A PET/MR Imaging Approach for the Integrated Assessment of Chemotherapy-induced Brain, Heart, and Bone Injuries in Pediatric Cancer Survivors: A Pilot Study

Purpose To develop a positron emission tomography (PET)/magnetic resonance (MR) imaging protocol for evaluation of the brain, heart, and joints of pediatric cancer survivors for chemotherapy-induced injuries in one session. Materials and Methods Three teams of experts in neuroimaging, cardiac imagin...

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Published inRadiology Vol. 285; no. 3; pp. 971 - 979
Main Authors Theruvath, Ashok J., Ilivitzki, Anat, Muehe, Anne, Theruvath, Johanna, Gulaka, Praveen, Kim, Christine, Luna-Fineman, Sandra, Sakamoto, Kathleen M., Yeom, Kristen W., Yang, Phillip, Moseley, Michael, Chan, Frandics, Daldrup-Link, Heike E.
Format Journal Article
LanguageEnglish
Published United States Radiological Society of North America 01.12.2017
Subjects
Adolescent
Antineoplastic Agents - adverse effects
Bone Diseases - chemically induced
Bone Diseases - diagnostic imaging
Brain Diseases - chemically induced
Brain Diseases - diagnostic imaging
Cancer Survivors
Female
Heart Diseases - chemically induced
Heart Diseases - diagnostic imaging
Humans
Magnetic Resonance Imaging - methods
Magnetic Resonance Imaging - statistics & numerical data
Male
Multimodal Imaging
Neoplasms - diagnostic imaging
Neoplasms - drug therapy
Observer Variation
Original Research
Positron-Emission Tomography - methods
Reproducibility of Results
Risk Factors
Sensitivity and Specificity
Systems Integration
Treatment Outcome
Young Adult
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Abstract Purpose To develop a positron emission tomography (PET)/magnetic resonance (MR) imaging protocol for evaluation of the brain, heart, and joints of pediatric cancer survivors for chemotherapy-induced injuries in one session. Materials and Methods Three teams of experts in neuroimaging, cardiac imaging, and bone imaging were tasked to develop a 20-30-minute PET/MR imaging protocol for detection of chemotherapy-induced tissue injuries of the brain, heart, and bone. In an institutional review board-approved, HIPAA-compliant, prospective study from April to July 2016, 10 pediatric cancer survivors who completed chemotherapy underwent imaging of the brain, heart, and bone with a 3-T PET/MR imager. Cumulative chemotherapy doses and clinical symptoms were correlated with the severity of MR imaging abnormalities by using linear regression analyses. MR imaging measures of brain perfusion and metabolism were compared among eight patients who were treated with methotrexate and eight untreated age-matched control subjects by using Wilcoxon rank-sum tests. Results Combined brain, heart, and bone examinations were completed within 90 minutes. Eight of 10 cancer survivors had abnormal findings on brain, heart, and bone images, including six patients with and two patients without clinical symptoms. Cumulative chemotherapy doses correlated significantly with MR imaging measures of left ventricular ejection fraction and end-systolic volume, but not with the severity of brain or bone abnormalities. Methotrexate-treated cancer survivors had significantly lower cerebral blood flow and metabolic activity in key brain areas compared with control subjects. Conclusion The feasibility of a single examination for assessment of chemotherapy-induced injuries of the brain, heart, and joints was shown. Earlier detection of tissue injuries may enable initiation of timely interventions and help to preserve long-term health of pediatric cancer survivors. RSNA, 2017 Online supplemental material is available for this article.
AbstractList The authors of this study present a PET/MR imaging protocol for pediatric cancer survivors that allows assessment of the brain, heart, and bone for chemotherapy-induced tissue injuries in one session.
Purpose To develop a positron emission tomography (PET)/magnetic resonance (MR) imaging protocol for evaluation of the brain, heart, and joints of pediatric cancer survivors for chemotherapy-induced injuries in one session. Materials and Methods Three teams of experts in neuroimaging, cardiac imaging, and bone imaging were tasked to develop a 20-30-minute PET/MR imaging protocol for detection of chemotherapy-induced tissue injuries of the brain, heart, and bone. In an institutional review board-approved, HIPAA-compliant, prospective study from April to July 2016, 10 pediatric cancer survivors who completed chemotherapy underwent imaging of the brain, heart, and bone with a 3-T PET/MR imager. Cumulative chemotherapy doses and clinical symptoms were correlated with the severity of MR imaging abnormalities by using linear regression analyses. MR imaging measures of brain perfusion and metabolism were compared among eight patients who were treated with methotrexate and eight untreated age-matched control subjects by using Wilcoxon rank-sum tests. Results Combined brain, heart, and bone examinations were completed within 90 minutes. Eight of 10 cancer survivors had abnormal findings on brain, heart, and bone images, including six patients with and two patients without clinical symptoms. Cumulative chemotherapy doses correlated significantly with MR imaging measures of left ventricular ejection fraction and end-systolic volume, but not with the severity of brain or bone abnormalities. Methotrexate-treated cancer survivors had significantly lower cerebral blood flow and metabolic activity in key brain areas compared with control subjects. Conclusion The feasibility of a single examination for assessment of chemotherapy-induced injuries of the brain, heart, and joints was shown. Earlier detection of tissue injuries may enable initiation of timely interventions and help to preserve long-term health of pediatric cancer survivors. RSNA, 2017 Online supplemental material is available for this article.
Purpose To develop a positron emission tomography (PET)/magnetic resonance (MR) imaging protocol for evaluation of the brain, heart, and joints of pediatric cancer survivors for chemotherapy-induced injuries in one session. Materials and Methods Three teams of experts in neuroimaging, cardiac imaging, and bone imaging were tasked to develop a 20-30-minute PET/MR imaging protocol for detection of chemotherapy-induced tissue injuries of the brain, heart, and bone. In an institutional review board-approved, HIPAA-compliant, prospective study from April to July 2016, 10 pediatric cancer survivors who completed chemotherapy underwent imaging of the brain, heart, and bone with a 3-T PET/MR imager. Cumulative chemotherapy doses and clinical symptoms were correlated with the severity of MR imaging abnormalities by using linear regression analyses. MR imaging measures of brain perfusion and metabolism were compared among eight patients who were treated with methotrexate and eight untreated age-matched control subjects by using Wilcoxon rank-sum tests. Results Combined brain, heart, and bone examinations were completed within 90 minutes. Eight of 10 cancer survivors had abnormal findings on brain, heart, and bone images, including six patients with and two patients without clinical symptoms. Cumulative chemotherapy doses correlated significantly with MR imaging measures of left ventricular ejection fraction and end-systolic volume, but not with the severity of brain or bone abnormalities. Methotrexate-treated cancer survivors had significantly lower cerebral blood flow and metabolic activity in key brain areas compared with control subjects. Conclusion The feasibility of a single examination for assessment of chemotherapy-induced injuries of the brain, heart, and joints was shown. Earlier detection of tissue injuries may enable initiation of timely interventions and help to preserve long-term health of pediatric cancer survivors. © RSNA, 2017 Online supplemental material is available for this article.Purpose To develop a positron emission tomography (PET)/magnetic resonance (MR) imaging protocol for evaluation of the brain, heart, and joints of pediatric cancer survivors for chemotherapy-induced injuries in one session. Materials and Methods Three teams of experts in neuroimaging, cardiac imaging, and bone imaging were tasked to develop a 20-30-minute PET/MR imaging protocol for detection of chemotherapy-induced tissue injuries of the brain, heart, and bone. In an institutional review board-approved, HIPAA-compliant, prospective study from April to July 2016, 10 pediatric cancer survivors who completed chemotherapy underwent imaging of the brain, heart, and bone with a 3-T PET/MR imager. Cumulative chemotherapy doses and clinical symptoms were correlated with the severity of MR imaging abnormalities by using linear regression analyses. MR imaging measures of brain perfusion and metabolism were compared among eight patients who were treated with methotrexate and eight untreated age-matched control subjects by using Wilcoxon rank-sum tests. Results Combined brain, heart, and bone examinations were completed within 90 minutes. Eight of 10 cancer survivors had abnormal findings on brain, heart, and bone images, including six patients with and two patients without clinical symptoms. Cumulative chemotherapy doses correlated significantly with MR imaging measures of left ventricular ejection fraction and end-systolic volume, but not with the severity of brain or bone abnormalities. Methotrexate-treated cancer survivors had significantly lower cerebral blood flow and metabolic activity in key brain areas compared with control subjects. Conclusion The feasibility of a single examination for assessment of chemotherapy-induced injuries of the brain, heart, and joints was shown. Earlier detection of tissue injuries may enable initiation of timely interventions and help to preserve long-term health of pediatric cancer survivors. © RSNA, 2017 Online supplemental material is available for this article.
Author Gulaka, Praveen
Luna-Fineman, Sandra
Daldrup-Link, Heike E.
Ilivitzki, Anat
Theruvath, Johanna
Chan, Frandics
Muehe, Anne
Moseley, Michael
Sakamoto, Kathleen M.
Yang, Phillip
Theruvath, Ashok J.
Kim, Christine
Yeom, Kristen W.
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  organization: From the Department of Radiology and the Molecular Imaging Program (A.J.T., A.I., A.M., J.T., P.G., C.K., K.W.Y., M.M., F.C., H.E.D.L.), Department of Pediatrics, Division of Pediatric Hematology/Oncology (S.L.F., K.M.S., H.E.D.L.), and Department of Medicine, Division of Cardiology (P.Y.), Lucile Packard Children’s Hospital, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305-5654
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  surname: Theruvath
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  organization: From the Department of Radiology and the Molecular Imaging Program (A.J.T., A.I., A.M., J.T., P.G., C.K., K.W.Y., M.M., F.C., H.E.D.L.), Department of Pediatrics, Division of Pediatric Hematology/Oncology (S.L.F., K.M.S., H.E.D.L.), and Department of Medicine, Division of Cardiology (P.Y.), Lucile Packard Children’s Hospital, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305-5654
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  givenname: Christine
  surname: Kim
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  organization: From the Department of Radiology and the Molecular Imaging Program (A.J.T., A.I., A.M., J.T., P.G., C.K., K.W.Y., M.M., F.C., H.E.D.L.), Department of Pediatrics, Division of Pediatric Hematology/Oncology (S.L.F., K.M.S., H.E.D.L.), and Department of Medicine, Division of Cardiology (P.Y.), Lucile Packard Children’s Hospital, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305-5654
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  givenname: Kathleen M.
  surname: Sakamoto
  fullname: Sakamoto, Kathleen M.
  organization: From the Department of Radiology and the Molecular Imaging Program (A.J.T., A.I., A.M., J.T., P.G., C.K., K.W.Y., M.M., F.C., H.E.D.L.), Department of Pediatrics, Division of Pediatric Hematology/Oncology (S.L.F., K.M.S., H.E.D.L.), and Department of Medicine, Division of Cardiology (P.Y.), Lucile Packard Children’s Hospital, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305-5654
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  givenname: Phillip
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  organization: From the Department of Radiology and the Molecular Imaging Program (A.J.T., A.I., A.M., J.T., P.G., C.K., K.W.Y., M.M., F.C., H.E.D.L.), Department of Pediatrics, Division of Pediatric Hematology/Oncology (S.L.F., K.M.S., H.E.D.L.), and Department of Medicine, Division of Cardiology (P.Y.), Lucile Packard Children’s Hospital, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305-5654
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  givenname: Michael
  surname: Moseley
  fullname: Moseley, Michael
  organization: From the Department of Radiology and the Molecular Imaging Program (A.J.T., A.I., A.M., J.T., P.G., C.K., K.W.Y., M.M., F.C., H.E.D.L.), Department of Pediatrics, Division of Pediatric Hematology/Oncology (S.L.F., K.M.S., H.E.D.L.), and Department of Medicine, Division of Cardiology (P.Y.), Lucile Packard Children’s Hospital, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305-5654
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  organization: From the Department of Radiology and the Molecular Imaging Program (A.J.T., A.I., A.M., J.T., P.G., C.K., K.W.Y., M.M., F.C., H.E.D.L.), Department of Pediatrics, Division of Pediatric Hematology/Oncology (S.L.F., K.M.S., H.E.D.L.), and Department of Medicine, Division of Cardiology (P.Y.), Lucile Packard Children’s Hospital, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305-5654
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  surname: Daldrup-Link
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  organization: From the Department of Radiology and the Molecular Imaging Program (A.J.T., A.I., A.M., J.T., P.G., C.K., K.W.Y., M.M., F.C., H.E.D.L.), Department of Pediatrics, Division of Pediatric Hematology/Oncology (S.L.F., K.M.S., H.E.D.L.), and Department of Medicine, Division of Cardiology (P.Y.), Lucile Packard Children’s Hospital, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305-5654
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Author contributions: Guarantors of integrity of entire study, A.J.T., A.I., J.T., K.W.Y., H.E.D.L.; study concepts/study design or data acquisition or data analysis/interpretation, all authors; manuscript drafting or manuscript revision for important intellectual content, all authors; approval of final version of submitted manuscript, all authors; agrees to ensure any questions related to the work are appropriately resolved, all authors; literature research, A.J.T., A.I., A.M., J.T., C.K., K.W.Y., P.Y., H.E.D.L.; clinical studies, A.J.T., A.I., A.M., P.G., C.K., S.L.F., K.W.Y., P.Y., M.M., F.C., H.E.D.L.; experimental studies, A.I., P.Y., F.C.; statistical analysis, A.J.T., A.I., A.M., J.T., M.M., F.C.; and manuscript editing, all authors
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Snippet Purpose To develop a positron emission tomography (PET)/magnetic resonance (MR) imaging protocol for evaluation of the brain, heart, and joints of pediatric...
The authors of this study present a PET/MR imaging protocol for pediatric cancer survivors that allows assessment of the brain, heart, and bone for...
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StartPage 971
SubjectTerms Adolescent
Antineoplastic Agents - adverse effects
Bone Diseases - chemically induced
Bone Diseases - diagnostic imaging
Brain Diseases - chemically induced
Brain Diseases - diagnostic imaging
Cancer Survivors
Female
Heart Diseases - chemically induced
Heart Diseases - diagnostic imaging
Humans
Magnetic Resonance Imaging - methods
Magnetic Resonance Imaging - statistics & numerical data
Male
Multimodal Imaging
Neoplasms - diagnostic imaging
Neoplasms - drug therapy
Observer Variation
Original Research
Positron-Emission Tomography - methods
Reproducibility of Results
Risk Factors
Sensitivity and Specificity
Systems Integration
Treatment Outcome
Young Adult
Title A PET/MR Imaging Approach for the Integrated Assessment of Chemotherapy-induced Brain, Heart, and Bone Injuries in Pediatric Cancer Survivors: A Pilot Study
URI https://www.ncbi.nlm.nih.gov/pubmed/28777701
https://www.proquest.com/docview/1926686071
https://pubmed.ncbi.nlm.nih.gov/PMC5708284
Volume 285
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