A PET/MR Imaging Approach for the Integrated Assessment of Chemotherapy-induced Brain, Heart, and Bone Injuries in Pediatric Cancer Survivors: A Pilot Study

Theruvath, Ashok J.; Ilivitzki, Anat; Muehe, Anne M.; Theruvath, Johanna; Gulaka, Praveen; Kim, Christine; Luna‐Fineman, Sandra; Sakamoto, Kathleen M.; Yeom, Kristen W.; Yang, Phillip C.; Moseley, Michael E.; Chan, Frandics P.

doi:10.1148/radiol.2017170073

Cited by 8 publications

(2 citation statements)

References 28 publications

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“…A reduction by chemotherapy of regional blood flow, possibly due to a reduction in blood vessel density, has also been reported [ 78 – 80 ], including more recently a clinical study in pediatric cancer survivors [ 81 ]. Using positron emission tomography/magnetic resonance imaging (PET/MR), these investigators measured significantly lower cerebral blood flow and metabolic activity in key brain areas compared to control subjects.…”

Section: Introductionmentioning

confidence: 99%

Chemotherapy and the pediatric brain

Ikonomidou

2018

Mol Cell Pediatr

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Survival rates of children with cancer are steadily increasing. This urges our attention to neurocognitive and psychiatric outcomes, as these can markedly influence the quality of life of these children. Neurobehavioral morbidity in childhood cancer survivors affects diverse aspects of cognitive function, which can include attention, memory, processing speed, intellect, academic achievement, and emotional health. Reasons for neurobehavioral morbidity are multiple with one major contributor being chemotherapy-induced central nervous system (CNS) toxicity. Clinical studies investigating the effects of chemotherapy on the CNS in children with cancer have reported causative associations with the development of leukoencephalopathies as well as smaller regional grey and white matter volumes, which have been found to correlate with neurocognitive deficits.Preclinical work has provided compelling evidence that chemotherapy drugs are potent neuro- and gliotoxins in vitro and in vivo and can cause brain injury via excitotoxic and apoptotic mechanisms. Furthermore, chemotherapy triggers DNA (deoxyribonucleic acid) damage directly or through increased oxidative stress. It can shorten telomeres and accelerate cell aging, cause cytokine deregulation, inhibit hippocampal neurogenesis, and reduce brain vascularization and blood flow. These mechanisms, when allowed to operate on the developing brain of a child, have high potential to not only cause brain injury, but also alter crucial developmental events, such as myelination, synaptogenesis, neurogenesis, cortical thinning, and formation of neuronal networks.This short review summarizes key publications describing neurotoxicity of chemotherapy in pediatric cancers and potential underlying pathomechanisms.

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Section: Introductionmentioning

confidence: 99%

Chemotherapy and the pediatric brain

Ikonomidou

2018

Mol Cell Pediatr

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“…Since 2018, new emerging tracers have been added to those most commonly used. With about 18% use of tracers, [ 68 Ga]Ga-Citrate, a Fe 3+ biomimetic that binds to apo-transferrin in the blood, can detect high-grade glioma in adults and children. 72 Moreover, this latter can also be used to develop targeted internal radiation therapies.…”

Section: Discussionmentioning

confidence: 99%

Update on the Use of PET/MRI Contrast Agents and Tracers in Brain Oncology: A Systematic Review

Smeraldo¹,

Ponsiglione²,

Soricelli³

et al. 2022

IJN

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The recent advancements in hybrid positron emission tomography–magnetic resonance imaging systems (PET/MRI) have brought massive value in the investigation of disease processes, in the development of novel treatments, in the monitoring of both therapy response and disease progression, and, not least, in the introduction of new multidisciplinary molecular imaging approaches. While offering potential advantages over PET/CT, the hybrid PET/MRI proved to improve both the image quality and lesion detectability. In particular, it showed to be an effective tool for the study of metabolic information about lesions and pathological conditions affecting the brain, from a better tumor characterization to the analysis of metabolic brain networks. Based on the PRISMA guidelines, this work presents a systematic review on PET/MRI in basic research and clinical differential diagnosis on brain oncology and neurodegenerative disorders. The analysis includes literature works and clinical case studies, with a specific focus on the use of PET tracers and MRI contrast agents, which are usually employed to perform hybrid PET/MRI studies of brain tumors. A systematic literature search for original diagnostic studies is performed using PubMed/MEDLINE, Scopus and Web of Science. Patients, study, and imaging characteristics were extracted from the selected articles. The analysis included acquired data pooling, heterogeneity testing, sensitivity analyses, used tracers, and reported patient outcomes. Our analysis shows that, while PET/MRI for the brain is a promising diagnostic method for early diagnosis, staging and recurrence in patients with brain diseases, a better definition of the role of tracers and imaging agents in both clinical and preclinical hybrid PET/MRI applications is needed and further efforts should be devoted to the standardization of the contrast imaging protocols, also considering the emerging agents and multimodal probes.

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