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Whole-body PET/MRI of Pediatric Patients: The Details That Matter
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[18F]FDG PET/MRI in children suffering from lymphoma: does MRI contrast media make a difference?

Kai Jannusch1, Janna Morawitz1, Bernd Schweiger2

  • 1Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany.

European Radiology
|June 20, 2023
PubMed
Abstract

Insights

Contrast-enhanced MRI offers no additional benefit for staging pediatric lymphoma patients using [18F]FDG PET/MRI. A contrast-free protocol provides accurate staging, potentially reducing side effects, time, and costs.

Area of Science:

  • Oncology
  • Radiology
  • Nuclear Medicine

Background:

  • Accurate staging of pediatric lymphoma is crucial for treatment planning.
  • 18F]FDG PET/MRI combines metabolic and anatomical imaging for comprehensive evaluation.
  • The role of MRI contrast agents in this combined imaging modality requires clarification.

Purpose of the Study:

  • To evaluate the impact of MRI contrast agent application on the accuracy of primary and follow-up staging in pediatric lymphoma patients.
  • To determine if a contrast-free [18F]FDG PET/MRI protocol is sufficient for staging.
  • To assess the potential for reducing adverse effects, time, and costs associated with contrast agents.

Main Methods:

  • A retrospective analysis of 105 [18F]FDG PET/MRI datasets from pediatric lymphoma patients.
  • Comparison of two reading protocols: one unenhanced (PET/MRI-1) and one with contrast enhancement (PET/MRI-2).
  • Staging was performed according to the International Pediatric Non-Hodgkin's Lymphoma Staging System (IPNHLSS), with validation against histopathology and follow-up imaging.

Main Results:

  • Both PET/MRI-1 and PET/MRI-2 achieved correct staging in 86% of patient-based analyses (90/105).
  • Region-based analysis demonstrated high accuracy for both protocols (94%).
  • No significant differences in sensitivity, specificity, or diagnostic accuracy were observed between the contrast-enhanced and unenhanced protocols.

Conclusions:

  • MRI contrast agents do not provide additional diagnostic benefit for primary or follow-up staging of pediatric lymphoma patients using [18F]FDG PET/MRI.
  • A contrast-free [18F]FDG PET/MRI protocol is highly accurate for staging pediatric lymphoma.
  • Consideration of a contrast-free protocol can improve patient safety and streamline the examination process.
Keywords:
Contrast mediaLymphomaMagnetic resonance imagingNeoplasm stagingPositron-emission tomography

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