Pediatric Oncology

  • M. Eiber
  • L. Merlini
  • O. Ratib
  • K. Scheidhauer
  • M. Souvatzoglou
  • C. Tabouret-Viaud
  • T. Zand


In pediatric oncology 18F-FDG PET-CT imaging is used mainly for staging and restaging of lymphoma and bone tumors. In this special patient collective minimizing the radiation dose is one of the major goals. With the introduction of PET-MR, the CT exposure component previously produced in PET-CT studies potentially can be eliminated [1]. Preliminary reports state that compared to PET-CT the radiation exposure from a single hybrid imaging PET-MR-scan is reduced by around 80 %, to only one effective dose of 4.6 mSv) [2, 3]. In addition, especially in bone tumors (e.g. Ewing-sarcoma, multifocal osteosarcoma) patient require both whole-body MR and 18F-FDG PET and, therefore, the combination of both examinations in one single ­session has also substantial logistical advantages (e.g. only one anesthesia). Furthermore, compared to PET-CT this technique also enables whole-body diffusion-weighted imaging (DWI) providing additional information about cellularity and nuclear/cytoplasmic ratio of tumors. Recent studies in pediatric patients with lymphoma demonstrated high sensitivity for the detection of lesions and allows quantitative assessment of diffusion that may aid in the evaluation of malignant lymphomas [4]. For soft-tissue and bone tumors the advantage of PET-MR compared to PET-CT also lies in its high soft-tissue contrast [5]. 18F-FDG PET-CT does not provide exact information as MRI for T-staging in sarcomas, however it can give additional prognostic information [6, 7]. e.g. in one study assessing therapy response in pediatric osteosarcomas 18F-FDG PET could discriminate responders from nonresponders [8]. In regards of the advantages of both modalities integrated PET/MRI can replace PET-CT for these indications with a focus of the 18F-FDG PET component for prognostic questions and assessment of N-stage and M-stage and the MR-examination on local staging.


Ewing Sarcoma Hodgkin Disease Additional Prognostic Information Mediastinal Lymph Node Station Multifocal Osteosarcoma 
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  1. 1.
    Pichler BJ, Kolb A, Nägele T, Schlemmer H-P (2010) PET/MRI: paving the way for the next generation of clinical multimodality imaging applications. J Nucl Med 51(3):333–336PubMedCrossRefGoogle Scholar
  2. 2.
    Hirsch FW, Sattler B, Sorge I, Kurch L, Viehweger A, Ritter L et al (2013) PET/MR in children. Initial clinical experience in paediatric oncology using an integrated PET/MR scanner. Pediatr Radiol (in press)Google Scholar
  3. 3.
    Chawla SC, Federman N, Zhang D, Nagata K, Nuthakki S, ­McNitt-Gray M et al (2010) Estimated cumulative radiation dose from PET/CT in children with malignancies: a 5-year ­retrospective review. Pediatr Radiol 40(5):681–686PubMedCrossRefGoogle Scholar
  4. 4.
    Kwee TC, Takahara T, Vermoolen MA, Bierings MB, Mali WP, Nievelstein RAJ (2010) Whole-body diffusion-weighted imaging for staging malignant lymphoma in children. Pediatr Radiol 40(10):1592–1602; quiz 1720–1721PubMedCrossRefGoogle Scholar
  5. 5.
    Sinha S, Peach AHS (2010) Diagnosis and management of soft ­tissue sarcoma. BMJ 341(1):c7170–c7170PubMedCrossRefGoogle Scholar
  6. 6.
    Tateishi U, Hosono A, Makimoto A, Nakamoto Y, Kaneta T, Fukuda H et al (2009) Comparative study of FDG PET/CT and ­conventional imaging in the staging of rhabdomyosarcoma. Ann Nucl Med 23(2):155–161PubMedCrossRefGoogle Scholar
  7. 7.
    Baum SH, Frühwald M, Rahbar K, Wessling J, Schober O, Weckesser M (2011) Contribution of PET/CT to prediction of ­outcome in children and young adults with rhabdomyosarcoma. J Nucl Med 52(10):1535–1540PubMedCrossRefGoogle Scholar
  8. 8.
    Denecke T, Hundsdörfer P, Misch D, Steffen IG, Schönberger S, Furth C et al (2010) Assessment of histological response of ­paediatric bone sarcomas using FDG PET in comparison to ­morphological volume measurement and standardized MRI ­parameters. Eur J Nucl Med Mol Imaging 37(10):1842–1853PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • M. Eiber
    • 1
  • L. Merlini
    • 2
  • O. Ratib
    • 3
  • K. Scheidhauer
    • 4
  • M. Souvatzoglou
    • 4
  • C. Tabouret-Viaud
    • 5
  • T. Zand
    • 6
  1. 1.Department of Radiology, Klinikum Rechts der IsarTechnische Universität MünchenMunichGermany
  2. 2.Division of Pediatric Radiology, Department of Medical ImagingGeneva University HospitalsGenevaSwitzerland
  3. 3.Division of Nuclear Medicine and Molecular Imaging, Department of Medical ImagingGeneva University HospitalsGenevaSwitzerland
  4. 4.Department of Nuclear MedicineTechnische Universität MünchenMunichGermany
  5. 5.Division of Nuclear Medicine and Molecular Imaging, Department of Medical ImagingGeneva University and Geneva University HospitalsGenevaSwitzerland
  6. 6.Division of Pediatric Radiology, Department of Medical ImagingGeneva University and Geneva University HospitalsGenevaSwitzerland

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