Combining anatomic and molecularly targeted imaging in the diagnosis and surveillance of embryonal tumors of the nervous and endocrine systems in children |
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Authors: | M Sue O’Dorisio Geetika Khanna David Bushnell |
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Institution: | (1) Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA;(2) Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA |
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Abstract: | Combining anatomical and functional imaging can improve sensitivity and accuracy of tumor diagnosis and surveillance of pediatric
malignancies. MRI is the state-of-the-art modality for demonstrating the anatomical location of brain tumors with contrast
enhancement adding additional information regarding whether the tumor is neuronal or glial. Addition of SPECT imaging using
a peptide that targets the somatostatin receptor (Octreoscan) can now differentiate medulloblastoma from a cerebellar pilocytic
astrocytoma. Combined MRI and Octreoscan is now the most sensitive and accurate imaging modality for differentiating recurrent
medulloblastoma from scar tissue. CT is the most common imaging modality for demonstrating the anatomical location of tumors
in the chest and abdomen. Addition of SPECT imaging with either MIBG or Octreoscan has been shown to add important diagnostic
information on the nature of tumors in chest and abdomen and is often more sensitive than CT for identification of metastatic
lesions in bone or liver. Combined anatomical and functional imaging is particularly helpful in neuroblastoma and in neuroendocrine
tumors such as gastrinoma and carcinoid. Functional imaging with MIBG and Octreoscan is predictive of response to molecularly
targeted therapy with 131I-MIBG and 90Y-DOTA-tyr3-Octreotide. Dosimetry using combined anatomical and functional imaging is
being developed for patient-specific dosing of targeted radiotherapy and as an extremely sensitive monitor of response to
therapy. Both MIBG and Octreotide are now being adapted to PET imaging which will greatly improve the utility of PET in medulloblastoma
as well as increase the sensitivity for detection of metastatic lesions in neuroblastoma and neuroendocrine tumors. |
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Keywords: | Medulloblastoma Neuroblastoma Neuroendocrine tumors Pediatric Diagnostic imaging Surveillance imaging PET SPECT MRI CT |
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