Ionising radiation-free whole-body MRI versus (18)F-fluorodeoxyglucose PET/CT scans for children and young adults with cancer: a prospective, non-randomised, single-centre study

Christopher Klenk; Rakhee Gawande; Lebriz Uslu; Aman Khurana; Deqiang Qiu; Andrew Quon; Jessica Donig; Jarrett Rosenberg; Sandra Luna-Fineman; Michael Moseley; Heike E Daldrup-Link

doi:10.1016/S1470-2045(14)70021-X

Ionising radiation-free whole-body MRI versus (18)F-fluorodeoxyglucose PET/CT scans for children and young adults with cancer: a prospective, non-randomised, single-centre study

Lancet Oncol. 2014 Mar;15(3):275-85. doi: 10.1016/S1470-2045(14)70021-X. Epub 2014 Feb 19.

Affiliations

¹ Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, CA, USA.
² Pediatric Hematology/Oncology, Stanford University, Stanford, CA, USA.
³ Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, CA, USA. Electronic address: heiked@stanford.edu.

PMID: 24559803
DOI: 10.1016/S1470-2045(14)70021-X

Abstract

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 (18)F-fluorodeoxyglucose ((18)F-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 (18)F-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 (18)F-FDG PET/CT compared with zero for whole-body diffusion-weighted MRI. (18)F-FDG PET/CT detected 163 of 174 malignant lesions at 1325 anatomical regions and whole-body diffusion-weighted MRI detected 158. Comparing (18)F-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 (18)F-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.

Publication types

Comparative Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Child
Diffusion Magnetic Resonance Imaging / methods*
Fluorodeoxyglucose F18*
Humans
Multimodal Imaging
Neoplasms / diagnosis*
Positron-Emission Tomography / methods*
Prospective Studies
Radiopharmaceuticals*
Tomography, X-Ray Computed / methods*
Whole Body Imaging / methods*
Young Adult

Substances

Radiopharmaceuticals
Fluorodeoxyglucose F18

Associated data

ClinicalTrials.gov/NCT01542879