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¹⁸F-FDG PET/CT in Evaluating Non-CNS Pediatric Malignancies

¹ Division of Nuclear Medicine, Department of Radiology, The Johns Hopkins Medical Institutions, Baltimore, Maryland; and ² Pediatric Radiology, Department of Radiology, The Johns Hopkins Medical Institutions, Baltimore, Maryland

View larger version (74K): [in this window] [in a new window]   FIGURE 1.  A 17-y-old female with gonadal stromal tumor. (A) FDG PET, (B) CT, (C) fused PET/CT, and (D) contrast CT (performed on a different day from PET/CT) (all transaxial images). FDG PET clearly showed a focus of intense FDG uptake in left pelvic region (arrow), where CT and fused PET/CT depicted a small lymph node (arrow). Contrast-enhanced CT diagnosed the lymph node as negative (not clinically significant) for malignancy due to the size criterion (arrow). Progression of disease was observed from this lymph node lesion during the follow-up period in this study.

View larger version (25K): [in this window] [in a new window]   FIGURE 2.  A 15-y-old male with Hodgkin's lymphoma. (A) FDG PET, (B) CT, and (C) fused PET/CT (all transaxial images). Diffuse and intense FDG uptake was observed in enlarged spleen on PET/CT, which corresponded to involvement. Splenic involvement was not detected on contrast-enhanced CT (not shown) but was diagnosed as mild splenomegaly.

View larger version (73K): [in this window] [in a new window]   FIGURE 3.  A 13-y-old female with Hodgkin's lymphoma. (A and E) FDG PET, (B and F) CT, (C and G) fused PET/CT, and (D and H) contrast CT (performed on different day from PET/CT) (all transaxial images). Patient presented with right mediastinal soft-tissue mass. In first PET/CT examination for this patient after chemotherapy (A–D), a focus of FDG uptake was observed in peripheral area of the mass (arrowhead), which was considered to be a residual active portion. Mass was also diagnosed as positive on contrast-enhanced CT (arrow). In next examination session after further treatment (E–H), the mediastinal mass still existed (arrow), although PET/CT showed a negative finding for this lesion. The same findings were observed in the follow-up PET/CT and CI examinations, indicating the PET/CT finding in second examination was correct and the mediastinal mass was posttreatment scar.

View larger version (61K): [in this window] [in a new window]   FIGURE 4.  A 15-y-old male with neurofibromatosis. (A and B) FDG PET, (C and D) CT, and (E and F) fused PET/CT (all transaxial images). There were many soft-tissue masses in the body (A, C, and E) with mild-to-moderate FDG uptake, consistent with benign lesions of neurofibromatosis (arrow). However, in his left lower leg (B, D, and F), masses with intense FDG uptake were observed (arrow), which proved to be lesions of malignant transformation by histopathologic evaluation. PET/CT was valuable in discriminating malignant lesions from other benign soft-tissue masses in this patient.