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Whole-Body MR Imaging for Detection of Bone Metastases in Children and Young Adults

Comparison with Skeletal Scintigraphy and FDG PET

Heike E. Daldrup-Link1,2, Christiane Franzius3, Thomas M. Link1,2, Daniela Laukamp1, Joachim Sciuk3, Heribert Jürgens4, Otmar Schober3 and Ernst J. Rummeny1,2

1 Department of Clinical Radiology, University Hospital of Münster, 48129 Münster, Germany.
2 Present address: Department of Radiology, Technical University of Munich, Ismaninger Str. 22, 81625 Munich, Germany.
3 Department of Nuclear Medicine, University Hospital of Münster, Münster, Germany.
4 Department of Pediatric Oncology, University Hospital of Münster, Münster, Germany.



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  		Fig. 1. —Representative whole-body MR images of 14-year-old boy with Langerhans' cell histiocytosis. Nine slabs of T1-weighted spin-echo images (TR/TE, 500/15) with 10-15 slices each cover head, upper spine, lower spine, thorax, abdomen, and upper and lower extremities. Lesion from Langerhans' cell histiocytosis is depicted in right femur (arrowhead).

 


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  		Fig. 2A. —6-year-old boy with rhabdomyosarcoma of right axillary region. Whole-body MR images using both short tau inversion recovery and spin-echo pulse sequences (TR/TE, 500/15) show only one lesion in metacarpal bone V of right hand (arrowheads) that was considered equivocal because of partial volume effects.

 


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  		Fig. 2B. —6-year-old boy with rhabdomyosarcoma of right axillary region. Skeletal scintigram confirmed lesion (arrowhead) in metacarpal bone V.

 


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  		Fig. 2C. —6-year-old boy with rhabdomyosarcoma of right axillary region. FDG PET scan shows lesion (arrowhead) in metacarpal bone V but also shows additional metastasis in capitate bone (arrow) that was verified by follow-up studies.

 


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  		Fig. 3A. —8-year-old girl with Ewing's sarcoma of pelvis. Whole-body MR image delineates primary tumor in right os ilium (arrowheads) and metastasis in fourth lumbar vertebra (arrow).

 


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  		Fig. 3B. —8-year-old girl with Ewing's sarcoma of pelvis. Skeletal scintigram shows primary tumor (arrowheads) but misses metastasis.

 


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  		Fig. 3C. —8-year-old girl with Ewing's sarcoma of pelvis. FDG PET scan detected both primary tumor (arrowheads) and metastasis in fourth lumbar vertebra (arrow).

 


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  		Fig. 4A. —3-year-old boy with Langerhans' cell histiocytosis that showed initial manifestation in left femur (not shown). T1-weighted MR image clearly delineates additional lesion (arrow) near left orbit.

 


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  		Fig. 4B. —3-year-old boy with Langerhans' cell histiocytosis that showed initial manifestation in left femur (not shown). Skeletal scintigram shows increased radionuclide uptake (arrowheads) in same region.

 


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  		Fig. 4C. —3-year-old boy with Langerhans' cell histiocytosis that showed initial manifestation in left femur (not shown). FDG PET scan shows high glucose metabolism in brain, but lesion in orbit could not be seen.

 


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  		Fig. 5A. —9-year-old boy with osteosarcoma of right humerus. T1-weighted MR image (A) and skeletal scintigram (B) do not exhibit any suspicious lesions of lower extremities.

 


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  		Fig. 5B. —9-year-old boy with osteosarcoma of right humerus. T1-weighted MR image (A) and skeletal scintigram (B) do not exhibit any suspicious lesions of lower extremities.

 


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  		Fig. 5C. —9-year-old boy with osteosarcoma of right humerus. FDG PET scan shows focally increased radionuclide accumulation in left tibia (arrowhead), which was not verified by clinical and imaging follow-up studies.

 

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