الفهرس 
General Highlights on Pediatric OncologyOnly 14 pages are availabe for public view
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Abstract
Children with cancer deserve the very best and most
compassionate care that society can provide. Those charged
with creating public policy in the content of diagnostic
medicine must make common cause with physicians and other
scientists to ensure that the best possible care is realized at the
bedside. It has been said that developments in molecular
biology and genomics will cause medicine to change more in
the next few decades than it has over the past several centuries.
moreover, PET will have an important role to play at the
”bedside” in realizing the benefits of our growing understanding
of the molecular basis of disease and its treatment.
PET is emerging as an important diagnostic imaging tool
in the evaluation of pediatric cancers together with the recent
event of dual-modality. It is important to consider potential
causes of misinterpretation of FDG-PET that relate to
physiologic variations in FDG distribution in children. These
include a more extensive distribution of hematopoietic marrow
than in adults and the occurrence of high FDG uptake in the
thymus, in the adenoids and tonsils, and in the skeletal growth
centers. Particularly those of the long bone physes. Other
potential pitfalls. similar to those in adults, include variable
FDG uptake in working skeletal muscles, brown fat,
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myocardium, thyroid gland, and gastrointestinal tract, as well as
accumulation of excreted FDG in the renal pelvis, ureter, and
bladder, and possible tracer accumulation in draining lymph
nodes from extravagated tracer at the time of intravenous tracer
administration. Diffuse increased bone marrow and splenic
FDG uptake after the administration of hematopoietic
stimulating factors also may resemble disseminated metastatic
disease.
PET/CT imaging systems that has added unprecedented
diagnostic capability by revealing the precise anatomical
localization of metabolic information and metabolic
characterization of normal and abnormal structures in a single
study. The use of CT transmission scanning for attenuation
correction has shortened the total acquisition time, which is an
especially desirable attribute in pediatric imaging.
It was shown that most tumors in children are
metabolically active and thus concentrate and retain FDG,
FDG-PET and FDG-PET/CT provide useful diagnostic and
staging information in individual tumor types, it plays a total
role in the clinical management and care of children with cancer
as it adds a new dimension to response and risk assessment in
pediatric tumors. There is potential not only to improve the
outcomes of suboptimally responding patients through earlier
intervention but also to spare low risk patients from aggressive
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130
treatments. Treatment plan to the individual patient is based on
the PET/CT result should be feasible.
PET/CT exhibits significantly higher sensitivity,
specificity, and accuracy than conventional imaging (CT). It has
led to important changes in the clinical management of
lymphoma (32%), brain tumors (15%) and sarcomas (13%).
Radiation exposure should be fully considered in
examinations of pediatric patients. The injection dose of 18FFDG
and the tube current of the CT portion of PET/CT are
adjusted according to the patient’s weight. Thus, the total
radiation dose per examination was lower in pediatric
population than that in adult patients, while the image quality of
the PET or CT portion in each examination was kept sufficient.
However, reduction of radiation dose per examination may be
necessary, if applicable in pediatric patients requiring repeated
imaging evaluation, such as patient’s with lymphoma