Magnetic resonance imaging (MRI), frequently with contrast enhancement, is the preferred imaging modality for many indications in children. Practice varies widely between centers, reflecting the rapid pace of change and the need for further research. Guide-line changes, for example on contrast-medium choice, require continued practice reappraisal. This article reviews recent developments in pediatric contrast-enhanced MRI and offers recommendations on current best practice. Nine leading pediatric radiologists from internationally recognized radiology centers convened at a consensus meeting in Bordeaux, France, to discuss applications of contrast-enhanced MRI across a range of indications in children. Review of the literature indicated that few published data provide guidance on best practice in pediatric MRI. Discussion among the experts concluded that MRI is preferred over ionizing-radiation modalities for many indications, with advantages in safety and efficacy. Awareness of age-specific adaptations in MRI technique can optimize image quality. Gadolinium-based contrast media are recommended for enhancing imaging quality. The choice of most appropriate contrast medium should be based on criteria of safety, tolerability, and efficacy, characterized in age-specific clinical trials and personal experience.
Abstract:We report on two infants of 11 and 12 months of age, respectively, with large solid-cystic retroperitoneal tumors. Complete resection was achieved, and both children are doing well over a follow-up of more than 17 months. The presented paper focuses on surgical anatomy of this very rare type of tumor. Teratomas were located mainly within the upper abdominal cavity, and both tumors displaced the pancreas in an anterior position. The following anatomical features were observed (1) displacement of surrounding organs, (2) deformation and elongation of large retroperitoneal vessels, (3) fi brous incorporation of large vessels by the tumor pseudocapsule, (4) wrapping of anterior aortic branches by lobes and fi ngers of the tumor.
Introduction: Radiotherapy is an important risk factor for the development of secondary malignancies in children with Hodgkin’s lymphoma. The GPOH-HD-study group tries to restrict the indication for radiotherapy after two cycles of intensive OPPA (OEPA) chemotherapy. In the GPOH-HD 95 trial 113/394 (29%) of patients with early stage HL were in complete remission (CR) after chemotherapy based on CT/MRI (=CRI) criteria. They were not irradiated and achieved an excellent 97% EFS rate at 5 yrs (Dörffel, 2003).
Objective: Our next study will drop radiotherapy also in patients with residual findings according to CRI criteria if FDG-PET converts to negative after chemotherapy as ascertained by real-time central review of all images. Here we report pilot data on the conversion rate.
Results: During the GPOH-HD 2002 Pilot study 41 patients with early stage HL received both a staging PET at diagnosis and a restaging PET after chemotherapy. Images were centrally reviewed in Leipzig. 7 patients were in CR based on both PET and CRI criteria, one patient with CRI-based CR had still a positive PET result; in a further patient PET was not completely evaluable. In 17/32 patients with residual masses PET was completely negative after chemotherapy. In one patient PET was completely negative except for one initially involved site, where it was not informative due to a local artefact; however, CRI showed local CR in this region. In summary, 27/41 (66%) patients would qualify for no radiotherapy within a PET-based response adaptation strategy in contrast to only 9/41 (22%) patients when CRI-based. Interestingly, in 13/17 patients with negative PET, a residual mass within the mediastinum was found, indicating that a PET-based strategy will prevent many patients from mediastinal irradiation.
Conclusion: A FDG-PET-based response evaluation has the prospect to avoid radiotherapy in about 60 – 70% of all patients with early stage HL. Our next trial is designed to demonstrate that this does not lead to an unacceptable increase of the relapse rate.
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