![]() The implementation of PET/MRI scanners enables the simultaneous acquisition of complementary metabolic and MR-derived morphologic and functional imaging datasets and therefore arises the potential for a characterization and staging of primary bone tumors within a single imaging session. In addition, 18F-FDG PET provides valuable information about tumor metabolism that can be used for the discrimination of viable or nonviable tumors as well as to assess the effectiveness of therapeutic interventions due to measurable changes of the FDG-uptake under treatment. In this context, previous studies reported that PET/CT enables the identification of lymph node or bone metastases with a higher sensitivity than conventional imaging modalities. Moreover, hybrid imaging with the use of 18F-FDG PET has been shown to be an efficacious imaging technique for staging and restaging malignant bone tumors. A precise determination of the primary tumor extant is of high importance for the selection of the local treatment procedure. Based on its higher soft-tissue contrast compared to other morphological imaging techniques, MRI is considered the imaging modality of choice for regional tumor evaluation. In addition, reliable information about metastatic spread is of high importance to plan further therapeutic steps and to assess the patient’s prognosis. An accurate initial diagnostic of these tumors is of particular importance to select the most appropriate multimodal therapeutic concept, frequently starting with induction polychemotherapy according to the VIDE-regimen, followed by local treatment of the primary tumor. Conclusion: PET/MRI may serve as a valuable imaging tool for primary staging and response assessment of juvenile patients with Ewing sarcoma to induction chemotherapy, accompanied by a reasonable radiation dose for the patient.Įwing sarcoma is the second most common malignant bone tumor of pediatric and juvenile patients. PERCIST defined response to treatment in 9/11 patients correctly and misclassified two patients with a PR as CR. RECIST1.1 categorized the response to treatment in 5/11 patients correctly and showed a tendency to underestimate the response to treatment in the remaining six patients. ![]() According to the reference standard, three patients achieved complete response, six patients partial response, and one patient showed stable disease while another patient showed progressive disease. Results: In eight patients lymph node and/or distant metastases were detected at initial diagnosis. They were asked to perform a whole-body staging in all three examinations and to define treatment response according to the RECIST1.1 and PERCIST criteria for each patient. Two experienced physicians analysed the imaging datasets. Methods: A total of 11 juvenile patients with confirmed Ewing sarcoma, scheduled for induction polychemotherapy, were prospectively enrolled for a PET/MR examination before, during and after the end of treatment. Background: This study was conducted to evaluate the clinical applicability of integrated PET/MRI for staging and monitoring the effectiveness of neoadjuvant chemotherapy in Ewing sarcoma patients. ![]()
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