Background. Tumors in the brain and spinal cord are among the most common causes of death and
disability by cancer in children and adolescents. MRI is used for primary diagnosis as well
as follow-up but is often challenged by tissue changes caused by the treatment. The amino
acid analog 18F-FET is used increasingly in adults to delineate tumor and discriminate tumor
from treatment effects. A hybrid PET/MRI scanner enables the simultaneous imaging with PET
and MRI, which is important in especially the younger children needing anaesthesia to
cooperate to the procedure.
Aim The aim of the study is to compare diagnostics using MRI alone with 18F-FET PET/MRI (or
sequential MRI and PET) in children and adolescents diagnosed with a central nervous system
(CNS) tumor before the age of 18 years. The scans will be performed at primary
diagnosis/before operation/biopsy, within 72 hours after operation, planning radiation
therapy, evaluation of treatment effect, when relapse is suspected.
Exclusion criteria are MRI contraindications, pregnancy, or a syndrome with increased
sensitivity to radiation.
The investigators wish to evaluate which cases and for which tumor types, 18F-FET PET/MRI
will increase sensitivity and specificity of diagnosing CNS tumors.
Side effects The side effects are mainly the side effect from the MRI with venous puncture,
the MRI contrast leading that can lead to shortlived nausea or headache, fasting for 6 hours
and the radioactivity exposure of 4.2 mSv (1,4 times the early background radiation) for each
scan procedure. The maximal number of scans in the project is 3, 6 or 10 depending on the
Data Analysis The correlation between 18F-FET uptake in tumor and tumor grading (obtained
from operation/biopsy) will be investigated.
When relapse is suspected, sensitivity and specificity for recurrence/progression for MRI
alone versus PET/MRI will be compared.
It will be analysed if the addition of PET influences the diagnosis/chosen treatment. A major
impact of 6% will be regarded significant.
The prognostic value of 18F-FET uptake after treatment will be investigated.