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

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Abstract

Purpose

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.

Procedure

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.

Results

[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).

Conclusion

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

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Acknowledgments

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

Funding

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

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Authors and Affiliations

  1. The Department of Radiology and Molecular Imaging Program at Stanford (MIPS), Stanford University School of Medicine, 725 Welch Rd, Rm 1665, Stanford, CA, 94305-5654, USA

    Arian Pourmehdi Lahiji, Tatianie Jackson, Hossein Nejadnik, Daniel Rubin & Heike Daldrup-Link

  2. Department of Radiology, Boston University Medical Center, Boston, MA, USA

    Tatianie Jackson

  3. Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA

    Rie von Eyben

  4. Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA

    Daniel Rubin

  5. Department of Pediatrics, Division of Hematology/Oncology, Stanford University School of Medicine, Stanford, CA, USA

    Sheri L. Spunt & Heike Daldrup-Link

  6. Department of Nuclear Medicine, Stanford University School of Medicine, Stanford, CA, USA

    Andrew Quon

Authors
  1. Arian Pourmehdi Lahiji
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  2. Tatianie Jackson
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  6. Sheri L. Spunt
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  7. Andrew Quon
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Correspondence to Heike Daldrup-Link.

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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.”

Additional information

Arian Pourmehdi Lahiji and Tatianie Jackson are both co-first authors

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Pourmehdi Lahiji, A., Jackson, T., Nejadnik, H. et al. Association of Tumor [18F]FDG Activity and Diffusion Restriction with Clinical Outcomes of Rhabdomyosarcomas. Mol Imaging Biol 21, 591–598 (2019). https://doi.org/10.1007/s11307-018-1272-1

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  • DOI: https://doi.org/10.1007/s11307-018-1272-1

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