Protocol requirements and diagnostic value of PET/MR imaging for liver metastasis detection

Reiner, Caecilia S.; Stolzmann, Paul; Husmann, Lars; Burger, Irene A.; Hüllner, Martin; Schaefer, Niklaus; Schneider, Paul M.; Schulthess, Gustav K. von; Veit-Haibach, Patrick

doi:10.1007/s00259-013-2654-x

Cited by 73 publications

(44 citation statements)

References 29 publications

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“…2). The value of incorporating DWI into whole-body staging protocols has already been demonstrated for the metastatic evaluation of organs with high background FDG uptake [14] and for the initial staging of newly diagnosed lymphoma [15]. Overall, our observations, in conjunction with the results of these other studies, indicate that DWI may play an important role in making sense of otherwise indeterminate PET findings.…”

Section: Discussionsupporting

confidence: 75%

Indeterminate Findings on Oncologic PET/CT: What Difference Does PET/MRI Make?

Fraum

Fowler

McConathy

et al. 2016

Nucl Med Mol Imaging

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Background Positron emission tomography/computed tomography (PET/CT) with 2-deoxy-2-[ 18 F]fluoro-D-glucose (FDG) has become the standard of care for the initial staging and subsequent treatment response assessment of many different malignancies. Despite this success, PET/CT is often supplemented by MRI to improve assessment of local tumor invasion and to facilitate detection of lesions in organs with high background FDG uptake. Consequently, PET/MRI has the potential to expand the clinical value of PET examinations by increasing reader certainty and reducing the need for subsequent imaging. This study evaluates the ability of FDG-PET/MRI to clarify findings initially deemed indeterminate on clinical FDG-PET/CT studies. Methods A total of 190 oncology patients underwent whole-body PET/CT, immediately followed by PET/MRI utilizing the same FDG administration. Each PET/CT was interpreted by our institution's nuclear medicine service as a standard-of-care clinical examination. Review of these PET/CT reports identified 31 patients (16 %) with indeterminate findings. Two readers evaluated all 31 PET/CT studies, followed by the corresponding PET/MRI studies. A consensus was reached for each case, and changes in interpretation directly resulting from PET/MRI review were recorded. Interpretations were then correlated with follow-up imaging, pathology results, and other diagnostic studies.Results In 18 of 31 cases with indeterminate findings on PET/CT, PET/MRI resulted in a more definitive interpretation by facilitating the differentiation of infection/inflammation from malignancy (15/18), the accurate localization of FDGavid lesions (2/18), and the characterization of incidental non-FDG-avid solid organ lesions (1/18). Explanations for improved reader certainty with PET/MRI included the superior soft tissue contrast of MRI and the ability to assess cellular density with diffusion-weighted imaging. The majority (12/18) of such cases had an appropriate standard of reference; in all 12 cases, the definitive PET/MRI interpretation proved correct. These 12 patients underwent six additional diagnostic studies to clarify the initial indeterminate PET/ CT findings. In the remaining 13 of 31 cases with indeterminate findings on both PET/CT and PET/MRI, common reasons for uncertainty included the inability to distinguish reactive from malignant lymphadenopathy (4/13) and local recurrence from treatment effect (2/13). Conclusions Indeterminate PET/CT findings can result in equivocal reads and additional diagnostic studies. PET/MRI may reduce the rate of indeterminate findings by facilitating better tumor staging, FDG activity localization, and lesion characterization. In our study, PET/ MRI resulted in more definitive imaging interpretations with high accuracy. PET/MRI also showed potential in reducing the number of additional diagnostic studies prompted by PET/CT findings. Our results suggest that whole-body PET/MRI provides certain diagnostic advantages over PET/CT, promotes more definitive imaging interpretations, and m...

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Section: Discussionsupporting

confidence: 75%

Indeterminate Findings on Oncologic PET/CT: What Difference Does PET/MRI Make?

Fraum

Fowler

McConathy

et al. 2016

Nucl Med Mol Imaging

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“…In accordance with these results, a study by Beiderwellen et al (31) on 70 patients undergoing PET/ CT and simultaneously acquired PET/ MRI, showed higher lesion conspicuity, as well as diagnostic confidence, using PET/MRI. These results were confirmed by Reiner et al (32) who reported on 55 patients with suspected liver metastases undergoing PET/CT and PET/MRI using a trimodality system. The authors found that PET/MRI had significantly higher diagnostic confidence in comparison to contrast-enhanced PET/CT.…”

Section: Oncologysupporting

confidence: 80%

Clinical applications of PET/MRI: current status and future perspectives

Nensa

Beiderwellen²,

Heusch³

et al. 2014

Diagn Interv Radiol

110

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Fully integrated positron emission tomography (PET)/magnetic resonance imaging (MRI) scanners have been available for a few years. Since then, the number of scanner installations and published studies have been growing. While feasibility of integrated PET/MRI has been demonstrated for many clinical and preclinical imaging applications, now those applications where PET/MRI provides a clear benefit in comparison to the established reference standards need to be identified. The current data show that those particular applications demanding multiparametric imaging capabilities, high soft tissue contrast and/or lower radiation dose seem to benefit from this novel hybrid modality. Promising results have been obtained in whole-body cancer staging in non-small cell lung cancer and multiparametric tumor imaging. Furthermore, integrated PET/MRI appears to have added value in oncologic applications requiring high soft tissue contrast such as assessment of liver metastases of neuroendocrine tumors or prostate cancer imaging. Potential benefit of integrated PET/ MRI has also been demonstrated for cardiac (i.e., myocardial viability, cardiac sarcoidosis) and brain (i.e., glioma grading, Alzheimer's disease) imaging, where MRI is the predominant modality. The lower radiation dose compared to PET/computed tomography will be particularly valuable in the imaging of young patients with potentially curable diseases. However, further clinical studies and technical innovation on scanner hard-and software are needed. Also, agreements on adequate refunding of PET/MRI examinations need to be reached. Finally, the translation of new PET tracers from preclinical evaluation into clinical applications is expected to foster the entire field of hybrid PET imaging, including PET/MRI. B oth positron emission tomography (PET) and magnetic resonance imaging (MRI) are well-established imaging modalities that have been clinically available for more than 30 years. However, the combination of PET and computed tomography (CT) into PET/CT has heralded a new era of hybrid imaging driven by the rapid ascend of PET/CT and the decline of stand-alone PET. The integration of PET and CT into a hybrid system provided added value that exceeds the sum of its parts, in particular fast and accurate attenuation correction and the combination of anatomical and molecular information.Inspired by the vast success of PET/CT, the combination of PET and MRI was an obvious goal. Therefore initial solutions comprised the software based co-registration and post-hoc fusion (1) of independently acquired PET and MRI data, as well as shared tabletop sequential PET and MRI acquisition (2, 3). While the integration of PET and CT into a hybrid system was challenging but technically feasible, the integration of PET and MRI was considered extremely demanding, if not impossible. Two main technical challenges that had to be solved: in the first place development of a PET insert that is compatible to high magnetic field strengths normally used in MRI, and vice versa development ...

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“…PET-MR imaging with T1-weighted (T1w) or T2w sequences or both results in similar diagnostic accuracy for the detection of liver metastases compared with PET/CE-CT. To significantly improve the characterization of liver lesions, however, the use of dynamic CE imaging was still recommended. 14 In our preliminary experience with PET-MR and liver lesions, we observe even further advantageous aspects of PET-MR compared with standard-of-care imaging. PET-MR has become a very helpful tool in comprehensively assessing CRC, more precisely rectal cancer, in which MRI plays an essential role for local staging.…”

Section: Secondary Malignant Disease To the Livermentioning

confidence: 91%