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Nuklearmedizin 2010; 49(06): 225-233
DOI: 10.3413/nukmed-0322
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Schattauer GmbH

Empfehlungen zur Durchführung der Ganz körper-18F-FDG-PET und -PET/CT bei Kindern mit onkologischen Erkrankungen

Anpassung der EANM-Guideline[*] an aktuelle Gegebenheiten in DeutschlandProcedure guidelines for whole-body 18F-FDG PET and PET/CT in children with malignant diseases
C. Franzius
1   MR-, Nuklearmedizin- und PET/CT-Zentrum Bremen-Mitte, Deutschland
2   Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Münster, Deutschland
,
J. Stauss
3   Department of Radiology, Brigham and Woman's Hospital, Boston, MA, USA
,
T. Pfluger
4   Klinik und Poliklinik für Nuklearmedizin, Ludwig-Maximilians-Universität München, Deutschland
,
K. U. Juergens
1   MR-, Nuklearmedizin- und PET/CT-Zentrum Bremen-Mitte, Deutschland
5   Institut für Klinische Radiologie, Universitätsklinikum Münster, Deutschland
,
R. Kluge
6   Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Leipzig, Deutschland
,
H. Amthauer
7   Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Magdeburg, Deutschland
,
H. Juergens
8   Klinik und Poliklinik für Kinderheilkunde – Pädiatrische Hämatologie und Onkologie, Universitäts-klinikum Münster, Deutschland
,
G. Henze
9   Klinik für Pädiatrie – Onkologie und Hämatologie, Charité der Humboldt-Universität Berlin, Campus Virchow- Klinikum, Berlin, Deutschland
,
B. Stoever
10   Klinik für Strahlenheilkunde, Abt. Pädiatrische Radiologie, Universitäts klinikum Charité der Humboldt-Universität Berlin, Campus Virchow-Klinikum, Berlin, Deutschland
,
K. Hahn
4   Klinik und Poliklinik für Nuklearmedizin, Ludwig-Maximilians-Universität München, Deutschland
› Author Affiliations
Further Information

Publication History

received: 04 May 2010

accepted in revised form: 04 May 2010

Publication Date:
24 January 2018 (online)

Also available at
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Summary

The purpose of these guidelines is to offer the nuclear medicine and the appropriate interdisciplinary team a framework for performing and reporting positron emission tomography (PET) and the combination with computed tomography (PET/CT) in children with malignant diseases mainly using the radiopharmaceutical 18F-fluorodeoxy-glucose (FDG). These guidelines are based on the recent guidelines of the Paediatric Committee of the European Association of Nuclear Medicine (EANM) (57) and have been translated and adapted to the current conditions in Germany. The adaptation of CT-parameters using PET/CT in children is covered in a more detailed way than in the EANM guideline taking into account that in Germany already a good portion of PET examinations is performed using an integrated PET/CT-scanner. Furthermore, a CT-scan without adaption of the CT acquisition parameters would result in a not tolerably high radiation exposition of the child. There are excellent guidelines for FDG PET and PET/CT in oncology published by the German Society of Nuclear Medicine (Deutsche Gesellschaft für Nuklearmedizin, DGN) (42) and EANM (4). These guidelines aim at providing additional information on issues particularly relevant to PET and PET/CT imaging in children. These guidelines should be taken in the context of local and national current standards of quality and rules.

Zusammenfassung

Das Ziel dieser Leitlinie ist es, dem nuklearmedizinischen und ggf. interdisziplinären Team Hilfestellungen für die Indikationsstellung, Durchführung, Interpretation und Dokumentation der Positronenemissionstomographie (PET) und der Kombination mit der Computertomographie (PET/CT) bei Kindern mit malignen Erkrankungen zu geben. Im Wesentlichen wird auf die Anwendung von 18F-Fluordesoxyglukose eingegangen. Diesen Empfehlungen liegt die aktuelle Leitlinie des Paediatric Committee der EANM zugrunde (57), die ins Deutsche übertragen und an die aktuellen Gegebenheiten in Deutschland angepasst wurde. Das Thema Anpassung der CT-Parameter bei der PET/CT im Kindesalter wird ausführlicher behandelt als in der EANM-Leitlinie. Dies berücksichtigt, dass in Deutschland ein Großteil der PET-Untersuchungen an PET/CTGeräten durchgeführt wird, und ein unkritisches Übernehmen der Erwachsenenprotokolle für die CT-Komponente zu einer nicht zu tolerierenden Strahlenexposition der Kinder führt. Diese Empfehlungen verstehen sich als Ergänzung der Leitlinien für die FDG-PET und PET/CT in der Onkologie, wie sie von der Deutschen Gesellschaft für Nuklearmedizin (DGN) (42) und der European Association of Nuclear Medicine (EANM) (4) publiziert wurden. Die Ergänzungen betreffen ausschließlich die speziellen Anforderungen bei der Untersuchung von Kindern. Diese Empfehlungen müssen immer im Zusammenhang mit lokalen und aktuellen nationalen Qualitätsstandards und Vorschriften gesehen werden.

Keywords

FDG - PET - PET/CT - children - paediatrics

Schlüsselwörter

FDG - PET - PET/CT - Kinder - Pädiatrie

* Stauss J, Franzius C, Pfluger T, Juergens KU, Biassoni L, Begent J, Kluge R, Amthauer H, Voelker T, Højgaard L, Barrington S, Hain S, Lynch T, Hahn K. Guideline for F-18-FDG PET and PET-CT imaging in paediatric oncology. Eur J Nucl Med Mol Imaging 2008; 35: 1581–1588.


** Weiterführende Literatur (1, 2, 5, 10–12, 14, 17–20, 23–26, 28, 29, 31, 33–38, 40, 43, 47–51, 53, 54, 56, 58).


 

  • Literatur[**]

  • 1 Amthauer H, Furth C, Denecke T. et al. FDG-PET in 10 children with non-Hodgkin's lymphoma: initial experience in staging and follow-up. Klin Paediatr 2005; 217: 327-333.
    Thieme ConnectPubMedSearch in Google Scholar
  • 2 Barrington S, Begent J, Lynch T. et al. Guideline for the use of PET-CT in children. Nucl Med Commun 2008; 29: 418-424.
    CrossrefPubMedSearch in Google Scholar
  • 3 Bartenstein P, Asenbaum S, Catafau A. et al. European Association of Nuclear Medicine procedure guidelines for brain imaging using F-18-FDG. Eur J Nucl Med Mol Imaging 2002; 29: BP43-48.
    Search in Google Scholar
  • 4 Bombardieri E, Aktolun C, Baum R. et al. FDG-PET: procedure guidelines for tumour imaging. Eur J Nucl Med Mol Imaging 2003; 30: BP115-124.
    PubMedSearch in Google Scholar
  • 5 Brink I, Renhardt M, Hoegerle S. et al. Increased metabolic activity in the thymus gland studied with F-18-FDG PET: age dependency and frequency after chemotherapy. J Nucl Med 2001; 42: 591-595.
    PubMedSearch in Google Scholar
  • 6 Bundesamt für Strahlenschutz. Bekanntmachung der diagnostischen Referenzwerte für radiologische und nuklearmedizinische Untersuchungen. BAnz Nr. 143 vom 05.08 2003
    PubMedSearch in Google Scholar
  • 7 Chugani H. A critical period of brain develope- ment: studies of cerebral glucose utilization with PET. Prev Med 1998; 27: 184-188.
    CrossrefPubMedSearch in Google Scholar
  • 8 El Fakhri G, Holdsworth C, Badawi R. et al. Impact of acquisition geometry and patient habitus on lesion detectability in whole body FDG-PET: a channelized hotelling observer study. IEEE Nuclear Science Symposium Conference Record, NJ: IEEE 2002; 3: 1402-1405.
    Search in Google Scholar
  • 9 Fahey F. Dosimetry of pediatric PET/CT. J Nucl Med 2009; 50: 1483-1491.
    CrossrefPubMedSearch in Google Scholar
  • 10 Fahey F, Palmer M, Strauss K. et al. Dosimetry and adequacy of CT-based attenuation correction for pediatric PET: phantom study. Radiology 2007; 243: 96-104.
    CrossrefPubMedSearch in Google Scholar
  • 11 Franzius C, Daldrup-Link HE, Sciuk J. et al. FDG- PET for detection of pulmonary metastases from malignant primary bone tumors: comparison with spiral CT. Ann Oncol 2001; 12: 479-486.
    CrossrefPubMedSearch in Google Scholar
  • 12 Franzius C, Daldrup-Link HE, Wagner-Bohn A. et al. FDG PET for detection of recurrences from malignant primary bone tumors: Comparison with conventional imaging. Ann Oncol 2002; 13: 157-160.
    PubMedSearch in Google Scholar
  • 13 Franzius C, Hartmann L, Juergens K. et al. Analyse der PET-CT-Akquisitionsprotokolle pädiatrischer Patienten: Bildqualität, Kontrastierung, Strahlen- exposistion. Nuklearmedizin 2008; 47: A79.
    Search in Google Scholar
  • 14 Franzius C, Hermann K, Weckesser M. et al. Whole- body PET/CT with C-11-meta-hydroxyephedrine in tumors of the sympathetic nervous system: feasibility study and comparison with I-123-mIBG SPECT/CT. J Nucl Med 2006; 47: 1635-1642.
    PubMedSearch in Google Scholar
  • 15 Franzius C, Juergens K, Schober O. Is PET/CT necessary in paediatric oncology? For. Eur J Nucl Med Mol Imaging 2006; 33: 960-965.
    CrossrefPubMedSearch in Google Scholar
  • 16 Franzius C, Juergens KU, Vormoor J. PET/CT with diagnostic CT in the evaluation of childhood sarcoma. Am J Roentgenol 2006; 186: 581.
    CrossrefPubMedSearch in Google Scholar
  • 17 Franzius C, Jürgens K. PET/CT in paediatric oncology: indications and pitfalls. Pediatr Radiol 2009; 39 Suppl 3 446-449.
    CrossrefPubMedSearch in Google Scholar
  • 18 Franzius C, Schober O. Assessment of therapy response by FDG PET in Pediatric Patients. Q J Nucl Med 2003; 47: 41-45.
    PubMedSearch in Google Scholar
  • 19 Franzius C, Sciuk J, Brinkschmidt C. et al. Evaluation of chemotherapy response in primary bone tumors with F-18-FDG-PET compared with histo- logically assessed tumor necrosis. Clin Nucl Med 2000; 25: 874-881.
    CrossrefPubMedSearch in Google Scholar
  • 20 Franzius C, Sciuk J, Daldrup-Link HE. et al. FDG- PET for detection of osseous metastases from malignant primary bone tumors: comparison with bone scintigraphy. Eur J Nucl Med 2000; 27: 1305-1311.
    CrossrefPubMedSearch in Google Scholar
  • 21 Gelfand M. Dosimetry of FDG PET/CT and other molecular imaging applications in pediatric patients. Pediatr Radiol 2009; 39 (Suppl 1) S46-S56.
    CrossrefPubMedSearch in Google Scholar
  • 22 Gelfand M, O'Hara S, Curtwright L. et al. Pre-medication to block F-18-FDG uptake in brown adipose tissue of pediatric and adolescent patients. Pediatr Radiol 2005; 35: 984-990.
    CrossrefPubMedSearch in Google Scholar
  • 23 Gerth H, Juergens K, Dirksen U. et al. Significant benefit of multimodal imaging: PET/CT compared with PET alone in staging and follow-up of patients with Ewing sarcoma. J Nucl Med 2007; 48: 1932-1939.
    CrossrefPubMedSearch in Google Scholar
  • 24 Gutzeit A, Debatin J, Antoch G. Tumor staging with PET/CT. Detection of a second tumor. Röfo 2004; 176: 122-124.
    PubMedSearch in Google Scholar
  • 25 Hahn K, Fischer S. Radiation dose and radiation protection from paediatric nuclear medicine procedures. Der Nuklearmediziner 2002; 25: 90-100.
    Thieme ConnectSearch in Google Scholar
  • 26 Hahn K, Pfluger T. Has PET become an important clinical tool in paediatric imaging. Eur J Nucl Med Mol Imaging 2004; 31: 615-621.
    CrossrefPubMedSearch in Google Scholar
  • 27 Hahn K, Pfluger T. Is PET/CT necassary in paediatric oncology? Against. Eur J Nucl Med Mol Imaging 2006; 33: 966-968.
    CrossrefPubMedSearch in Google Scholar
  • 28 Hawkins DS, Rajendran JG, Conrad EU. et al. Evaluation of chemotherapy response in pediatric bone sarcomas by [F-18]-Fluorodeoxy-D-Glucose Positron Emission Tomography. Cancer 2002; 94: 3277-3284.
    CrossrefPubMedSearch in Google Scholar
  • 29 Hermann S, Wormanns D, Pixberg M. et al. Staging in childhood lymphoma: differences between FDG- PET and CT. Nuklearmedizin 2005; 44: 1-7.
    Thieme ConnectPubMedSearch in Google Scholar
  • 30 Holm S, Borgwardt L, Loft A. et al. Paediatric doses - a critical appraisal of the EANM paediatric dosage card. Eur J Nucl Med Mol Imaging 2007; 34: 1713-1718.
    CrossrefPubMedSearch in Google Scholar
  • 31 Hudson MM, Krasin MJ, Kaste SC. PET imaging in pediatric Hodgkin's lymphoma. Pediatr Radiol 2004; 34: 190-198.
    CrossrefPubMedSearch in Google Scholar
  • 32 ICRP Publication 80: Radiation dose to patients from radiopharmaceuticals. Vol. 28, 3. Oxford: Pergamon Press; 1998
    Search in Google Scholar
  • 33 Jacobs F, Thierens H, Piepsz A. et al. Optimized tracer-dependent dosage cards to obtain weight-independent effective doses. Eur J Nucl Med Mol Imaging 2005; 32: 581-588.
    CrossrefPubMedSearch in Google Scholar
  • 34 Jadvar H, Connolly L, Fahey F. et al. PET and PET/ CT in pediatric oncology. Semin Nucl Med 2007; 37: 316-331.
    CrossrefPubMedSearch in Google Scholar
  • 35 Jürgens K, Weckesser M, Stegger L. et al. Tumor staging using whole-body high-resolution 16-channel PET-CT: Does additional low-dose chest CT in inspiration improve the detection of solitary pulmonary nodules?. Eur Radiol 2006; 16: 1131-1137.
    CrossrefPubMedSearch in Google Scholar
  • 36 Kaste S. F-18-PET-CT in extracranial paediatric oncology: when and for whom is it useful. Pediatr Radiol 2008; 38: S459-S466.
    CrossrefPubMedSearch in Google Scholar
  • 37 Kaste S. Issues specific to implementing PET-CT for pediatric oncology: what have we learned along the way. Pediatr Radiol 2004; 34: 205-213.
    CrossrefPubMedSearch in Google Scholar
  • 38 Kaste SC, Howard SC, McCarville EB. et al. 18F-FDG-avid sites mimicking active disease in pediatric Hodgkin's. Pediatr Radiol 2005; 35: 141-154.
    CrossrefPubMedSearch in Google Scholar
  • 39 Kobe C, Dietlein M, Mauz-Körholz C. et al. FDG- PET beim Hodgkin-Lymphom. Nuklearmedizin 2008; 47: 225-274.
    Thieme ConnectPubMedSearch in Google Scholar
  • 40 Körholz D, Kluge R, Wickmann L. et al. Importance of F-18-fluorodeoxy-D-2-glucose positron emission tomographie (FDG-PET) for staging and therapy control of Hodgkin's lymphoma in childhood and adolescence - consequences for the GPOH-HD 2003 protocol. Onkologie 2003; 26: 489-493.
    PubMedSearch in Google Scholar
  • 41 Kotzerke J, Oehme L, Lindner O. et al. Positron emission tomography 2008, Results of the query and current status. Nuklearmedizin 2010; 49: 58-64.
    Thieme ConnectPubMedSearch in Google Scholar
  • 42 Krause B, Beyer T, Bockisch A. et al. FDG-PET/CTin der Onkologie. Nuklearmedizin 2007; 46: 291-301.
    Thieme ConnectPubMedSearch in Google Scholar
  • 43 Kushner BH, Yeung HW, Larson SM. et al. Extending positron emission tomography scan utility to high- risk neuroblastoma: fluorine-18-fluorodeoxyglu- cose positron emission tomography as sole imaging modality in follow-up of patients. J Clin Oncol 2001; 19: 3397-3405.
    CrossrefPubMedSearch in Google Scholar
  • 44 la Fougère C, Pfluger T, Schneider V. et al. Restaging von Lymphom-Patienten mit PET/CT - Vergleich von Niedrigdosis-CT (20 mAs) mit kontrastmittelverstärkter diagnostischer CT. Nuklearmedizin 2009; 47: 37-42.
    Thieme ConnectSearch in Google Scholar
  • 45 Lassmann M, Biassoni L, Monieurs M. et al. The new EANM dosage card. Eur J Nucl Med Mol Imaging 2007; 34: 796-798.
    CrossrefPubMedSearch in Google Scholar
  • 46 Lassmann M, Biassoni L, Monsieurs M. et al. The new EANM paediatric dosage card. Additional notes with respect to F-18. Eur J Nucl Med Mol Imaging 2008; 35: 1748.
    Search in Google Scholar
  • 47 Lucas JD, O'Doherty MJ, Cronin BF. et al. Prospective evaluation of soft tissue masses and sarcomas using fluorodeoxyglucose positron emission tomography. Br J Surg 1999; 86: 550-556.
    CrossrefPubMedSearch in Google Scholar
  • 48 Lucas JD, O'Doherty MJ, Wong JCH. et al. Evaluation of fluorodeoxyglucose positron emission tomography in the management of soft-tissue sarcoma. J Bone Joint Surg (Br) 1998; 80 -B 441-447.
    CrossrefPubMedSearch in Google Scholar
  • 49 McCarville MB, Christie R, Daw NC. et al. PET/CT in evaluation of childhood sarcomas. Am J Roentgenol 2005; 184: 1293-1304.
    CrossrefPubMedSearch in Google Scholar
  • 50 Montravers F, McNamara D, Landman-Parker J. et al. 18F-FDG in childhood lymphoma: clinical utility and impact on management. Eur J Nucl Med 2002; 29: 1155-1165.
    CrossrefPubMedSearch in Google Scholar
  • 51 O'Hara SA, Donnelly LF, Coleman RE. Pediatric body applications of FDG PET. Am J Roentgen 1999; 172: 1019-1024.
    CrossrefPubMedSearch in Google Scholar
  • 52 Parysow O, Mollerach A, Jager V. et al. Low-dose oral propanolol could reduce brow adipose tissue F-18 FDG uptake in patients undergoing PET scans. Clin Nucl Med 2007; 32: 351-357.
    CrossrefPubMedSearch in Google Scholar
  • 53 Shulkin B. PET applications in pediatrics. Q J Nucl Med 1997; 41: 281-291.
    PubMedSearch in Google Scholar
  • 54 Shulkin BL, Hutchinson RJ, Castle VP. et al. Neuroblastoma: positron emission tomography with 2-[fluorine-18]-fluoro-2-deoxy-D-glucose compared with metaiodobenzylguanidine scintigraphy. Radiology 1996; 199: 743-750.
    CrossrefPubMedSearch in Google Scholar
  • 55 Söderlund V, Larsson S, Jacobsson H. Reduction of FDG uptake in brow adipose tissue in clinical patients by a single dose of propanolol. Eur J Nucl Med Mol Imaging 2007; 34: 1018-1022.
    CrossrefPubMedSearch in Google Scholar
  • 56 Stabin M, Gelfand M. Dosimetry of pediatric nuclear medicine procedures. Q J Nucl Med 1998; 42: 93-112.
    PubMedSearch in Google Scholar
  • 57 Stauss J, Franzius C, Pfluger T. et al. Guideline for F-18-FDG PET and PET-CT imaging in paediatric oncology. Eur J Nucl Med Mol Imaging 2008; 35: 1581-1588.
    CrossrefPubMedSearch in Google Scholar
  • 58 Voelker T, Denecke T, Steffen I. et al. Positron emission tomography for staging of pediatric sarcoma patients: results of a prospective multicenter trial. J Clin Oncol 2007; 25: 5435-5441.
    CrossrefPubMedSearch in Google Scholar
  • 59 Warbey V, Schleyer P, Barrington S. et al. The new EANM paediatric dosage card - does it conform to ALARA for PET/CT. Eur J Nucl Med Mol Imaging 2007; 34: 1881-1882.
    CrossrefPubMedSearch in Google Scholar
  • 60 Wegner E, Barrington S, Kingston J. et al. The impact of PET scanning on management of paediatric oncology patients. Eur J Nucl Med Mol Imaging 2005; 32: 23-30.
    CrossrefPubMedSearch in Google Scholar