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Mol Imaging Biol. 2019 Jun;21(3):591-598. doi: 10.1007/s11307-018-1272-1.

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

Author information

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.
2
Department of Radiology, Boston University Medical Center, Boston, MA, USA.
3
Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA.
4
Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA.
5
Department of Pediatrics, Division of Hematology/Oncology, Stanford University School of Medicine, Stanford, CA, USA.
6
Department of Nuclear Medicine, Stanford University School of Medicine, Stanford, CA, USA.
7
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. H.E.Daldrup-Link@stanford.edu.
8
Department of Pediatrics, Division of Hematology/Oncology, Stanford University School of Medicine, Stanford, CA, USA. H.E.Daldrup-Link@stanford.edu.

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.

KEYWORDS:

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

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