Pediatric PET Imaging

Pediatric PET Imaging

Pediatric PET Imaging

Martin Charron, MD, FRCP(C)

Professor, Department of Radiology, University of Toronto, Division Head of Nuclear Medicine, Head of Research for Diagnostic Imaging, Senior Associate Scientist, Research Institute, The Hospital for Sick Children, Toronto, Canada

Editor

Martin Charron, MD, FRCP(C) Professor, Department of Radiology University of Toronto

Division Head of Nuclear Medicine Head of Research for Diagnostic Imaging Senior Associate Scientist

Research Institute

The Hospital for Sick Children Toronto M5G 1X8

Canada

Library of Congress Control Number: 2005932082

ISBN-10: 0-387-28836-8 ISBN-13: 978-0387-28836-9 Printed on acid-free paper.

© 2006 Springer Science+Business Media, Inc.

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To my wife Teran, without whose love and support this book would not be possible and who is the better

part of me,

To my children Sophie, Claire, George, Annie, and Mimi for providing meaning to my life, To the memory of my dad who taught me what is

important,

To my mother who made me what I am and gave me the necessary patience to deal with the aforemen-

tioned kids!

Positron emission tomography (PET) has been at the forefront of func- tional and molecular imaging for a number of years. The future of diag- nostic imaging depends upon the ability to change from imaging anatomy to examining the processes at work in the body. The fact that there are now monographs examining particular aspects of PET, such as this book on the examination of children, speaks to the newly won maturity of PET. The authors are to be congratulated for the timely appearance of this volume.

In recent years, PET has transformed the contributions of nuclear medicine to the diagnosis, staging, and follow-up of patients with cancer. Children with cancer deserve the very best and most compas- sionate care that society can provide. Ultimately the greatest compas- sion we can offer as physicians is to provide the best possible care.

Those charged with creating public policy in the context of diagnostic medicine must make common cause with physicians and other scien- tists to ensure that that best possible care is realized at the bedside. All of the evidence suggests that PET is central to such optimal cancer care.

In addition to the distinguished cast of physicians and researchers who contributed to this book, I welcome the contributions from tech- nologists who are a key part of the interaction between the diagnostic process and the sick or potentially sick child. Good care is contingent upon putting parents and child at ease, and the technologist has a lead role in this.

Scientists, working alongside physicians and physician-scientists, have done much to ensure that PET continues to evolve in at least two directions. One direction is the technical development of imag- ing devices, particularly in the form of hybrid detector systems to image both biochemistry and morphology simultaneously; combined positron emission and x-ray computed tomography (PET-CT) is an example of this. In another direction, new radio-labeled molecular probes are emerging that will take PET beyond the mapping of regional glucose metabolism. PET will continue to evolve in ways we can now see but dimly. The inherent power of PET is represented for me by the fact that it has been the first technology in diagnostic imaging to serve

vii

Foreword I

not only in the diagnosis of individual patients but also to address the wider issue of our understanding of disease mechanisms and the local- ization of biochemical events in the living body.

Pediatric PET Imaging clearly represents the importance of PET. The reader will be enriched with useful clinical information for daily prac- tice and alerted to recent developments so as to be in a position to anti- cipate and benefit from evolution in a field that is in a constant process of change.

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. I have no doubt that 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. I am sure my colleagues will join me in welcoming Pediatric PET Imaging as a timely synthesis of our current knowledge in pediatric PET, coming as it does at the cusp of so much progress in diagnostic methods and in our ability to image disease.

Brian Lentle, MD

Emeritus Professor of Radiology

University of British Columbia

viii Foreword I

Foreword II

While the importance of PET in the understanding of physiologic and pathological conditions in adults has been well described, this is the first book to be published concerning the importance of PET imaging in pediatric patients.

The use of PET in medicine is a relatively recent development. In 1968 Kuhl and Edwards at the University of Pennsylvania introduced the concept of emission tomography and built a device to measure the regional distribution of single gamma emitters. In 1975 Ter-Pogossian and colleagues at Washington University described the first instrument designed to image positron emitting radioligands. Interest in using short-lived positron emitters for the study of biologic functions in humans was greatly enhanced by the development of the

C- deoxyglucose method for measuring region cerebral glucose metabo- lism (rCMRgl) autoradiographically in animals by Sokoloff and colleagues at the National Institute of Mental Health and Reivich at the University of Pennsylvania in 1977. It was clear that adapting this method to studies in humans offered great potential, and in late 1973 Reivich, Kuhl, and Alavi discussed the possibility of labeling deoxy- glucose with a gamma-emitting radionuclide for measuring rCMRgl in humans. We contacted Alfred Wolf at Brookhaven National Laboratory, and at a joint meeting in December 1973 Wolf suggested using

F to label the glucose analogue fluorodeoxyglucose (FDG) because of its rel- atively long half-life and its low positron energy. By 1975,

F-FDG was successfully synthesized by Ido in Wolf’s laboratory in sufficient quan- tity to be shipped to the University of Pennsylvania for human studies.

In preparation for these studies, the Mark IV scanner at the University of Pennsylvania was equipped with high-energy collimators to image the

Kev gamma rays emitted by

F-FDG. In August of 1976, the first study of rCMRgl in humans was performed at the University of Pennsylvania. The development of the

F-FDG method for the mea- surement of regional cerebral glucose metabolism in humans, together with the method for the measurement of regional cerebral blood flow using

O labeled water pioneered by Herscovitch, Raichle and co- investigators in 1983 gave birth to functional imaging of the human

ix

brain. Since then, hundreds of tracers labeled with positron-emitting radionuclides have been developed to measure various physiologic and biochemical processes in the human body. In recognition of the stimulus provided to this field, FDG was nominated as the “molecule of the century” by Henry Wagner in 1996 at the meeting of the Society of Nuclear Medicine. FDG continues to be the most widely used PET tracer.

Pediatric PET Imaging amply documents the great importance that these developments have had in the field of pediatrics. The application of PET methodology to pediatric patients has expanded our under- standing of disorders ranging from attention deficit hyperactivity dis- order, learning disorders, and neuropsychiatric disorders to epilepsy, central nervous system tumors, cardiac disorders, and infectious processes, among others. This book is extremely informative for health care professionals caring for children with these conditions including nuclear medicine technologists performing the PET scan, researchers preparing a proposal utilizing PET in the pediatric population, nuclear medicine physicians interpreting the PET scan, and clinicians treating the patients.

Martin Reivich, MD

Emeritus Professor

University of Pennsylvania

x Foreword II

Preface

Positron emission tomography (PET), a powerful research tool 20 years ago, has recently gained widespread application in oncology and is now a procedure clinically available on each continent. Despite the fact only a few PET centers are dedicated to children, data from Children’s Oncology Group indicate that virtually all children in North America have easy access to a PET center. As the table of contents of this book indicates, clinical and research applications of PET for children with cancer represent only a fraction of the current pediatric uses for PET technology. Small animal PET scanners are now available commercially as there has been tremendous interest in applying PET technology to in vivo imaging of animal models.

PET can dynamically image trace amounts of radiopharmaceuticals in vivo. By applying appropriate tracer kinetic models, tracer concen- trations can be determined quantitatively. In addition to superior spatial resolution and quantitative potential, PET also offers much greater sensitivity (i.e., number of y-rays detected per unit injected dose) than single photon emission computed tomography (SPECT).

Furthermore, the biologic ubiquity of the elements that are positron emitters gives PET unprecedented power to image the distribution and kinetics of natural and analog biologic tracers. Because of the exquis- ite sensitivity of detection systems to y-ray emission, these biologic probes can be introduced in trace amounts (nano- or even picomolar concentrations) that do not disturb the biologic process under investi- gation. By combining a tracer that is selective for a specific biochemi- cal pathway, an accurate tracer kinetic model, and a dynamic sequence of quantitative images from the PET scanner, it is possible to estimate the absolute rates of biologic processes in that pathway. Examples of such processes that have been successfully measured with PET include regional cerebral and myocardial blood flow, rates of glucose utilization, rates of protein synthesis, cerebral and myocardial oxygen consumption, synthesis of neurotransmitters, enzyme assays, and receptor assays. In summary, some of the distinctive advantages of PET are its exquisite sensitivity, the flexible chemistry, and the better imaging characteristics of PET isotopes. Thus PET provides access to

xi

biological processes that is well beyond the scope of current MR technology.

Although FDG has been successfully and widely employed in oncol- ogy, it has not demonstrated significant uptake in some tumors in adults. Some other positron emitter tracers seem to be more promising.

Among the many radiopharmaceuticals that show great potential is the serotonin precursor 5-hydroxytryptophan (5-HTP) labeled with 11C, which shows increased uptake in carcinoids. Another radiopharma- ceutical in development for PET is 11C L-DOPA, which seems to be useful in visualizing endocrine pancreatic tumors such as Hyper- insulinism (Chapter 26).

PET is now widely used in children in most health care institutions in North America, Europe, and Asia. When an imaging modality is used routinely in children, it usually implies that it has reached a certain maturity, that the modality in question has achieved wide- spread recognition in the clinical field by peers. Yet there are no PET books available to pediatricians that offer a comprehensive review of diseases and/or issues specific to children. Often those diseases are not reviewed in sufficient details in “adult textbooks,” and issues specific to children not discussed at all (e.g., sedation, dosage). The goal of this text is to fill those gaps. We did a comprehensive review of all clinical and research applications of PET in children and gathered a distin- guished cast of authorities from the Americas, Europe, and Australia to summarize their experience with PET and to perform exhaustive reviews of the literature in their areas of interest. Although this book focuses on practical applications, it includes detailed reviews of current and future research applications.

Pediatric PET Imaging offers a comprehensive review of practical issues specific to the pediatric population such as sedation, radiophar- maceutical dosage, approach to imaging children, and “tips” for tech- nologists. For those interested in the research applications of PET, the book also offers practical reviews of regulations, IRB requirements, ethical issues, and biological effects of low level radiation exposure.

The scope of the pathologies reviewed in this work is much wider than what is seen in the typical “adult textbook.” The physiopathology and the imaging findings of the most common cancers afflicting children are scrutinized. Many chapters of this book review non- oncological applications such as neurological and psychiatric diseases, some unique to children, some affecting both children and adults. Some chapters are thorough reviews of inflammation, or variants of it (FUO, IBD, and infection). New applications that appear to have the poten- tial to offer great clinical usefulness, such as imaging of hyperinsulin- ism, are included. Because the biodistribution of FDG and the “normal variants” are different in children, two imaging atlases are included to allow readers to become familiar with those idiosyncrasies.

The book also reviews principles of operations and instrumentation challenges specific to children. A chapter is dedicated to coincidence imaging, as some of us do not have access to dedicated PET imaging.

(One could also foresee similar imaging findings with coincidence

imaging and Tc99 –glucose scanning, which may become a viable alter-

xii Preface

native to PET imaging in some precise clinical applications.) Finally, there are also expert reviews of multimodality imaging such as PET/CT and PET/MR.

Pediatric PET Imaging addresses typical concerns about imaging chil- dren and will be useful to the nuclear medicine physician who sees an occasional pediatric patient in his/her clinical practice. This book may also become a bedside reference for nuclear physicians and radiologists who practice only pediatric imaging. The book is also designed to be useful to all pediatricians, especially oncologists and radiation thera- pists, clinicians, or researchers looking to learn how the many recent imaging innovations in PET can influence their own areas of interests.

Finally, this book offers a comprehensive review of research issues valuable to scientists.

PET will offer many new solutions to current and future problems of medicine. As a scientific community, we need to ensure that the current or proposed uses of PET are evaluated with the greatest accu- racy, rigor, and appropriateness within the inherent limits of our current economic infrastructure. One of our many ethical challenges is to choose which pathology should first be scrutinized.

As PET technology continues to mature, we are seeing the beginning of a powerful merger among biology, pharmacology, and imaging, and with it the true birth of in vivo biologic imaging. Because of the flexi- ble chemistry inherent to positron emitting isotopes, PET is vested with tremendous potential to evaluate the physiopathology of pediatric diseases.

Martin Charron, MD, FRCP(C) Toronto, Canada

Preface xiii

Contents

xv

Foreword I by Brian Lentle . . . . vii

Foreword II by Martin Reivich . . . . ix

Preface . . . . xi

Contributors . . . . xix

Section 1 Basic Science and Practical Issues 1 The Nuclear Imaging Technologist and the Pediatric Patient . . . . 3

Maria Green 2 Sedation of the Pediatric Patient . . . . 21

Robin Kaye 3 The Biologic Effects of Low-Level Radiation . . . . 30

Martin Charron 4 Dosage of Radiopharmaceuticals and Internal Dosimetry . . . . 37

Xiaowei Zhu 5 Pediatric PET Research Regulations . . . . 47

Geoffrey Levine 6 Issues in the Institutional Review Board Review of PET Scan Protocols . . . . 59

Robert M. Nelson 7 Ethics of PET Research in Children . . . . 72

Suzanne Munson, Neir Eshel, and Monique Ernst

8 Physics and Instrumentation in PET . . . . 92 Roberto Accorsi, Suleman Surti, and Joel S. Karp

9 How to Image a Child by

PET–Computed Tomography . . . . 121 Sue C. Kaste and M. Beth McCarville

10 Coincidence Imaging . . . . 135 Girish Bal, Stefaan Vandenberghe, and Martin Charron

Section 2 Oncology

11 Brain Tumors . . . . 175 Michael J. Fisher and Peter C. Phillips

12 Lymphoma . . . . 220 Christopher J. Palestro, Josephine N. Rini, and Maria B. Tomas

13 Neuroblastoma . . . . 243 Barry L. Shulkin

14 Wilms’ Tumor . . . . 256 Sue C. Kaste and Jeffrey S. Dome

15 Primary Bone Tumors . . . . 267 Robert Howman-Giles, Rodney J. Hicks, Geoffrey McCowage, and David K. Chung

16 Soft Tissue Sarcomas . . . . 302 Marc P. Hickeson

17 Other Tumors . . . . 312 Jian Qin Yu and Martin Charron

Section 3 Neurology and Psychiatry

18 The Developing Brain . . . . 323 Lorcan A. O’Tuama and Paul R. Jolles

19 Neurodevelopmental and

Neuropsychiatric Disorders . . . . 334 Marianne Glanzman and Josephine Elia

20 Epilepsy . . . . 361 Nicolaas I. Bohnen and James M. Mountz

21 Neurotransmitter Imaging . . . . 385 Alan J. Fischman and Rajendra D. Badgaiyan

xvi Contents

Section 4 Other Applications

22 Cardiovascular Applications . . . . 407 Miguel Hernandez-Pampaloni

23 Fever of Unknown Origin . . . . 428 Hongming Zhuang and Ghassan El-Haddad

24 Infection and Inflammation . . . . 448 Marc P. Hickeson

25 Inflammatory Bowel Disease . . . . 461 Jean-Louis Alberini and Martin Charron

26A Hyperinsulinism of Infancy: Noninvasive

Differential Diagnosis . . . . 472 Maria-João Santiago-Ribeiro, Nathalie Boddaert,

Pascale De Lonlay, Claire Nihoul-Fekete, Francis Jaubert, and Francis Brunelle

26B Hyperinsulinism of Infancy: Localization of

Focal Forms . . . . 479 Olga T. Hardy and Charles A. Stanley

27 Multimodal Imaging Using PET and MRI . . . . 485 Thomas Pfluger and Klaus Hahn

28 Current Research Efforts . . . . 502 Fabio Ponzo and Martin Charron

Section 5 Imaging Atlas

29 PET–Computed Tomography Atlas . . . . 527 M. Beth McCarville

30 Common Artifacts on PET Imaging . . . . 543 Peeyush Bhargava and Martin Charron

Index . . . . 565

Contents xvii

xvii

Contributors

Roberto Accorsi, PhD

Research Scientist, Nuclear Medicine, Children’s Hospital of Philadel- phia, Philadelphia, PA 19104, USA

Jean-Louis Alberini, MD

Nuclear Medicine Department, Cancer Research Center R. Huguenin, 92210 Saint-Cloud, France

Rajendra D. Badgaiyan, PhD, MD

Assistant Professor, Department of Radiology, Harvard University, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA

Girish Bal, PhD

Post-Doctorial Fellow, Nuclear Medicine, Department of Radiol- ogy, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA

Peeyush Bhargava, MD

Assistant Professor, Department of Radiology, Columbia University College of Physicians and Surgeons, Attending in Nuclear Medicine, St. Luke’s Roosevelt Hospital Center, New York, NY 10019, USA

Nathalie Boddaert, MD, PhD

Service de Radiologie Pédiatrique, Hôpital Necker-Enfants Malades, 75015 Paris, France

Nicolaas I. Bohnen, MD, PhD

Associate Professor, Departments of Radiology and Neurology, Divi- sion of Nuclear Medicine, University of Michigan, Ann Arbor, MI 48109, USA

xix

Francis Brunelle, MD

Professor and Chairman, Department of Radiology, Service de Radi- ologie Pédiatrique, Hôpital Necker-Enfants Malades, 75015 Paris, France

Martin Charron, MD, FRCP(C)

Professor, Department of Radiology, University of Toronto, Division Head of Nuclear Medicine, Head of Research for Diagnostic Imaging, Senior Associate Scientist, Research Institute, The Hospital for Sick Children, Toronto M5G 1X8, Canada

David K. Chung, BSc (Med), MB BS, FRACP, DDU, DCH

Physician, Department of Nuclear Medicine, The Children’s Hospital at Westmead, Sydney, Australia

Pascale De Lonlay, MD, PhD

Département de Métabolisme et Pédiatrie, Hôpital Necker-Enfants Malades, 75015 Paris, France

Jeffrey S. Dome, MD

Associate Member, Department of Hematology-Oncology, St. Jude Faculty, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA

Ghassan El-Haddad, MD

Chief Fellow, Nuclear Medicine Training Program, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA

Josephine Elia, MD

Assistant Professor, Department of Psychiatry, University of Pennsylvania, Medical Co-Director of the ADHD Center, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA

Monique Ernst, MD, PhD

Staff Clinician, National Institute of Mental Health, Section of Devel- opmental and Affective Neuroscience, Bethesda, MD 20892, USA

Neir Eshel

Undergraduate Student (Class of 2007), Princeton University, Bethesda, MD, USA

Alan J. Fischman, MD

Associate Professor, Department of Radiology, Harvard University, Massachusetts General Hospital Nuclear Medicine, Boston, MA 02114, USA

Michael J. Fisher, MD

Assistant Professor, Department of Pediatrics, University of Pennsylvania, Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA

xx Contributors

Marianne Glanzman, MD

Clinical Associate Professor, Department of Pediatrics, University of Pennsylvania School of Medicine, Division of Child Development and Rehabilitation, Children’s Seashore House of the Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA

Maria Green, RTNM

Team Leader, Nuclear Medicine, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto M5G 1X8, Canada

Klaus Hahn, MD

Professor, Head of the Department of Nuclear Medicine, University of Munich, Ludwig-Maximilians-University of Munich, D-80336 Munich, Germany

Olga T. Hardy, MD

Fellow, Departments of Endocrinology and Diabetes; Children’s Hospital of Philadelphia, Core Laboratory, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA

Miguel Hernandez-Pampaloni, PhD

Research Assistant Professor, Department of Nuclear Medicine, University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA

Marc P. Hickeson, MD

Assistant Professor, Department of Radiology, Division of Nuclear Medicine, McGill University, Royal Victoria Hospital, Montreal H3A 1A1, Canada

Rodney J. Hicks, MB BS (Hons), MD, FRACP

Professor, Department of Medicine, St. Vincent’s Medical School, The University of Melbourne, Director, Center for Molecular Imaging, The Peter MacCallum Cancer Center, East Melbourne, Victoria, Australia

Robert Howman-Giles, MB BS, MD, FRACP, DDU

Clinical Associate Professor, Departments of Nuclear Medicine and Pediatrics and Child Health, The Children’s Hospital at Westmead, University of Sydney, Sydney, Australia

Francis Jaubert, MD, PhD

Laboratoire de Anatomopathologie, Hôpital Necker-Enfants Malades, 75015 Paris, France

Paul R. Jolles, MD

Associate Professor, Department of Radiology, Director, Nuclear Medi- cine Residency Program, Virginia Commonwealth University Health System and Medical College of Virginia Hospitals, Richmond, VA 23298, USA

Contributors xxi

Joel S. Karp, PhD

Professor, Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA

Sue C. Kaste, DO

Member, Departments of Radiological Sciences and Hematology- Oncology, St. Jude Faculty, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA

Robin Kaye, MD

Assistant Professor, Department of Radiology, University of Pennsylvania, Chief, Interventional Radiologist, Children’s Hospital of Pennsylvania, Philadelphia, PA 19104, USA

Geoffrey Levine, PhD, RPh, BCNP (Ret.)

Associate Professor, Departments of Radiology and Pharmaceutical Sciences, University of Pittsburgh, Schools of Medicine and Pharmacy, Director of Nuclear Pharmacy, Presbyterian University Hospital of the University of Pittsburgh Medical Center, Clinical Director of the Monoclonal Antibody Imaging Center, Pittsburgh Cancer Institute, Pittsburgh, PA 15213, USA

M. Beth McCarville, MD

Assistant Member, Department of Radiological Sciences, St. Jude Faculty, St. Jude Children’s Research Hospital, Division of Diagnostic Imaging, Memphis, TN 38105, USA

Geoffrey McCowage, MB BS, FRACP

Senior Staff Specialist, Department of Oncology, The Children’s Hos- pital at Westmead, Sydney, Australia

James M. Mountz, MD, PhD

Associate Professor, Departments of Neurology and Radiology, Uni- versity of Pittsburgh Medical Center, Children’s Hospital of Pittsburgh, Pittsburgh, PA 15213, USA

Suzanne Munson, BA

Medical Student (Class of 2007), Virginia Commonwealth University School of Medicine, Medical College of Virginia, Richmond, VA, USA

Robert M. Nelson, MD, PhD

Associate Professor, Departments of Anesthesiology, Pediatrics and Critical Care Medicine, University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA

Claire Nihoul-Fekete, MD, PhD

Départment de Chirurgie Infantile, Hôpital Necker-Enfants Malades, 75015 Paris, France

xxii Contributors

Lorcan A. O’Tuama, MD

Professor, Departments of Radiology, Neuroradiology, and Nuclear Medicine, Virginia Commonwealth University Health System and Medical College of Virginia Hospitals, Richmond, VA 23298, USA

Christopher J. Palestro, MD

Professor, Departments of Nuclear Medicine and Radiology, Albert Einstein College of Medicine, Bronx, New York, Chief of Nuclear Medi- cine, Long Island Jewish Medical Center, New Hyde Park, NY 11040, USA

Thomas Pfluger, MD

Associate Professor, Department of Nuclear Medicine, Ludwig- Maximilians-University of Munich, D-80336 Munich, Germany

Peter C. Phillips, MD

Professor, Departments of Neurology and Oncology, University of Pennsylvania, Director of Neuro-Oncology Programs, Children’s Hos- pital of Philadelphia, Philadelphia, PA 19104, USA

Fabio Ponzo, MD

Assistant Professor, Department of Radiology, New York University School of Medicine, Nuclear Medicine, New York University Medical Centers, New York, NY 10016, USA

Josephine N. Rini, MD

Assistant Professor, Departments of Nuclear Medicine and Radiology, Albert Einstein College of Medicine, Bronx, New York, Attending Physician Nuclear Medicine, Long Island Jewish Medical Center, New Hyde Park, NY 11040, USA

Maria-João Santiago-Ribeiro, MD, PhD

Service Hospitalier Frédéric Joliot, Département de Recherche Médi- cale Direction des Sciences du Vivant, Commissariat à l’Energie Atom- ique, 91400 Orsay, France

Barry L. Shulkin, MD, MBA

Chief, Division of Nuclear Medicine, Department of Radiological Sciences, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA

Charles A. Stanley, MD

Professor, Division of Endocrinology, Department of Pediatrics, Uni- versity of Pennsylvania, Chief, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA

Suleman Surti, PhD

Assistant Professor, Department of Radiology, Hospital of the Univer- sity of Pennsylvania, Philadelphia, PA 19104, USA

Contributors xxiii

Maria B. Tomas, MD

Assistant Professor, Departments of Nuclear Medicine and Radiology, Albert Einstein College of Medicine, Bronx, New York, Attending Physician Nuclear Medicine, Long Island Jewish Medical Center, New Hyde Park, NY 11040, USA

Stefaan Vandenberghe, PhD

Clinical Site Researcher, Philips Research, USA, Department of Radiol- ogy (PET Instrumentation Group), University of Pennsylvania, Philadelphia, PA 19104, USA

Jian Qin Yu, MD

Nuclear Medicine Fellow, Department of Radiology, Hospital of University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, PA 19107, USA

Xiaowei Zhu, MS, DABMP

Director, Departments of Radiology Physics and Engineering, Chil- dren’s Hospital of Pennsylvania, Philadelphia, PA 19104, USA

Hongming Zhuang, MD, PhD

Assistant Professor, Department of Radiology, Attending Physician, Nuclear Medicine Service, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA

xxiv Contents