How to Provide Gadolinium-Free PET/MR Cancer Staging of Children and Young Adults in Less than 1 h: the Stanford Approach

Anne M Muehe; Ashok J Theruvath; Lillian Lai; Maryam Aghighi; Andrew Quon; Samantha J Holdsworth; Jia Wang; Sandra Luna-Fineman; Neyssa Marina; Ranjana Advani; Jarrett Rosenberg; Heike E Daldrup-Link

doi:10.1007/s11307-017-1105-7

How to Provide Gadolinium-Free PET/MR Cancer Staging of Children and Young Adults in Less than 1 h: the Stanford Approach

Mol Imaging Biol. 2018 Apr;20(2):324-335. doi: 10.1007/s11307-017-1105-7.

Authors

Affiliations

¹ Department of Radiology, Pediatric Radiology, Lucile Packard Children's Hospital, Stanford University, 725 Welch Rd, Stanford, CA, 94305-5654, USA.
² Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany.
³ Environmental Health and Safety, Stanford University, Stanford, CA, USA.
⁴ Department of Pediatrics, Pediatric Hematology/Oncology, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA.
⁵ Department of Medicine, Hematology/Oncology, Stanford Hospital, Stanford University, Stanford, CA, USA.
⁶ Department of Radiology, Pediatric Radiology, Lucile Packard Children's Hospital, Stanford University, 725 Welch Rd, Stanford, CA, 94305-5654, USA. H.E.Daldrup-Link@stanford.edu.
⁷ Department of Pediatrics, Pediatric Hematology/Oncology, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA. H.E.Daldrup-Link@stanford.edu.

Abstract

Purpose: To provide clinically useful gadolinium-free whole-body cancer staging of children and young adults with integrated positron emission tomography/magnetic resonance (PET/MR) imaging in less than 1 h.

Procedures: In this prospective clinical trial, 20 children and young adults (11-30 years old, 6 male, 14 female) with solid tumors underwent 2-deoxy-2-[¹⁸F]fluoro-D-glucose ([¹⁸F]FDG) PET/MR on a 3T PET/MR scanner after intravenous injection of ferumoxytol (5 mg Fe/kg) and [¹⁸F]FDG (2-3 MBq/kg). Time needed for patient preparation, PET/MR image acquisition, and data processing was compared before (n = 5) and after (n = 15) time-saving interventions, using a Wilcoxon test. The ferumoxytol-enhanced PET/MR images were compared with clinical standard staging tests regarding radiation exposure and tumor staging results, using Fisher's exact tests.

Results: Tailored workflows significantly reduced scan times from 36 to 24 min for head to mid thigh scans (p < 0.001). These streamlined PET/MR scans were obtained with significantly reduced radiation exposure (mean 3.4 mSv) compared to PET/CT with diagnostic CT (mean 13.1 mSv; p = 0.003). Using the iron supplement ferumoxytol "off label" as an MR contrast agent avoided gadolinium chelate administration. The ferumoxytol-enhanced PET/MR scans provided equal or superior tumor staging results compared to clinical standard tests in 17 out of 20 patients. Compared to PET/CT, PET/MR had comparable detection rates for pulmonary nodules with diameters of equal or greater than 5 mm (94 vs. 100 %), yet detected significantly fewer nodules with diameters of less than 5 mm (20 vs 100 %) (p = 0.03). [¹⁸F]FDG-avid nodules were detected with slightly higher sensitivity on the PET of the PET/MR compared to the PET of the PET/CT (59 vs 49 %).

Conclusion: Our streamlined ferumoxytol-enhanced PET/MR protocol provided cancer staging of children and young adults in less than 1 h with equivalent or superior clinical information compared to clinical standard staging tests. The detection of small pulmonary nodules with PET/MR needs to be improved.

Keywords: Cancer; Magnetic resonance imaging; Nanoparticles; Pediatrics; Positron-emission tomography.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Adolescent
Adult
Child
Gadolinium / chemistry*
Humans
Lung Neoplasms / diagnostic imaging
Lung Neoplasms / pathology
Magnetic Resonance Imaging*
Multimodal Imaging
Neoplasm Staging
Neoplasms / diagnostic imaging*
Neoplasms / pathology*
Positron Emission Tomography Computed Tomography*
Tomography, X-Ray Computed
Young Adult

Substances

Gadolinium

Abstract

Publication types

MeSH terms

Substances

Grants and funding