MR PET Imaging of Inflammation in Paediatric Oncology Patients · RCH MR PET Imaging statistics...
Transcript of MR PET Imaging of Inflammation in Paediatric Oncology Patients · RCH MR PET Imaging statistics...
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MR PET Imaging of Inflammation
in Paediatric Oncology Patients
Dr Timothy Cain
Paediatric Radiologist and Nuclear Medicine Specialist
The Royal Children’s Hospital Melbourne, Victoria, Australia
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RCH Medical Imaging has a research collaboration
with Siemens Healthineers through the Murdoch
Children’s Research Institute
RCH MR PET is a global reference site for Siemens
Healthineers
Declarations
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Objectives
• Be aware of MR PET for paediatric Imaging
• Demonstrate how MR PET can be used like PET CT for
investigation of inflammation
• Be aware of high frequency of incidental findings
• Be aware of benefits of MR for correlation with PET
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Indications for FDG MR PET Imaging
Infection/inflammation
• Oncology
• Febrile neutropaenia – diagnosis of infective and non-infective causes
• Prior to bone marrow transplantation - screening
• Assessment of infection treatment success or recurrence
• Non-oncologic
• PUO – especially immune deficiency syndromes
• Arthralgia/Autoimmune/Vasculitis
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RCH MR PET Imaging statistics
• 982 MR PET imaging studies were performed at the
RCH between April 2016 and December 2018
• 612 of these studies performed on oncology patients
• 28 oncology patients had imaging specifically to assess
inflammation
• febrile neutropenia
• assess response to treatment for infection.
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Febrile Neutropaenia
• 15 yo male with
relapsed AML
• Febrile neutropenia
• Previous lung infection
with worsening fevers
despite appropriate
therapy – infection
elsewhere?
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Febrile Neutropaenia
• LZ 5 yo female
• ALL - delayed consolidation
chemotherapy because of
candida sepsis
• FDG PET to determine
extent of disease
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Persistent Fevers post BMT
• 9 yo male
• Persistent
unexplained high-
grade fever for over
1 week following
bone marrow
transplant
• Pancreatitis post
BMT
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MR PET Inflammation
• 17 yo male T-cell ALL
• Febrile 6 days, hypotension
• Findings consistent with diffuse
inflammatory process involving
joints and muscles
• No focal source of infection or
inflammation demonstrated
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RCH MR PET Findings
Incidental inflammation common
• Lung – pneumonia and anaesthesia related atelectasis
• Gastrointestinal tract – oesophagus, stomach, bowel
• Lymphoid tissue – cervical, axillary, inguinal
• Other
• Injection sites, muscle inflammation, skin inflammation
• Central line, surgical scar
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MR PET Unexpected Lung uptake
Oct 2016 Nov 2017 Feb 2018
• 6 yo female
• Spitz naevus of left upper
arm; unknown potential
(Malignant melanoma?)
• Asymptomatic at time of
all studies
• MR imaging showed
unexpected RUL
collapse and RML
consolidation
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MR PET Unexpected lung Inflammation
9 yo male with
Hodgkins Lymphoma
Unexpected Right
basal lung lesion on
late assessment PET
scan
Nov 2017 Jan 2018 May 2018
Initial staging early & late response assessment
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MR PET ‘Incidental’ Inflammation
9 yo male with
Hodgkins
Lymphoma
Unexpected
Right basal
lung lesion
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MR PET Reactive lymph nodes
• 12 yo Female with
incomplete excision of
fibrohistiocytic tumour
from left hand
• Enlarged and isotope
avid lymph nodes
• Biopsy proven reactive
nodes – post
immunisation left deltoid
muscle
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MR PET – CVC related Inflammation
• 16 yo male Hodgkins
Lymphoma
• Good response post
treatment
• Focal uptake right
atrium – line tip related
inflammation
Baseline scan End of treatment
Sep 2107 Mar 2018
CT Mar 2018 (inspiration)
MR PET Mar 2018 (expiration)
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MR PET - MSK Inflammation
• 7-year-old with Burkitt's lymphoma - primary in mandible
• Bilateral greater trochanter uptake
• Right infraspinatus (rotator cuff) tendinitis – high T2
signal in muscle
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MR PET Bowel activity
• 7 yo male
• f/up PTLD post cardiac transplantation
• Recent diarrhoea suspicious of small bowel
PTLD recurrence
• RLL uptake unexpected pulmonary infection
• Lt deltoid recent immunisation (no uptake
on right side bilateral injections
• Colonic uptake suspicious of PTLD
recurrence
• Colonic biopsy –ve
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MR PET in paediatric Infection and Inflammation
• Useful to identify source of infection in febrile patients
• Can be used to assess treatment response
• Detects a wide range of infective and inflammatory conditions
• Incidental or unexpected signs of inflammation are common,
but not all are significant
• Simultaneous MR often provides anatomical correlation that CT
would not be expected to provide
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Acknowledgements…..
• RCH Foundation and Good Friday
Appeal
• Michael Kean and MR Technologists
• Duncan Veysey and Nuc Med
Technologists
• Peter Francis and MID imaging
specialists
• MID Nurses and Clerical staff
• Anaesthetists & Anaesthetic
technologists
• RCH Clinicians
• Simon Harvey and epilepsy team
• Michael Sullivan and oncology colleagues
• Child Life Therapists
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Interested in Paediatric Imaging? Come to AOSPR 2019
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Thank you for your attention
Dr Timothy Cain
Paediatric Radiologist and Nuclear Medicine Specialist
The Royal Children’s Hospital Melbourne, Australia