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Melzer, Henriette Ingrid (2013): Multimodale Bildgebung in der pädiatrischen Onkologie. Dissertation, LMU München: Medizinische Fakultät



The evaluation of multimodal imaging in paediatric oncology is the main theme of this thesis. Both published studies evaluate 18F-fluorodesoxyglucose positron emission tomography (18FFDG-PET) combined with an additional imaging modality in paediatric oncological patients. 18F-FDG-PET is a functional imaging modality, using radioactive glucose to demonstrate hypermetabolism in malignant transformed cells. Therefore, it enables the visualisation of the primary tumour, helps with the search for metastases, and leads to exact tumour staging. The first study focuses on combined 18F-FDG-PET/MR imaging in comparison to 18F-FDGPET or MR imaging alone for the detection of malignant lesions in a non-selected patient collective. In patients suffering from a variety of paediatric tumours, combined 18F-FDGPET/MR imaging proofed its utility in the primary diagnostic work-up. In the follow-up, 18FFDG-PET is recommended as single imaging modality due to its high specificity unless the malignancy is located in 18F-FDG-PET inaccessible regions such as the urinary tract, where unspecific radiotracer accumulation hides malignant transformed tissue. The focus of the second study is on 18F-FDG-PET as a diagnostic tool in children with peripheral neuroblastic tumours. Neuroblastomas are commonly visualized on the 123I-metaiodobenzylguanidine(123I-MIBG)-scintigraphy/single photon emission computer tomography (SPECT). However, a subgroup of neuroblastomas fails to accumulate the specific radiotracer 123I-MIBG. In this study, the non-specific radiotracer 18F-FDG demonstrated a high affinity to neuroblastoma and helped detecting malignant disease. In case of a discrepancy between 123I-MIBG scintigraphy/SPECT, MRI and clinical findings in patients with neuroblastic tumours, 18F-FDG is recommended in the primary diagnostic workup. In the follow-up of primary 123I-MIBG negative neuroblastic tumours, 18F-FDG-PET is sufficient as single imaging modality. To sum up, in both studies, 18F-FDG-PET combined with an additional imaging modality demonstrated to be indispensable in paediatric oncology for both the primary diagnostic work-up and the follow-up.