Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Lucile Packard Children's Hospital, Stanford University, 725 Welch Road, Room 1665, Stanford, CA, 94305-5614, USA.
Department of Pediatrics, Stanford University, Stanford, CA, USA.
Pediatr Radiol. 2022 Feb;52(2):391-400. doi: 10.1007/s00247-021-05076-x. Epub 2021 Apr 30.
Accurate staging and re-staging of cancer in children is crucial for patient management. Currently, children with a newly diagnosed cancer must undergo a series of imaging tests, which are stressful, time-consuming, partially redundant, expensive, and can require repetitive anesthesia. New approaches for pediatric cancer staging can evaluate the primary tumor and metastases in a single session. However, traditional one-stop imaging tests, such as CT and positron emission tomography (PET)/CT, are associated with considerable radiation exposure. This is particularly concerning for children because they are more sensitive to ionizing radiation than adults and they live long enough to experience secondary cancers later in life. In this review article we discuss child-tailored imaging tests for tumor detection and therapy response assessment - tests that can be obtained with substantially reduced radiation exposure compared to traditional CT and PET/CT scans. This includes diffusion-weighted imaging (DWI)/MRI and integrated [F-18]2-fluoro-2-deoxyglucose (F-FDG) PET/MRI scans. While several investigators have compared the value of DWI/MRI and F-FDG PET/MRI for staging pediatric cancer, the value of these novel imaging technologies for cancer therapy monitoring has received surprisingly little attention. In this article, we share our experiences and review existing literature on this subject.
准确分期和重新分期儿童癌症对于患者管理至关重要。目前，新诊断出癌症的儿童必须接受一系列影像学检查，这些检查既紧张又耗时，部分检查内容重复，费用昂贵，而且可能需要重复麻醉。新的儿科癌症分期方法可以在一次检查中评估原发性肿瘤和转移灶。然而，传统的一站式影像学检查，如 CT 和正电子发射断层扫描（PET）/CT，会导致相当大的辐射暴露。这对儿童来说尤其令人担忧，因为他们比成年人对电离辐射更敏感，而且他们的寿命足够长，以至于在以后的生活中可能会患上继发性癌症。在这篇综述文章中，我们讨论了针对儿童的肿瘤检测和治疗反应评估的影像学检查——与传统 CT 和 PET/CT 扫描相比，这些检查可以显著降低辐射暴露。这包括扩散加权成像（DWI）/MRI 和整合[F-18]2-氟-2-脱氧葡萄糖（F-FDG）PET/MRI 扫描。虽然有几位研究人员比较了 DWI/MRI 和 F-FDG PET/MRI 对儿童癌症分期的价值，但这些新型影像学技术在癌症治疗监测中的价值却很少受到关注。在本文中，我们分享了我们的经验并回顾了这一主题的现有文献。
