PMCC PMCC

Search tips
Search criteria

Advanced
Results 1-8 (8)
 

Clipboard (0)
None

Select a Filter Below

Journals
Year of Publication
Document Types
author:("sulkin, Barry")
1.  Evaluation of children with craniopharyngioma using carbon-11 methionine PET prior to proton therapy 
Neuro-Oncology  2013;15(4):506-510.
Background
Fluorine-18 (18F) fluorodeoxyglucose (FDG) positron emission tomography (PET) is limited in its evaluation of brain tumors due to the high basal activity of the cerebral cortex and white matter. Carbon-11 methionine (11C MET) has little uptake under normal conditions. We prospectively investigated the uptake of 18F FDG and 11C MET PET in patients with craniopharyngioma prior to proton therapy.
Methods
Ten patients newly diagnosed with craniopharyngioma underwent PET imaging using 18F FDG and 11C MET. PET and MRI studies were registered to help identify tumor volume. Measurements of maximum standardized uptake value (SUVmax) were taken of the tumor and compared with noninvolved left frontal background white matter using a paired t-test. Uptake was graded using a 4-point scale.
Results
Median patient age was 9 years (range 5–19). Seven patients were diagnosed by pathology, 1 by cyst fluid aspiration, and 2 by neuroimaging. Median FDG SUVmax for tumor and background were 2.65 and 3.2, respectively. Median MET SUVmax for tumor and background were 2.2 and 1, respectively. There was a significant difference between MET tumor SUVmax and MET background SUVmax (P = .0001). The difference between FDG tumor SUVmax and FDG background SUVmax was not significant (P = .3672).
Conclusion
11C MET PET uptake is significantly greater within the tumor compared with noninvolved background white matter, making it more useful than FDG PET in identifying active tumor in patients with craniopharyngioma. Future work will focus on using 11C MET PET to discriminate between active and inactive tumor after irradiation.
doi:10.1093/neuonc/nos321
PMCID: PMC3607263  PMID: 23408862
craniopharyngioma; fluorodeoxyglucose; FDG; methionine; positron emission tomography; proton therapy
2.  Positron emission tomography-computed tomography for staging and follow-up of pediatric nasopharyngeal carcinoma 
Purpose
While evaluations of FDG PET-CT in adult patients with NPC have documented advantages and disadvantages of the technique compared with conventional imaging, to our knowledge, no such studies have been performed with pediatric patients. In this investigation, we studied the utility of FDG PET-CT in children with NPC.
Methods
Eighteen children with biopsy-proven NPC who underwent FDG PET-CT and MRI were studied (total 38 pairs of imagings). All baseline and follow-up FDG PET-CT and MRI studies were independently reviewed for restaging of disease.
Results
The concordance between FDG PET-CT and MRI in T, N, and overall staging was 29%, 64%, and 43%, respectively. Compared with MRI, FDG PET-CT yielded lower T and overall staging and showed less cervical and retropharyngeal lymphadenopathy. The concordance between follow-up FDG PET-CT and MRI was 79% overall and 100% 9 months after therapy. In patients who achieved complete remission, FDG PET-CT showed disease clearance 3-6 months earlier than MRI. There were no false positive or false negative FDG PET-CT scans during follow-up.
Conclusions
FDG PET-CT may underestimate tumor extent and regional lymphadenopathy compared with MRI at the time of diagnosis, but it helps to detect metastasis and clarify ambiguous findings. FDG PET-CT is sensitive and specific for follow-up and enables earlier determination of disease remission. FDG PET-CT is a valuable imaging modality for the evaluation of and monitoring NPC in pediatric patients.
doi:10.1007/s00259-012-2091-2
PMCID: PMC3531235  PMID: 22532252
positron emission tomography; magnetic resonance imaging; nasopharyngeal carcinoma; child
3.  PET-CT of the Normal Spinal Cord in Children 
Academic radiology  2009;16(7):881-885.
Rationale and Objectives
To assess the correlation between age and spinal cord metabolic activity in children using positron emission tomography-computed tomography.
Materials and Methods
The cohort included 128 children imaged from January 2003 through April 2007, excluding those with spinal disease. Using axial images we subjectively graded as minimal, moderate or intense, the fluorodeoxyglucose activity in the pons and three cervical, three thoracic, and two lumbar spinal cord levels. From regions of interest at each level, we determined the maximum standardized uptake value. Patients were grouped by age: Group 1, < 5 years; Group 2, ≥ 5 to < 10 years; Group 3, ≥10 to <15 years; and Group 4, ≥15 < 22 years. We compared subjective grade and standardized uptake values at each level and for each level between age groups. Alpha was set at 0.0046 based on the Bonferroni correction for multiple comparisons.
Results
There were 16 patients in Group 1, 19 in Group 2, 33 in Group 3, and 60 in Group 4. Subjective grade and standardized uptake values were higher in the pons, mid cervical and low thoracic areas than elsewhere in all age groups. Subjective grade significantly increased with age in the cervical and thoracic cord (P <0.0005). Standardized uptake values in the pons and all cord levels significantly increased with increasing age (P≤0.0008).
Conclusions
In children, metabolic activity of the spinal cord increases with age. On positron emission tomography, the cord can appear intensely avid in the mid cervical and low thoracic areas.
doi:10.1016/j.acra.2009.01.022
PMCID: PMC3680129  PMID: 19427802
positron emission tomography-computed tomography; spinal cord; children
4.  Role of lymphoscintigraphy and sentinel lymph node biopsy in the management of pediatric melanoma and sarcoma 
Pediatric surgery international  2012;28(6):571-578.
Purpose
The purpose of this study was to describe the use of lymphoscintigraphy and sentinel lymph node biopsy for the management of children with melanoma and sarcomas. We report the experience of two children’s hospitals that utilize this technique to identify sentinel lymph nodes for lymph node biopsy and dissection.
Methods
We identified 56 patients (median age 10.8 years) who underwent 58 lymphoscintigraphy procedures. There were 33 patients with melanoma and melanocytic lesions, and 23 with sarcomas.
Results
Of 58 lymphoscintigraphy procedures, sentinel lymph nodes were identified in 52 (90% success rate). Using the combination of intraoperative blue dye injection and lymphoscintigraphy, the success rate was 95% (55/58). Metastatic disease was found in 14 sentinel lymph nodes (13 patients with melanoma and melanocytic lesions, and 1 patient with rhabdomyosarcoma).
Conclusion
We have found that lymphoscintigraphy with sentinel lymph node biopsy is an effective method to identify patients who may benefit from more extensive lymph node dissection and to identify those patients who are unlikely to benefit from further lymph node exploration.
doi:10.1007/s00383-012-3066-x
PMCID: PMC3608674  PMID: 22526545
lymphoscintigraphy; sentinel node; melanoma; sarcoma; pediatric
5.  Evaluation of 18F-FDG PET and MRI Associations in Pediatric Diffuse Intrinsic Brain stem Glioma: A Report from the Pediatric Brain Tumor Consortium 
Rationale
To assess 18F-labeled 2-fluoro-2-deoxy-D-glucose (18F-FDG) uptake in children with a newly diagnosed diffuse intrinsic brainstem glioma (BSG) and to investigate associations with progression-free survival (PFS), overall survival (OS) and MRI indices.
Methods
Two Pediatric Brain Tumor Consortium (PBTC) therapeutic trials in children with newly diagnosed BSG were designed to test radiation therapy combined with molecularly targeted agents (PBTC-007: Phase I/II study of gefitinib; PBTC-014: Phase I/II study of tipifarnib). Baseline brain 18F-FDG PET scans were obtained in 40 children in these trials. Images were evaluated by consensus of two PET experts for intensity and uniformity of tracer uptake. Associations of 18F-FDG uptake intensity and uniformity with both PFS and OS were evaluated as well as associations with tumor MRI indices at baseline (tumor volume on FLAIR, baseline intratumoral enhancement, diffusion and perfusion values.
Results
In the majority of children, BSG 18F-FDG uptake was less than gray matter uptake. Survival was poor irrespective of intensity of 18F-FDG uptake, with no association between intensity of 18F-FDG uptake and PFS or OS. However, hyperintense 18F-FDG uptake in tumor compared to gray matter suggested poorer survival rates. Patients with 18F-FDG uptake in ≥ 50% of the tumor had shorter PFS and OS compared to patients with 18F-FDG uptake in < 50% of tumor. There was some evidence that tumors with higher 18F-FDG uptake were more likely to show enhancement; and when the diffusion ratio was lower the uniformity of 18F- FDG uptake appeared higher.
Conclusion
Children with BSG where 18F-FDG uptake involves at least half the tumor appear to have inferior survival compared to children with uptake in <50% of tumor. A larger independent study is needed to verify this hypothesis. Intense tracer uptake in the tumors compared to gray matter suggests decreased survival. Higher 18F-FDG uptake within the tumor was associated with enhancement on MRI. Increased tumor cellularity as reflected by restricted MR diffusion may be associated with increased 18F-FDG uniformity throughout the tumor.
doi:10.2967/jnumed.110.081463
PMCID: PMC3526809  PMID: 21233173
pediatric; brainstem glioma; 18F-FDG PET; MRI; diffusion; enhancement; perfusion; brain tumor
6.  Phase II study of oral capsular 4-hydroxyphenylretinamide (4-HPR/fenretinide) in pediatric patients with refractory or recurrent neuroblastoma: A report from the Children’s Oncology Group NSC #374551; IND# 40294 
Purpose
To determine the response rate to oral capsular fenretinide in children with recurrent or biopsy proven refractory high-risk neuroblastoma.
Experimental Design
Patients received 7 days of fenretinide: 2475 mg/m2/day divided TID (<18 years) or 1800 mg/m2/day divided BID (≥18 years) every 21 days for a maximum of 30 courses. Patients with stable or responding disease after course 30 could request additional compassionate courses. Best response by course 8 was evaluated in Stratum 1 (measurable disease on CT/MRI +/− bone marrow and/or MIBG avid sites) and Stratum 2 (bone marrow and/or MIBG avid sites only).
Results
Sixty-two eligible patients, median age 5 years (range 0.6–19.9), were treated in Stratum 1 (n=38) and Stratum 2 (n=24). One partial response (PR) was seen in Stratum 2 (n=24 evaluable). No responses were seen in Stratum 1 (n=35 evaluable). Prolonged stable disease (SD) was seen in 7 patients in Stratum 1 and 6 patients in Stratum 2 for 4–45+ (median 15) courses. Median time to progression was 40 days (range 17–506) for Stratum 1 and 48 days (range 17–892) for Stratum 2. Mean 4-HPR steady state trough plasma concentrations were 7.25 µM (coefficient of variation 40–56%) at day 7 course 1. Toxicities were mild and reversible.
Conclusions
Although neither stratum met protocol criteria for efficacy, 1 PR + 13 prolonged SD occurred in 14/59 (24%) of evaluable patients. Low bioavailability may have limited fenretinide activity. Novel fenretinide formulations with improved bioavailability are currently in pediatric Phase I studies.
doi:10.1158/1078-0432.CCR-11-0995
PMCID: PMC3207022  PMID: 21908574
fenretinide; neuroblastoma; Phase II; ANBL0321
7.  Retrospective Evaluation of PET-MRI Registration Algorithms 
Journal of Digital Imaging  2010;24(3):485-493.
The purpose of this study is to evaluate the accuracy of registration positron emission tomography (PET) head images to the MRI-based brain atlas. The [18F]fluoro-2-deoxyglucose PET images were normalized to the MRI-based brain atlas using nine registration algorithms including objective functions of ratio image uniformity (RIU), normalized mutual information (NMI), and normalized cross correlation (CC) and transformation models of rigid-body, linear, affine, and nonlinear transformations. The accuracy of normalization was evaluated by visual inspection and quantified by the gray matter (GM) concordance between normalized PET images and the brain atlas. The linear and affine registration based on the RIU provided the best GM concordance (average similarity index of 0.71 for both). We also observed that the GM concordances of linear and affine registration were higher than those of the rigid and nonlinear registration among the methods evaluated.
doi:10.1007/s10278-010-9300-y
PMCID: PMC3092046  PMID: 20437075
Normalization; PET; MR; brain; tissue concordance
8.  FDG PET Imaging of Childhood Sarcomas 
Pediatric blood & cancer  2010;54(2):222-227.
Background
Positron-emission tomography (PET) imaging using [18F]fluorodeoxyglucose (FDG) is useful for detection, staging, and monitoring a variety of malignancies, including lymphoma, in adults, but its utility in sarcomas, especially soft tissue sarcomas (STS), in children and young adults is not clear.
Procedure
To evaluate the potential utility of FDG PET in the care of STS in children and young adults, we analyzed 46 PET scans in 25 patients acquired over 12 years. Scans were interpreted by two imaging physicians blinded to findings from other imaging studies and clinical information. Results were compared with computed tomography and magnetic resonance imaging, biopsy results, where available, and clinical follow-up of at least 12 months.
Results
For a total of 46 scans in 25 patients, there were 25 true positive scans, 3 false positive scans, 12 true negative scans, and 6 false negative scans. The sensitivity of the PET scan was 86%, specificity was 80%, positive predictive value was 89%, and negative predictive value was 67%.
Conclusion
FDG PET may be a useful imaging modality in the management of children and young adults with STS, although prospective studies are needed to establish its true utility.
doi:10.1002/pbc.22307
PMCID: PMC2794959  PMID: 19890901
fluorodeoxyglucose; FDG; PET; Ewing; rhabdomyosarcoma; pediatric

Results 1-8 (8)