Pediatric Cancer Predisposition Imaging: Focus on Whole-Body MRI

Abstract

The American Association for Cancer Research convened a meeting of international pediatric oncologists, geneticists, genetic counselors, and radiologists expert in childhood cancer predisposition syndromes (CPS) in October 2016 to propose consensus surveillance guidelines. Imaging plays a central role in surveillance for most, though not all, syndromes discussed. While encompassing the full gamut of modalities, there is increasing emphasis on use of nonionizing radiation imaging options such as magnetic resonance imaging (MRI) in children and adolescents, especially in the pediatric CPS population. In view of rapid evolution and widespread adoption of whole-body MRI (WBMRI), the purpose of our review is to address WBMRI in detail. We discuss its place in the surveillance of a range of pediatric CPS, the technical and logistical aspects of acquiring and interpreting these studies, and the inherent limitations of WBMRI. We also address issues associated with sedation and use of gadolinium-based contrast agents in MRI in children.

Trends of National and Subnational Incidence of Childhood Cancer Groups in Iran: 1990–2016

“…Thereby, targeting high-risk populations for cancer screening would be a cost-effective solution. In this regard, American Association for Cancer Research has published a set of screening protocols for genetic syndromes predisposing children to cancers (40)(41)(42)(43)(44)(45).…”

The Future of Surveillance in the Context of Cancer Predisposition: Through the Murky Looking Glass

“…The majority of recommendations across all disease groups represented here are based on conventional imaging studies, biochemical or metabolic assays and routine physical examination and history. In some instances, such as the use of wholebody magnetic resonance imaging (WB-MRI), significant constraints may be encountered in funding and insurance coverage, challenges in expertise of reading the images, potential risks associated with sedation in young children, and/or technological availability particularly in underserved regions of the world (5). In other instances, incidental findings resulting from the recommended studies may lead to additional and possibly more invasive diagnostic tests, which may not confirm a malignancy (false positives), or subtle findings initially interpreted as incidental or "benign" that subsequently turn out to be malignant (false negatives).…”

“…For this, critical improvements in development of ever more precise imaging modalities to take advantage of detection of the molecular fingerprint of the tumor are required. Some of these radiogenomic approaches are addressed in the series article by Greer and colleagues (5). These improvements include refinements in MRI technique, MR spectroscopy, positron emission tomography (PET)-MRI, and other molecular imaging techniques in which tumor-specific molecular targets may be labeled and home to specific malignant lesions.…”

Whole-body MRI for staging and interim response monitoring in paediatric and adolescent Hodgkin’s lymphoma: a comparison with multi-modality reference standard including 18F-FDG-PET-CT

“…Whole-body magnetic resonance imaging (WB-MRI) is an attractive alternative to 18 F-FDG-PET-CT as it does not impart ionising radiation and can provide high quality anatomical images through the body in less than 1 h [ 6 , 8 , 9 ]. Moreover, there is evidence suggesting that diffusion-weighted imaging (DWI) may act as a surrogate for the functional information provided by 18 F-FDG [ 10 , 11 ].…”