Comparison of PET-CT and conventional imaging in staging pediatric rhabdomyosarcoma

Sara M. Federico, Sheri L. Spunt, Matthew J. Krasin, Catherine A. Billup, Jianrong Wu, Barry Shulkin, Gerald Mandell, M. Beth Mccarville

Research output: Contribution to journalArticlepeer-review

89 Scopus citations


Background: Over the past decade, PET-CT has been used to assess rhabdomyosarcoma (RMS) in children. However, the role of PET-CT in staging RMS is unknown. Procedure: Thirty subjects with RMS, median age 7.3 years, underwent PET-CT before therapy. PET-CTs and conventional imaging (CI) were independently reviewed by two radiologists and two nuclear medicine physicians to determine the presence of metastases. Accuracy, sensitivity, and specificity of PET-CT for detecting metastases were compared to CI using biopsy and clinical follow-up as reference standards. Maximum standardized uptake values (SUVmax) of primary tumors, lymph nodes, and pulmonary nodules were measured. Results: Primary tumors had an average SUVmax of 7.2 (range, 2.5-19.2). Accuracy rates for 17 subjects with nodal disease were 95% for PET-CT and 49% for CI. PET-CT had 94% sensitivity and 100% specificity for nodal disease. Of seven pulmonary nodules detected by CI, three were not identified by PET-CT, two were indeterminate, and one was malignant with a SUVmax (3.4)>twice that of benign nodules. Two subjects had bone disease; both were identified by PET-CT but only one by CI. Four subjects had bone marrow disease, two had positive PET-CTs but none had positive CI. Two subjects had soft tissue metastases detected by PET-CT but not CI. Conclusions: PET-CT performed better than CI in identifying nodal, bone, bone marrow, and soft tissue disease in children with RMS. CI remains essential for detection of pulmonary nodules. We recommend PET-CT for staging of children with RMS. CI with Tc99m bone scan can be eliminated.

Original languageEnglish
Pages (from-to)1128-1134
Number of pages7
JournalPediatric Blood and Cancer
Issue number7
StatePublished - Jul 2013


  • Conventional imaging
  • Diagnosis
  • PET-CT
  • Rhabdomyosarcoma
  • Staging

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology


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