PET Review in Respect to Pediatric Neuroblastoma

Running Head: PET REVIEW IN RESPECT TO PEDIATRIC NEUROBLASTOMA
PET REVIEW IN RESPECT TO PEDIATRIC NEUROBLASTOMA
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PET REVIEW IN RESPECT TO PEDIATRIC NEUROBLASTOMA1
Introduction
Skeletal metastases results from the invasion of tumor into the bone. It causes severe
bone pain, fractures, instability of the spinal cord and rapid decrease in the mobility of the
patient. Neuroblastoma is one of the primary malignancies that leads to the skeletal
metastases in neonates. In children it is characterized by various clinical behavior as the
tumor progresses that often leads to death. Radiography plays an important part in the
analysis and diagnosis of the disease in neonates. Earlier there was use of conventional CT
scan techniques along with MRI in the primary treatment of the disease. Now-a-days PET
imaging techniques are used in order to check the bone deformities and abnormalities as it
becomes difficult to identify the morphological characters in plain radiographs or even in CT
scan or MRI (Marcin 2019).
Discussion
Normal or plain radiographs poses difficulties in the identification of skeletal
metastases during the early stages as there should be extensive loss of bone mineral before it
the loss on bone density becomes visible in radiography. The lesions are sometimes visible in
normal radiographs due to additional co-morbidities like destruction of the cortex, or the
presence of sclerosis that is visible (Marcin 2019). CT scan is an imaging tool used in
imaging that combines x-rays along with the computer technology so as to produce a more
detailed picture of the cross-sectional area of the body. However, CT scan plays no important
role in the preliminary assessment in the presence of metastases. MRI is another diagnostic
tool involved in imaging of the bone but unlike the CT scan it does not involve the use of
radiation. It uses high magnetic field as well as sophisticated computer that gives a high
resolution images of the bones and soft tissues (Chawla et al. 2010). MRI is useful in the
analysis of neuroblastoma as it produces high resolution images without using ionizing

PET REVIEW IN RESPECT TO PEDIATRIC NEUROBLASTOMA2
radiations. It is generally not used in children with neuroblastoma as the tool needs young
children to be sedated before the start of the imaging process because of its acquisition over a
long period of time.
A number of investigations are needed before the correct staging of the tumor. The
conventional techniques include plain radiographs or x-rays, ultrasound, CT scan or MRI.
These modalities often have own set of limitations as they can only delineate the structure or
the anatomy. Staging of the disease can be done by the functional imaging modalities. The
bone lytic lesions cannot be identified by the bone scan or normal radiographs. As
neuroblastoma involves evaluation of the bone and soft tissue use of MIBG along with PET
scan can be useful (Khembhavi et al. 2015). As PET scanning involves the entire body
without the use of invasive chemicals it has an added advantage as compared to that of CT or
MRI scan. The use of conventional imaging modalities in response to solid tumors in
neuroblastoma depends on the change in the size of the tumor can occur if the chemotherapy
is cytocidal. The role of positron emission tomography- computed tomography or PET-CT
has been generally used for detecting the initial stage, detection of treatment response and
evaluation of the chances of cancer recurrence. It can also show the changes in the various
stages of cancers. PET-CT has shown to detect early physiological and biochemical changes
that results from the effective therapy. Thus, it helps to lower the chances of the limitations in
the therapy based on the reduction in the size of the tumor (Chawla et al. 2010).
Positron Emission Technology or PET is a strong tool for the in vivo analysis of the
skeletal metastases in children (Rahim, Qi and Sossi 2013). In MRI or CT scan,
neuroblastoma is usually seen as a large, heterogeneous, lobulated solid mass that displaces
the adjacent organ. The tumor often shows calcification that can be detected by the PET
imaging. PET imaging is used extensively as compared to CT scan or MRI for detecting the
neuroblastoma in children due to higher accuracy of the technique (Piccardio et al. 2013). A