials encounter challenges due to varied responses and failing therapy in patients. Development of translatable cell imaging methods would provide invaluable information regarding the biological fate of T-cells. This work aims to evaluate a new approach for CAR T-cell labeling with ferumoxytol, which enables non-invasive cell tracking with magnetic resonance imaging (MRI) and a new imaging technique, magnetic particle imaging (MPI). Read More

Meeting name: SPR 2020 Annual Meeting & Postgraduate Course , 2020

Authors: Kiru Louise, Wu Wei, Nejadnik Hossein, Liu Anna, Majzner Robbie, Sulchek Todd, Daldrup-link Heike

Keywords: Osteosarcoma, Chimeric antigen receptor T cells, Cell tracking

PET/MR is a valuable and growing imaging method for the assessment and management of pediatric bone tumors. Although plain radiography remains the first line modality for initial evaluation, cross sectional imaging is often required for further characterization of indeterminate or aggressive appearing lesions. Due to its superior soft tissue contrast resolution compared to CT, MR has become the mainstay in tissue characterization, locoregional staging, and surgical planning of pediatric bone tumors. By adding functional and metabolic information, FDG-PET imaging is useful for “one stop” local tumor and whole-body staging, evaluating response to therapy and surveillance. 18F-FDG PET/MR scans have the benefit of lower radiation and increased patient convenience compared to 18F-FDG PET/CT scans. However, due to the relatively recent development of this technology, many radiologists may be unfamiliar with the technical considerations and interpretation pearls and pitfalls of PET/MR. This educational exhibit reviews the imaging technique, reporting requirements, and imaging characteristics of the most common pediatric bone tumors with 18F-FDG PET/MR. Read More

Meeting name: SPR 2019 Annual Meeting & Postgraduate Course , 2019

Authors: Farrell Crystal, Pareek Anuj, Muehe Anne, Pribnow Allison, Steffner Robert, Avedian Raffi, Daldrup-link Heike

Keywords: PET/MR, bone tumor, cancer

To compare the detection of lesions between DW-MRI and ¹⁸F-FDG PET/MR for staging and restaging of Langerhans Cell Histiocytosis (LCH), using all clinical outcomes and imaging data as the reference standard. Also, this study will compare the differences between LCH chemotherapy responders and non-responders. Read More

Meeting name: SPR 2020 Annual Meeting & Postgraduate Course , 2020

Authors: Nyalakonda Ramyashree, Muehe Anne, Iles Benjamin, Theruvath Ashok, Siedek Florian, Agarwal Vibhu, Hawk Kristina, Jeng Michael, Daldrup-link Heike

Keywords: Langerhans Cell Histiocytosis, Diffusion Weighted Imaging, 18F-FDG PET/MR