title: Correlative imaging strategies implementing CT, MRI, and PET for staging of childhood Hodgkin disease.
abstract: BACKGROUND
  The value of different correlative imaging strategies with F18-fluorodeoxyglucose positron emission tomography (FDG-PET) and conventional imaging modalities (CIM) for initial staging of pediatric Hodgkin disease (HD) was assessed.
  
  
  METHODS
  Thirty-three patients (age, 4 to 18 y) with histologically proven HD underwent initial staging with computed tomography (thorax), magnetic resonance imaging (neck, abdomen, pelvis), and FDG-PET in a prospective study. Image fusion (PET-CIM) was performed using a semiautomatic voxel-based algorithm. Analysis of separate, side-by-side (SBS) and fused PET and CIM was performed evaluating 21 nodal and 6 extranodal regions per patient for presence of lymphoma, applying a 5-point confidence scale. The reference data was clinical follow-up (>12 mo).
  
  
  RESULTS
  Concerning lymph node regions above and below the diaphragm the accuracy of CIM, PET, SBS, and image fusion was 86%, 89%, 94%, 97%, and 94%, 94%, 97%, 98%. In extranodal regions, the accuracy was 96%, 96%, 100%, and 100%. The reviewers' confidence was improved significantly by image fusion. Staging and therapy assignment on the basis of CIM was correctly modified by SBS in 5 and 4, by image fusion in 7 and 5 patients.
  
  
  CONCLUSIONS
  Combined reading of FDG-PET and CIM is crucial for accurate staging in pediatric HD. Image fusion improves the observers' confidence and has impact on the therapeutic management.
authors.affiliation: Klinik für Strahlenheilkunde, Bereich Nuklearmedizin und PET-Zentrum Berlin, Campus Virchow-Klinikum, Germany. christian.furth@charite.de
authors.forename: Christian
authors.initials: C
authors.lastname: Furth
authors.forename: Timm
authors.initials: T
authors.lastname: Denecke
authors.forename: Ingo
authors.initials: I
authors.lastname: Steffen
authors.forename: Juri
authors.initials: J
authors.lastname: Ruf
authors.forename: Thomas
authors.initials: T
authors.lastname: Voelker
authors.forename: Daniel
authors.initials: D
authors.lastname: Misch
authors.forename: Florian
authors.initials: F
authors.lastname: Vondran
authors.forename: Michail
authors.initials: M
authors.lastname: Plotkin
authors.forename: Brigitte
authors.initials: B
authors.lastname: Stöver
authors.forename: Günter
authors.initials: G
authors.lastname: Henze
authors.forename: Arne-Jörn
authors.initials: AJ
authors.lastname: Lemke
authors.forename: Holger
authors.initials: H
authors.lastname: Amthauer
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods* / Q000592:standards; D008297:Male; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography / Q000379:methods* / Q000592:standards; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods* / Q000592:standards
chemical_list: D019788:Fluorodeoxyglucose F18