Current Trends in Functional Imaging of Pheochromocytomas and Paragangliomas

Most pheochromocytomas/paragangliomas should be evaluated with anatomical imaging (computed tomography or magnetic resonance imaging) followed by functional imaging (nuclear medicine modalities). Functional imaging assures that the tumor is indeed a pheochromocytoma/paraganglioma and enables more thorough localization, especially detecting as many lesions as possible (in particular for metastatic disease). Functional imaging for pheochromocytomas/paragangliomas, can use radiolabled ligands specific for pathways of synthesis, metabolism, and inactivation of catecholamines or nonspecific ligands. In an overview of the available nuclear medicine modalities, we summarize the accumulated experience and recommend when functional imaging should be applied to patients with pheochromocytoma/paraganglioma.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74881/1/annals.1353.041.pd

Age-Specific 18F-FDG Image Processing Pipelines and Analysis Are Essential for Individual Mapping of Seizure Foci in Paediatric Patients with Intractable Epilepsy

Fluoro-18-deoxyglucose positron emission tomography (FDG-PET) is an important tool for the pre-surgical assessment of children with drug-resistant epilepsy. Standard assessment is carried out visually and this is often subjective and highly user-dependent. Voxel-wise statistics can be used to remove user-dependent biases by automatically identifying areas of significant hypo/hyper-metabolism, associated to the epileptogenic area. In the clinical settings, this analysis is carried out using commercially available software. These software packages suffer from two main limitations when applied to paediatric PET data: 1) paediatric scans are spatially normalised to an adult standard template and 2) statistical comparisons use an adult control dataset. The aim of this work is to provide a reliable observer-independent pipeline for the analysis of paediatric FDG-PET scans, as part of pre-surgical planning in epilepsy. METHODS: A pseudo-control dataset (n = 19 for 6-9y, n = 93 for 10-20y) was used to create two age-specific FDG-PET paediatric templates in standard paediatric space. The FDG-PET scans of 46 epilepsy patients (n = 16 for 6-9y, n = 30 for 10-17y) were retrospectively collated and analysed using voxel-wise statistics. This was implemented with the standard pipeline available in the commercial software Scenium and an in-house Statistical Parametric Mapping v.8 (SPM8) pipeline (including age-specific paediatric templates and normal database). A kappa test was used to assess the level of agreement between findings of voxel-wise analyses and the clinical diagnosis of each patient. The SPM8 pipeline was further validated using post-surgical seizure-free patients. RESULTS: Improved agreement with the clinical diagnosis was reported using SPM8, in terms of focus localisation, especially for the younger patient group: kScenium=0.489 versus kSPM=0.805. The proposed pipeline also showed a sensitivity of ~70% in both age ranges, for the localisation of hypo-metabolic areas on paediatric FDG-PET scans in post-surgical seizure-free patients. CONCLUSION: We show that by creating age-specific templates and using paediatric control databases, our pipeline provides an accurate and sensitive semi-quantitative method for assessing FDG-PET scans of patients under 18y

MIBG detection of hepatic neuroblastoma: Correlation with CT, US and surgical findings

Metaiodobenzylguanidine (MIBG) imaging is used in the diagnosis, staging and follow-up of virtually every case of neuroblastoma seen at our institution. Normal sites of MIBG uptake include the liver and therefore difficulties have been predicted and encountered in the diagnosis of hepatic neuroblastoma due to inability to separate abnormally increased tracer deposition from normal hepatic activity. We reviewed every MIBG (I 123 and I 131 ) study performed at our pediatric hospital over a 4 year period encompassing 88 patients, 67 of whom had biopsy proven neuroblastoma. Hepatic findings on MIBG studies were compared with concurrent abdominal CT and US studies in all 67 patients. The clinical records of all patients with abnormal MIBG scans or abnormal CT or US studies of the liver were also reviewed. Eight patients were found to have abnormal liver findings on one or more imaging studies (MIBG, CT, or US). There were 3 true positive MIBG studies, one of which was an early study in a patient who later went on to have one of the false positive studies. Two patients had false positive MIBG scans for liver neuroblastoma. MIBG failed to detect liver involvement in 4 patients.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/46701/1/247_2005_Article_BF02010914.pd

Measurement of the impact of Winona Health Online

The purpose of this article is to present the methodology to study the clinical and financial outcomes associated with the use of Winona Health Online, a novel community-wide interactive healthcare Website in Winona, Minnesota. Outcome methodology was developed by the University of Minnesota School of Public Health and the Carlson School of Management in cooperation with nationally recognized outcomes and disease state management experts, healthcare practitioners in Winona, statisticians, and health economists. The main areas of measurement include health status, satisfaction, cost and utilization of services, and clinical quality

Semiquantitative mIBG Scoring as a Prognostic Indicator in Patients with Stage 4 Neuroblastoma: A Report from the Children’s Oncology Group

UnlabelledRadiolabeled metaiodobenzylguanidine (mIBG) is a highly sensitive and specific marker for detecting neuroblastoma. A semiquantitative mIBG score (Curie score [CS]) was assessed for utility as a prognostic indicator for a cohort of patients with high-risk metastatic disease.MethodsmIBG scans from 280 patients with mIBG-avid, stage 4 neuroblastoma enrolled on the Children's Oncology Group (COG) protocol A3973 were evaluated at diagnosis (n = 280), after induction chemotherapy (n = 237), and after an autologous stem cell transplantation (n = 178). Individual mIBG scans were evaluated at 10 different anatomic regions, with the scoring of each site (0-3) based on the extent of disease at that anatomic region.ResultsThere was no correlation between CS at diagnosis and subsequent treatment outcome. Patients with a CS > 2 after induction therapy had a significantly worse event-free survival (EFS) than those with scores ≤ 2 (3-y EFS: 15.4% ± 5.3% vs. 44.9% ± 3.9%, respectively; P < 0.001). A postinduction CS > 2 identified a cohort of patients at greater risk for an event, independent of other known neuroblastoma factors, including age, MYCN status, ploidy, mitosis-karyorrhexis index, and histologic grade. For MYCN-amplified tumors, the presence (CS > 0) versus absence (CS = 0) of residual mIBG avidity after induction was associated with a significantly worse outcome (3-y EFS: 11.8% ± 7.8% vs. 49.6% ± 7.7%, respectively; P = 0.003). After transplantation, patients with a CS > 0 had an EFS inferior to that of patients with a CS of 0 (3-y EFS: 28.9% ± 6.8% vs. 49.3% ± 4.9%, respectively [n = 133]; P = 0.009).ConclusionCurie scoring carries prognostic significance in the management of patients with high-risk neuroblastoma. In particular, patients with CSs > 2 after induction have extremely poor outcomes and should be considered for alternative therapeutic strategies

Value of the sentinel node procedure in pediatric extremity rhabdomyosarcoma: a systematic review and retrospective cohort study

Background Our aim is to show whether the sentinel node procedure (SNP) is recommendable for pediatric patients with extremity rhabdomyosarcoma (RMS). Lymph node metastases are an important prognostic factor in pediatric patients with extremity RMS. Accurate nodal staging is necessary to treat the patient accordingly. An alternative to the current recommended lymph node sampling is the sentinel node procedure (SNP). Methods A systematic review was performed summarizing all published cases of SNP in addition to 13 cases from our hospital and 8 cases from two other hospitals that have not been published before. Results For all patients (n = 55), at least one SLN was identified, but the SNP technique used was not uniform. The SNP changed the nodal classification of eight patients (17.0%) and had a false-negative rate of 10.5%. Conclusions The SNP is recommendable for pediatric patients with extremity RMS. It can change lymph node status and can be used to sample patients in a more targeted way than nodal sampling alone. Therefore, we recommend use of the SNP in addition to clinical and radiological nodal assessment for pediatric patients with extremity RMS.Development and application of statistical models for medical scientific researc

ASO visual abstract: the value of the sentinel node procedure in pediatric extremity Rhabdomyosarcoma: a systematic review and retrospective cohort study

Development and application of statistical models for medical scientific researc

Criteria for evaluation of disease extent by 123I-metaiodobenzylguanidine scans in neuroblastoma: a report for the International Neuroblastoma Risk Group (INRG) Task Force

BackgroundNeuroblastoma is an embryonic tumour of the sympathetic nervous system, metastatic in half of the patients at diagnosis, with a high preponderance of osteomedullary disease, making accurate evaluation of metastatic sites and response to therapy challenging. Metaiodobenzylguanidine (mIBG), taken into cells via the norepinephrine transporter, provides a sensitive and specific method of assessing tumour in both soft tissue and bone sites. The goal of this report was to develop consensus guidelines for the use of mIBG scans in staging, response assessment and surveillance in neuroblastoma.MethodsThe International Neuroblastoma Risk Group (INRG) Task Force, including a multidisciplinary group in paediatric oncology of North and South America, Europe, Oceania and Asia, formed a subcommittee on metastatic disease evaluation, including expert nuclear medicine physicians and oncologists, who developed these guidelines based on their experience and the medical literature, with approval by the larger INRG Task Force.ResultsGuidelines for patient preparation, radiotracer administration, techniques of scanning including timing, energy, specific views, and use of single photon emission computed tomography are included. Optimal timing of scans in relation to therapy and for surveillance is reviewed. Validated semi-quantitative scoring methods in current use are reviewed, with recommendations for use in prognosis and response evaluation.ConclusionsMetaiodobenzylguanidine scans are the most sensitive and specific method of staging and response evaluation in neuroblastoma, particularly when used with a semi-quantitative scoring method. Use of the optimal techniques for mIBG in staging and response, including a semi-quantitative score, is essential for evaluation of the efficacy of new therapy