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

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• 作者：Christopher Klenk ; MD^a ; Rakhee Gawande ; MD^a ; Lebriz Uslu ; MD^a ; Aman Khurana ; MD^a ; Deqiang Qiu ; PhD^a ; Andrew Quon ; MD^a ; Jessica Donig ; BA^a ; Jarrett Rosenberg ; PhD^a ; Sandra Luna-Fineman ; MD^b ; Prof Michael Moseley ; PhD^a ; Dr Heike E Daldrup-Link ; MD^a ; ^{heiked@stanford.edu" class="auth_mail}
• 刊名：Lancet Oncology
• 出版年：March, 2014
• 年：2014
• 卷：15
• 期：3
• 页码：275-285
• 全文大小：4109 K

文摘

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Summary

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 ¹⁸F-fluorodeoxyglucose (¹⁸F-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 ¹⁸F-FDG PET/CT scans. Tumour staging results were compared using Cohen's 魏 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 , number .

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路5 mSv (SD 4路1) for ¹⁸F-FDG PET/CT compared with zero for whole-body diffusion-weighted MRI. ¹⁸F-FDG PET/CT detected 163 of 174 malignant lesions at 1325 anatomical regions and whole-body diffusion-weighted MRI detected 158. Comparing ¹⁸F-FDG PET/CT to whole-body diffusion-weighted MRI, sensitivities were 93路7% (95% CI 89路0-96路8) versus 90路8% (85路5-94路7); specificities 97路7% (95% CI 96路7-98路5) versus 99路5% (98路9-99路8); and diagnostic accuracies 97路2% (93路6-99路4) versus 98路3% (97路4-99路2). Tumour staging results showed very good agreement between both imaging modalities with a 魏 of 0路93 (0路81-1路00). No adverse events after administration of ferumoxytol were recorded.

Interpretation

Ferumoxytol-enhanced whole-body diffusion-weighted MRI could be an alternative to ¹⁸F-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.