Molecular Imaging and Biology

, Volume 21, Issue 3, pp 591–598 | Cite as

Association of Tumor [18F]FDG Activity and Diffusion Restriction with Clinical Outcomes of Rhabdomyosarcomas

  • Arian Pourmehdi Lahiji
  • Tatianie Jackson
  • Hossein Nejadnik
  • Rie von Eyben
  • Daniel Rubin
  • Sheri L. Spunt
  • Andrew Quon
  • Heike Daldrup-LinkEmail author
Research Article



To evaluate whether the extent of restricted diffusion and 2-deoxy-2-[18F] fluoro-d-glucose ([18F]FDG) uptake of pediatric rhabdomyosarcomas (RMS) on positron emission tomography (PET)/magnetic resonance (MR) images provides prognostic information.


In a retrospective, IRB-approved study, we evaluated [18F]FDG PET/CT and diffusion-weighted (DW) MR imaging studies of 21 children and adolescents (age 1–20 years) with RMS of the head and neck. [18F]FDG PET and DW MR scans at the time of the initial tumor diagnosis were fused using MIM software. Quantitative measures of the tumor mass with restricted diffusion, [18F]FDG hypermetabolism, or both were dichotomized at the median and tested for significance using Gray’s test. Data were analyzed using a survival analysis and competing risk model with death as the competing risk.


[18F]FDG PET/MR images demonstrated a mismatch between tumor areas with increased [18F]FDG uptake and restricted diffusion. The DWI, PET, and DWI + PET tumor volumes were dichotomized at their median values, 23.7, 16.4, and 9.5 cm3, respectively, and were used to estimate survival. DWI, PET, and DWI + PET overlap tumor volumes above the cutoff values were associated with tumor recurrence, regardless of post therapy COG stage (p = 0.007, p = 0.04, and p = 0.07, respectively).


The extent of restricted diffusion within RMS and overlap of hypermetabolism plus restricted diffusion predict unfavorable clinical outcomes.

Key words

Rhabdomyosarcoma [18F]FDG Diffusion-weighted MR PET/MR 



We thank the members of Daldrup-Link lab for the valuable input and discussions regarding this project.

Funding information

This work was supported by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, grant number R01 HD081123.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the Institutional Review Board at our institution and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.”


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Copyright information

© World Molecular Imaging Society 2018

Authors and Affiliations

  • Arian Pourmehdi Lahiji
    • 1
  • Tatianie Jackson
    • 1
    • 2
  • Hossein Nejadnik
    • 1
  • Rie von Eyben
    • 3
  • Daniel Rubin
    • 1
    • 4
  • Sheri L. Spunt
    • 5
  • Andrew Quon
    • 6
  • Heike Daldrup-Link
    • 1
    • 5
    Email author
  1. 1.The Department of Radiology and Molecular Imaging Program at Stanford (MIPS)Stanford University School of MedicineStanfordUSA
  2. 2.Department of RadiologyBoston University Medical CenterBostonUSA
  3. 3.Department of Radiation OncologyStanford University School of MedicineStanfordUSA
  4. 4.Department of Biomedical Data ScienceStanford University School of MedicineStanfordUSA
  5. 5.Department of Pediatrics, Division of Hematology/OncologyStanford University School of MedicineStanfordUSA
  6. 6.Department of Nuclear MedicineStanford University School of MedicineStanfordUSA

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