Correlative imaging strategies implementing CT, MRI, and PET for staging of childhood Hodgkin disease.
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.
Furth
Christian
C
Klinik für Strahlenheilkunde, Bereich Nuklearmedizin und PET-Zentrum Berlin, Campus Virchow-Klinikum, Germany. christian.furth@charite.de
Denecke
Timm
T
Steffen
Ingo
I
Ruf
Juri
J
Voelker
Thomas
T
Misch
Daniel
D
Vondran
Florian
F
Plotkin
Michail
M
Stöver
Brigitte
B
Henze
Günter
G
Lemke
Arne-Jörn
AJ
Amthauer
Holger
H
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
D019788:Fluorodeoxyglucose F18