Name: whole-body pet/mri of pediatric patients: the details that matter
Uploaded: 2017-12-19T15:00:00
Description: Watch this Scientific Journal Video about Whole-body PET/MRI of Pediatric Patients: The Details That Matter at JoVE.com

这项工作得到了来自尤尼斯国家儿童健康和人类发展研究所的赠款, 赠款编号 R01 HD081123-01A1。Anuj Pareek 是丹麦奥胡斯大学医院放射学系的访问学者。作者承认技术专家黎明华立和苛刻的甘地从宠物/mri 代谢服务中心为他们的协助, 获取 pet/mri 扫描。我们感谢 Daldrup 连接实验室的成员、PET/MRI 服务中心、斯坦福大学的分子成像项目、放射科学实验室、儿科放射科、斯坦福癌症研究所和露西尔的儿科肿瘤学小组。儿童医院为这个项目提供有益的讨论和支持。

这里介绍的所有方法都是根据斯坦福大学机构审查委员会批准的一项研究报告建立的。ferumoxytol 的 "标签" 使用是在调查员发起的研究新药应用 (工业 111154) 下进行的。
1. 在 PET/MRI 扫描前24小时: 患者安全检查
<ol>
	<li>使用 MRI 安全问卷对患者进行潜在磁场危险的筛网。如果对静脉磁共振造影剂的管理进行计划, 检查禁忌症, 如过敏史和肾脏功能, 等等。</li>
	<li>在扫描前告知患?...

<ol>
	<li>Pichler, B. J., Judenhofer, M. S., Wehrl, H. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=PET/MRI+hybrid+imaging:+Devices+and+initial+results.">PET/MRI hybrid imaging: Devices and initial results.</a> Eur. Radiol. 18 (6), 1077-1086 (2008).</li><li>Torigian, D. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=PET+/+MR+Imaging+:+Technical+Aspects+and+Potential+Clinical+Applications.">PET / MR Imaging : Technical Aspects and Potential Clinical Applications.</a> Radiology. 267 (1), 26-44 (2013).</li><li>Daldrup-Link, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=How+PET/MR+Can+Add+Value+For+Children+With+Cancer.">How PET/MR Can Add Value For Children With Cancer.</a> Curr. Radiol. Rep. 5 (3), (2017).</li><li>Muehe, A. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=How+to+Provide+Gadolinium-Free+PET/MR+Cancer+Staging+of+Children+and+Young+Adults+in+Less+than+1+h:+the+Stanford+Approach.">How to Provide Gadolinium-Free PET/MR Cancer Staging of Children and Young Adults in Less than 1 h: the Stanford Approach.</a> Mol Imaging Biol. , (2017).</li><li>Spick, C., Herrmann, K., Czernin, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=18F-FDG+PET/CT+and+PET/MRI+perform+equally+well+in+cancer+patients:+Evidence+from+studies+in+more+than+2300+patients.">18F-FDG PET/CT and PET/MRI perform equally well in cancer patients: Evidence from studies in more than 2300 patients.</a> J. Nucl. Med. 57 (310), 1-38 (2016).</li><li>Sher, A. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessment+of+sequential+PET/MRI+in+comparison+with+PET/CT+of+pediatric+lymphoma:+A+prospective+study.">Assessment of sequential PET/MRI in comparison with PET/CT of pediatric lymphoma: A prospective study.</a> Am. J. Roentgenol. 206 (3), 623-631 (2016).</li><li>Jadvar, H., Colletti, P. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Competitive+Advantage+of+PET/MRI.">Competitive Advantage of PET/MRI.</a> Eur. J. Radiol. 83 (1), 84-94 (2014).</li><li>Wan, J. C. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Liquid+biopsies+come+of+age:+towards+implementation+of+circulating+tumour+DNA.">Liquid biopsies come of age: towards implementation of circulating tumour DNA.</a> Nat. Rev. Cancer. 17 (4), 223-238 (2017).</li><li>Grant, A. M., Deller, T. W., Khalighi, M. M., Maramraju, S. H., Delso, G., Levin, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=NEMA+NU+2-2012+performance+studies+for+the+SiPM-based+ToF-PET+component+of+the+GE+SIGNA+PET/MR+system.">NEMA NU 2-2012 performance studies for the SiPM-based ToF-PET component of the GE SIGNA PET/MR system.</a> Med. Phys. 43 (5), 2334-2343 (2016).</li><li>. FDA Drug Safety Communication: FDA strengthens warnings and changes prescribing instructions to decrease the risk of serious allergic reactions with anemia drug Feraheme (ferumoxytol) Available from: <a target="_blank" href="https://www.fda.gov/Drugs/DrugSafety/ucm440138.htm">https://www.fda.gov/Drugs/DrugSafety/ucm440138.htm</a> (2015)</li><li>Mattsson, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Radiation+Dose+to+Patients+from+Radiopharmaceuticals:+a+Compendium+of+Current+Information+Related+to+Frequently+Used+Substances.">Radiation Dose to Patients from Radiopharmaceuticals: a Compendium of Current Information Related to Frequently Used Substances.</a> Ann. ICRP. 44 (2 Suppl), 7-321 (2015).</li></ol>

我们已经为儿科癌症患者的 PET/MRI 研究显示了一个 step-by 步骤的协议。该协议最关键的部分是时间规划和处方的 PET 板和 MRI 序列的正确参数和正确的连续顺序, 然后启动全身扫描。这可以使整个身体持续获得。有效的扫描是特别重要的儿科设置, 在那里下患者可以很容易失去耐心, 要么开始移动或中止考试, 如果它需要太长时间。因此, 重要的是要仔细选择扫描方向 (从头或...

集成正电子发射断层扫描 (PET)/磁共振成像 (MRI) 使癌症分期和治疗监测高灵敏度, 高软组织对比度, 并增加代谢信息1,2,3,4. 在成年患者中, pet/MRI 对已建立的癌症分期进行了同样好的 pet/CT 检查5,6,7。在未来, 液体活检可能会导致早期发现癌症的发展 (例如, 通过转录和循环 DNA), 并要求更敏感的成像测试比目前可找到的小肿瘤在体内8.这可能会把 PET/磁共振成像的优势, 以评估整个身体和检测癌症的解剖领域, 已经被经典的 mri 评估单独的, 如大脑, 颈部, 腹部/骨盆, 和肌肉骨骼系统。
对于儿科患者, pet/mri 有几个优势超过 pet/CT: 首先, pet/mri 提供了明显减少的辐射暴露的病人高达 74%4。这可以通过使用电离无辐射的 MRI 代替 CT 技术来实现 PET 数据的解剖 co-registration。此外, 在 MRI 扫描过程中, 现代 pet 检测系统9和更长的 pet 数据获取的灵敏度提高, 使管理的示剂量比当前的 pet/CT 协议4显著减少30-50%。第二, 将原发肿瘤和全身的分期扫描结合起来的可能性, 可以节省时间, 避免某些患者, 如骨和软组织肉瘤患者的重复 sedations。然而, 只有当所有的 PET/MRI 数据 (局部肿瘤和全身) 能够有效地获得, 并且如果结果图像数据的丰度以易于理解的形式呈现给放射学家时, "一站式" 分期扫描才会是临床可行的。在这里提出的协议将提供 step-by 的指示, 获取 PET/MRI 数据, 可用于临床分期的儿童癌症, 特别注意儿科人口的特殊需要。

<table border="0" cellpadding="0" cellspacing="0" width="835">
	<tbody>
		<tr height="21">
			<td height="21" style="height:21px;width:304px;">Integrated PET/MRI scanner</td>
			<td style="width:189px;"></td>
			<td style="width:143px;"></td>
			<td style="width:199px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:304px;">SIgna PET/MR</td>
			<td style="width:189px;">GE</td>
			<td style="width:143px;"></td>
			<td>3.0 T integrated PET/MRI scanner</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:304px;">Software</td>
			<td style="width:189px;"></td>
			<td style="width:143px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:304px;">MP24_R03</td>
			<td style="width:189px;">GE</td>
			<td style="width:143px;"></td>
			<td>PET/MRI scanner software</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:304px;">MIM software version 6.6.13</td>
			<td style="width:189px;">MIM Software Inc.</td>
			<td style="width:143px;"></td>
			<td>PET/MRI analysis software</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:304px;">Contrast Agents</td>
			<td style="width:189px;"></td>
			<td style="width:143px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:304px;">Ferumoxytol</td>
			<td style="width:189px;">AMAG Pharmaceuticals</td>
			<td style="width:143px;"></td>
			<td>Iron Oxide nanoparticles</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:304px;">18F-FDG</td>
			<td style="width:189px;">-</td>
			<td style="width:143px;"></td>
			<td>2-Deoxy-2-(18F)fluoro-D-glucose</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:304px;">MRI coils available on the scanner</td>
			<td style="width:189px;"></td>
			<td style="width:143px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Nova 32 Channel Head coil</td>
			<td style="width:189px;">Nova&#160;</td>
			<td style="width:143px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Neocoil 1H 16 channel GEM Flex Large Array</td>
			<td style="width:189px;">GE</td>
			<td style="width:143px;">M7000SK</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Neocoil 1H 16 channel &#160;GEM Flex Medium Array</td>
			<td style="width:189px;">GE</td>
			<td style="width:143px;">M7000SL</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Neocoil 1H 16 channel GEM Flex Small Array</td>
			<td style="width:189px;">GE</td>
			<td style="width:143px;">M7000SM</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Everest Central Molecular Imaging Array (CMA)</td>
			<td style="width:189px;">GE</td>
			<td style="width:143px;">M8000RB</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Everest Head Neck Unit</td>
			<td style="width:189px;">GE</td>
			<td style="width:143px;">M8000CB</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Everest Lower and Upper Anterior Array</td>
			<td style="width:189px;">GE</td>
			<td style="width:143px;">M8000CC &#38; M8000CA</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Invivo 1H 8 channel High Res Brain Array</td>
			<td style="width:189px;">GE</td>
			<td style="width:143px;">M8000RA</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">3.0T HD Breast Array Coil</td>
			<td style="width:189px;">GE</td>
			<td style="width:143px;">M7000GG</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">3.0T Split-Top Head TR Single Ch Coil</td>
			<td style="width:189px;">GE</td>
			<td style="width:143px;">G6000BH</td>
			<td></td>
		</tr>
	</tbody>
</table>

whole-body pet/mri of pediatric patients: the details that matter

综合 PET/MRI 是一种混合成像技术, 使临床医生获得诊断图像的肿瘤评估和治疗监测与高软组织对比度和增加代谢信息。综合 PET/磁共振成像已证明是有价值的临床设置和有许多有前途的未来应用。在这里提出的协议将提供 step-by 步骤的指示, 获取全身 2-脱氧-2-(18f) 氟-d-葡萄糖 (18f 葡萄糖) PET/MRI 数据的儿童癌症。它还提供了有关如何将全身分期扫描与局部肿瘤扫描结合以评估原发肿瘤的说明。该协议的重点是全面和时间, 这是两个普遍需要的临床应用。本协议最初是为6岁以上的儿童开发的, 或年龄足以遵守呼吸控制指令, 但也可以应用于全身麻醉患者。同样, 这个协议可以被修改, 以适应机构偏好的选择磁共振脉冲序列的全身扫描和局部肿瘤评估。

我们展示了一个完整的全身 (从头到脚) 数据集的 MRI, pet 和融合宠物/mr 图像分别, 分别为 10 year-old 男孩与状态后切除的无差别肉瘤的第十二肋骨, 谁提出与肺部和 心脏转移 (图 1)。此处显示的数据集是在40分钟内获得的。在这次考试中, 病人的有效剂量是 3.3 mSv11。
对于接受主肿瘤的专门扫描的患者, 除了全身从头的 PET/磁共?...

Watch this Scientific Journal Video about Whole-body PET/MRI of Pediatric Patients: The Details That Matter at JoVE.com

Whole-body PET/MRI of Pediatric Patients: The Details That Matter

本文提供了全面的 step-by 步骤的指示, 获取全身 2-脱氧-2-(18f) 氟-d-葡萄糖 (18f 葡萄糖) PET/MRI 扫描的癌症分期儿科患者。该协议是为6岁以上的儿童, 或年龄足以遵守呼吸保持指示, 但也可以用于一般麻醉病人。

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