TY - JOUR
T1 - Ionising radiation-free whole-body MRI versus 18F-fluorodeoxyglucose PET/CT scans for children and young adults with cancer
T2 - A prospective, non-randomised, single-centre study
AU - Klenk, Christopher
AU - Gawande, Rakhee
AU - Uslu, Lebriz
AU - Khurana, Aman
AU - Qiu, Deqiang
AU - Quon, Andrew
AU - Donig, Jessica
AU - Rosenberg, Jarrett
AU - Luna-Fineman, Sandra
AU - Moseley, Michael
AU - Daldrup-Link, Heike E.
N1 - Funding Information:
We thank Sandy Napel and Daniel Owen for their valuable input and help with magnetic resonance image data fusion. We thank Karla and Kevin Epperson and Anne Saywer at the Richard M Lucas Center for their expert help with the whole-body MRI scans. We thank Jia Wang for his assistance regarding radiation dose calculations. LU was supported as a visiting scholar by the Scientific and Technological Research Council of Turkey (TÜBİTAK).
PY - 2014/3
Y1 - 2014/3
N2 - Background: Imaging tests are essential for staging of children with cancer. However, CT and radiotracer-based imaging procedures are associated with substantial exposure to ionising radiation and risk of secondary cancer development later in life. Our aim was to create a highly effective, clinically feasible, ionising radiation-free staging method based on whole-body diffusion-weighted MRI and the iron supplement ferumoxytol, used off-label as a contrast agent. Methods: We compared whole-body diffusion-weighted MRI with standard clinical 18F-fluorodeoxyglucose (18F-FDG) PET/CT scans in children and young adults with malignant lymphomas and sarcomas. Whole-body diffusion-weighted magnetic resonance images were generated by coregistration of colour-encoded ferumoxytol-enhanced whole-body diffusion-weighted MRI scans for tumour detection with ferumoxytol-enhanced T1-weighted MRI scans for anatomical orientation, similar to the concept of integrated 18F-FDG PET/CT scans. Tumour staging results were compared using Cohen's κ statistics. Histopathology and follow-up imaging served as the standard of reference. Data was assessed in the per-protocol population. This study is registered with ClinicalTrials.gov, number NCT01542879. Findings: 22 of 23 recruited patients were analysed because one patient discontinued before completion of the whole-body scan. Mean exposure to ionising radiation was 12·5 mSv (SD 4·1) for 18F-FDG PET/CT compared with zero for whole-body diffusion-weighted MRI. 18F-FDG PET/CT detected 163 of 174 malignant lesions at 1325 anatomical regions and whole-body diffusion-weighted MRI detected 158. Comparing 18F-FDG PET/CT to whole-body diffusion-weighted MRI, sensitivities were 93·7% (95% CI 89·0-96·8) versus 90·8% (85·5-94·7); specificities 97·7% (95% CI 96·7-98·5) versus 99·5% (98·9-99·8); and diagnostic accuracies 97·2% (93·6-99·4) versus 98·3% (97·4-99·2). Tumour staging results showed very good agreement between both imaging modalities with a κ of 0·93 (0·81-1·00). No adverse events after administration of ferumoxytol were recorded. Interpretation: Ferumoxytol-enhanced whole-body diffusion-weighted MRI could be an alternative to 18F-FDG PET/CT for staging of children and young adults with cancer that is free of ionising radiation. This new imaging test might help to prevent long-term side-effects from radiographic staging procedures. Funding: Thrasher Research Fund and Clinical Health Research Institute at Stanford University.
AB - Background: Imaging tests are essential for staging of children with cancer. However, CT and radiotracer-based imaging procedures are associated with substantial exposure to ionising radiation and risk of secondary cancer development later in life. Our aim was to create a highly effective, clinically feasible, ionising radiation-free staging method based on whole-body diffusion-weighted MRI and the iron supplement ferumoxytol, used off-label as a contrast agent. Methods: We compared whole-body diffusion-weighted MRI with standard clinical 18F-fluorodeoxyglucose (18F-FDG) PET/CT scans in children and young adults with malignant lymphomas and sarcomas. Whole-body diffusion-weighted magnetic resonance images were generated by coregistration of colour-encoded ferumoxytol-enhanced whole-body diffusion-weighted MRI scans for tumour detection with ferumoxytol-enhanced T1-weighted MRI scans for anatomical orientation, similar to the concept of integrated 18F-FDG PET/CT scans. Tumour staging results were compared using Cohen's κ statistics. Histopathology and follow-up imaging served as the standard of reference. Data was assessed in the per-protocol population. This study is registered with ClinicalTrials.gov, number NCT01542879. Findings: 22 of 23 recruited patients were analysed because one patient discontinued before completion of the whole-body scan. Mean exposure to ionising radiation was 12·5 mSv (SD 4·1) for 18F-FDG PET/CT compared with zero for whole-body diffusion-weighted MRI. 18F-FDG PET/CT detected 163 of 174 malignant lesions at 1325 anatomical regions and whole-body diffusion-weighted MRI detected 158. Comparing 18F-FDG PET/CT to whole-body diffusion-weighted MRI, sensitivities were 93·7% (95% CI 89·0-96·8) versus 90·8% (85·5-94·7); specificities 97·7% (95% CI 96·7-98·5) versus 99·5% (98·9-99·8); and diagnostic accuracies 97·2% (93·6-99·4) versus 98·3% (97·4-99·2). Tumour staging results showed very good agreement between both imaging modalities with a κ of 0·93 (0·81-1·00). No adverse events after administration of ferumoxytol were recorded. Interpretation: Ferumoxytol-enhanced whole-body diffusion-weighted MRI could be an alternative to 18F-FDG PET/CT for staging of children and young adults with cancer that is free of ionising radiation. This new imaging test might help to prevent long-term side-effects from radiographic staging procedures. Funding: Thrasher Research Fund and Clinical Health Research Institute at Stanford University.
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U2 - 10.1016/S1470-2045(14)70021-X
DO - 10.1016/S1470-2045(14)70021-X
M3 - Article
C2 - 24559803
AN - SCOPUS:84896733367
SN - 1470-2045
VL - 15
SP - 275
EP - 285
JO - The Lancet Oncology
JF - The Lancet Oncology
IS - 3
ER -