Guidelines for 18F-FDG PET and PET-CT imaging in paediatric oncology

Abstract

The guidelines summarize the views of the Paediatric Committee of the European Association of Nuclear Medicine. They should be taken in the context of "good practice" of nuclear medicine and of any national rules, which may apply to nuclear medicine examinations. The recommendations of these guidelines cannot be applied to all patients in all practice settings. The guidelines should not be deemed inclusive of all proper procedures or exclusive of other procedures reasonably directed to obtaining the same results.

Pediatric Oncologic Imaging: A Key Application of Combined PET/MRI

“…For FDG examinations, it is of importance to avoid activation of brown adipose tissue that has a high prevalence among pediatric patients and can impair diagnostic validity of PET. For this purpose, patients should be kept warm before and after tracer injection, and propanolol can be administered after consideration of contraindications [11,12]. Similarly, furosemide may be administered in order to minimize tracer accumulation within the urinary bladder when examining the anatomic area of the pelvis.…”

“…In patients with sarcoma, 18F-FDG-PET can add additional information with regard to risk stratification and detection of tumor recurrence [12,24]. In patients with neuroblastoma, the role of FDG-PET is limited to tumor characterization and risk stratification complementing diagnostic information from MIBG-scintigraphy [12,24] and to patients with MIBG-negative tumor load. However, new developments in radiopharmacy may enable comprehensive characterization of neuroblastoma with PET only by using fluoride-labeled 18F-MFBG [26] or specific antibody tracers [27].…”

“…Available data show that PET measurements acquired on PET/MRI systems have equivalent qualitative and quantitative characteristics compared to PET measurements of PET/CT in adult and pediatric patients [7,8,18,21]. According to national [22,23] and international [12] guidelines for PET in children with cancer, 18F-FDG-PET is indicated for diagnosis, staging, and restaging in a number of tumor entities, which are mainly lymphoma, sarcoma, neuroblastoma, and CNS tumors.…”

“…Especially in Hodgkin lymphoma, PET imaging plays a decisive role for therapy response monitoring and has a direct impact on diagnostic decisions concerning the indication for radiation therapy [25]. In patients with sarcoma, 18F-FDG-PET can add additional information with regard to risk stratification and detection of tumor recurrence [12,24]. In patients with neuroblastoma, the role of FDG-PET is limited to tumor characterization and risk stratification complementing diagnostic information from MIBG-scintigraphy [12,24] and to patients with MIBG-negative tumor load.…”

“…The role of 18F-FDG-PET in imaging of pediatric lymphoma is well-established for initial staging, risk stratification, and therapy monitoring [12,24]. Especially in Hodgkin lymphoma, PET imaging plays a decisive role for therapy response monitoring and has a direct impact on diagnostic decisions concerning the indication for radiation therapy [25].…”