Therapy Response Assessment of Pediatric Tumors with Whole-Body                    Diffusion-weighted MRI and FDG PET/MRI

Theruvath, Ashok J.; Siedek, Florian; Muehe, Anne M.; Garcia-Diaz, Jordi; Kirchner, Julian; Martin, Ole; Link, Michael P.; Spunt, Sheri L.; Pribnow, Allison; Rosenberg, Jarrett; Herrmann, Ken; Gatidis, Sergios; Schäfer, Jürgen; Moseley, Michael E.; Umutlu, Lale; Daldrup‐Link, Heike E.

doi:10.1148/radiol.2020192508

Cited by 30 publications

(22 citation statements)

References 43 publications

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“…Table 4 shows the amount of true-positive, false-positive, false-negative and true-negative disease stations and observed agreement for WB-MRI compared to the reference standard. 19). In Fig.…”

Section: Early Response Assessmentmentioning

confidence: 98%

“…The functional information provided by DWI has been found to be a useful addition to conventional WB-MRI protocols for staging Hodgkin's lymphoma [13], but despite these positive results for staging, the first studies focussing on response assessment do not show consistent results. Some authors have reported that WB-MRI cannot match [ 18 F]FDG -PET/CT for response assessment [10,[14][15][16], while others report that WB-MRI may be a useful alternative not only in staging but also in treatment response assessment in lymphoma patients [16][17][18][19]. Since most of these studies focus on heterogeneous lymphoma populations with different tumour characteristics and treatment protocols, drawing conclusions on the value of WB-MRI in paediatric Hodgkin's lymphoma is challenging [20].…”

Section: Introductionmentioning

confidence: 99%

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Whole-body MRI versus an [18F]FDG-PET/CT-based reference standard for early response assessment and restaging of paediatric Hodgkin’s lymphoma: a prospective multicentre study

et al. 2021

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Objectives To compare WB-MRI with an [18F]FDG-PET/CT-based reference for early response assessment and restaging in children with Hodgkin’s lymphoma (HL). Methods Fifty-one children (ages 10–17) with HL were included in this prospective, multicentre study. All participants underwent WB-MRI and [18F]FDG-PET/CT at early response assessment. Thirteen of the 51 patients also underwent both WB-MRI and [18F]FDG-PET/CT at restaging. Two radiologists independently evaluated all WB-MR images in two separate readings: without and with DWI. The [18F]FDG-PET/CT examinations were evaluated by a nuclear medicine physician. An expert panel assessed all discrepancies between WB-MRI and [18F]FDG-PET/CT to derive the [18F]FDG-PET/CT-based reference standard. Inter-observer agreement for WB-MRI was calculated using kappa statistics. Concordance, PPV, NPV, sensitivity and specificity for a correct assessment of the response between WB-MRI and the reference standard were calculated for both nodal and extra-nodal disease presence and total response evaluation. Results Inter-observer agreement of WB-MRI including DWI between both readers was moderate (κ 0.46–0.60). For early response assessment, WB-MRI DWI agreed with the reference standard in 33/51 patients (65%, 95% CI 51–77%) versus 15/51 (29%, 95% CI 19–43%) for WB-MRI without DWI. For restaging, WB-MRI including DWI agreed with the reference standard in 9/13 patients (69%, 95% CI 42–87%) versus 5/13 patients (38%, 95% CI 18–64%) for WB-MRI without DWI. Conclusions The addition of DWI to the WB-MRI protocol in early response assessment and restaging of paediatric HL improved agreement with the [18F]FDG-PET/CT-based reference standard. However, WB-MRI remained discordant in 30% of the patients compared to standard imaging for assessing residual disease presence. Key Points • Inter-observer agreement of WB-MRI including DWI between both readers was moderate for (early) response assessment of paediatric Hodgkin’s lymphoma. • The addition of DWI to the WB-MRI protocol in early response assessment and restaging of paediatric Hodgkin’s lymphoma improved agreement with the [18F]FDG-PET/CT-based reference standard. • WB-MRI including DWI agreed with the reference standard in respectively 65% and 69% of the patients for early response assessment and restaging.

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Section: Early Response Assessmentmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Whole-body MRI versus an [18F]FDG-PET/CT-based reference standard for early response assessment and restaging of paediatric Hodgkin’s lymphoma: a prospective multicentre study

et al. 2021

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“…100,123 Preoperative imaging however, is unfortunately not able to assess the response of tumors to neoadjuvant chemotherapy with sufficient reliability to influence surgical options. 124 Intraoperative imaging techniques, such as fluorescence using indocyanine green, offer the prospect of guiding surgeons towards improved surgical margins, but have yet to be proven in large scale clinical trials. 125 Novel techniques including intraoperative navigation and personalized custom jigs to guide bone resections, are becoming more established, may increase safety, and when matched with implants using additive layer manufacturing and porous ingrowth surfaces, offer the ability to improve margins whilst preserving normal tissue, (Fig.…”

Section: New Surgical Techniquesmentioning

confidence: 99%

Current Approaches to Management of Bone Sarcoma in Adolescent and Young Adult (AYA) Patients

Ingley

Maleddu

Grange

et al. 2021

Preprint

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Bone tumors are a group of histologically diverse diseases which occur across all ages. Two of the commonest, osteosarcoma (OS) and Ewing sarcoma (ES), are regarded as characteristic AYA cancers with an incidence peak in AYAs. They are curable for some but associated with unacceptably high rates of treatment failure and morbidity. The introduction of effective new therapeutics for bone sarcomas is slow, and to date, complex biology has been insufficiently characterized to allow more rapid therapeutic exploitation. This review focuses on current standards of care, recent advances that have or may soon change that standard of care and challenges to the expert clinical research community that we suggest must be met.

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“…With the implementation of integrated positron emission tomography (PET)/magnetic resonance imaging (MRI) systems, certain morphological, functional, and metabolic data sets can be obtained within one examination. A few studies already reported that both, 18F-fluorodeoxyglucose (18F-FDG) PET as well as MRI-derived diffusion-weighted imaging (DWI) data sets can be applied for response evaluation of soft-tissue sarcomas, based on measurable changes of these quantitative parameters under treatment [ 12 , 13 , 14 , 15 ]. In contrast, tumor size measurements have been shown to be insufficient for reliable therapy response assessment, yet it is well known that the initial extent of soft-tissue sarcomas has a considerable prognostic relevance [ 9 , 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Predictive Potential of 18F-FDG PET and DWI Data Sets for Relevant Prognostic Parameters of Primary Soft-Tissue Sarcomas

Chodyla

Demircioğlu

Schaarschmidt

et al. 2021

Cancers

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Background: To evaluate the potential of simultaneously acquired 18F-FDG PET- and MR-derived quantitative imaging data sets of primary soft-tissue sarcomas for the prediction of neoadjuvant treatment response, the metastatic status and tumor grade. Methods: A total of 52 patients with a high-risk soft-tissue sarcoma underwent a 18F-FDG PET/MR examination within one week before the start of neoadjuvant treatment. For each patient, the maximum tumor size, metabolic activity (SUVs), and diffusion-restriction (ADC values) of the tumor manifestations were determined. A Mann–Whitney-U test was used, and ROC analysis was performed to evaluate the potential to predict histopathological treatment response, the metastatic status or tumor grade. The results from the histopathological analysis served as reference standard. Results: Soft-tissue sarcomas with a histopathological treatment response revealed a significantly higher metabolic activity than tumors in the non-responder group. In addition, grade 3 tumors showed a significant higher 18F-FDG uptake than grade 2 tumors. Furthermore, no significant correlation between the different outcome variables and tumor size or calculated ADC-values could be identified. Conclusion: Measurements of the metabolic activity of primary and untreated soft-tissue sarcomas could non-invasively deliver relevant information that may be used for treatment planning and risk-stratification of high-risk sarcoma patients in a pretherapeutic setting.

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Therapy Response Assessment of Pediatric Tumors with Whole-Body Diffusion-weighted MRI and FDG PET/MRI

Cited by 30 publications

References 43 publications

Whole-body MRI versus an [18F]FDG-PET/CT-based reference standard for early response assessment and restaging of paediatric Hodgkin’s lymphoma: a prospective multicentre study

Whole-body MRI versus an [18F]FDG-PET/CT-based reference standard for early response assessment and restaging of paediatric Hodgkin’s lymphoma: a prospective multicentre study

Current Approaches to Management of Bone Sarcoma in Adolescent and Young Adult (AYA) Patients

Evaluation of the Predictive Potential of 18F-FDG PET and DWI Data Sets for Relevant Prognostic Parameters of Primary Soft-Tissue Sarcomas

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