Value of fusion of PET and MRI for staging of endometrial cancer: Comparison with 18F-FDG contrast-enhanced PET/CT and dynamic contrast-enhanced pelvic MRI

Kitajima, Kazuhiro; Suenaga, Yusaku; Ueno, Yoshiko; Kanda, Tomonori; Maeda, Takeyasu; Takahashi, Satoru; Ebina, Yasuhiko; Miyahara, Yoshiya; Yamada, Hideto; Sugimura, Kazuro

doi:10.1016/j.ejrad.2013.05.005

Cited by 82 publications

(58 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These cases speak to the increased confidence and accuracy with which PET/MRI allows readers to exclude an underlying malignancy in an area of indeterminate FDG uptake, likely due largely to the intrinsically higher soft tissue contrast of MRI. Similarly, several other studies, citing the high soft tissue contrast of MRI, have already suggested that PET/MRI may outperform PET/CT in the initial local tumor (T) staging of head/neck squamous cell carcinoma [8] and gynecologic malignancy [3,9], as well as in detecting intra-pelvic recurrence of gynecologic tumors [10] and diagnosing osseous metastases from various primary tumors [11]. This particular advantage of MRI may also reduce the false positive rate of PET/MRI relative to PET/CT, thereby limiting the number of unnecessary additional imaging studies or biopsies, as discussed below.…”

Section: Discussionmentioning

confidence: 93%

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

Fraum

Fowler

McConathy

et al. 2016

Nucl Med Mol Imaging

View full text Add to dashboard Cite

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...

show abstract

Section: Discussionmentioning

confidence: 93%

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

Fraum

Fowler

McConathy

et al. 2016

Nucl Med Mol Imaging

View full text Add to dashboard Cite

show abstract

“…Difference of diagnostic accuracy for N-staging between fused PET/MRI (90.0 %), PET/CT (90.0 %), and MRI (86.7 %) showed no statistical difference [24]. In endometrial cancer, fused PET/ MRI showed better sensitivity for detecting myometrial invasion than PET/CT (90.5 % vs. 76.2 %) and metastatic lymph nodes than MRI (100 % vs. 66.7 %) [25]. Fused PET/MRI improved lesion depiction, localization, and quality of diagnosis more than PET/CT in gynecologic malignancy [26].…”

Section: Retrospective Image Fusion Of Pet and Mrimentioning

confidence: 94%

FDG Whole-Body PET/MRI in Oncology: a Systematic Review

Kwon

Becker

Goo

et al. 2016

Nucl Med Mol Imaging

View full text Add to dashboard Cite

The recent advance in hybrid imaging techniques enables offering simultaneous positron emission tomography (PET)/magnetic resonance imaging (MRI) in various clinical fields. 18F-fluorodeoxyglucose (FDG) PET has been widely used for diagnosis and evaluation of oncologic patients. The growing evidence from research and clinical experiences demonstrated that PET/MRI with FDG can provide comparable or superior diagnostic performance more than conventional radiological imaging such as computed tomography (CT), MRI or PET/CT in various cancers. Combined analysis using structural information and functional/molecular information of tumors can draw additional diagnostic information based on PET/MRI. Further studies including determination of the diagnostic efficacy, optimizing the examination protocol, and analysis of the hybrid imaging results is necessary for extending the FDG PET/MRI application in clinical oncology.

show abstract

“…Recently, fused PET/MRI images of EC have been compared with 18F-FDG contrastenhanced PET/CT and MRI for the prediction of LN metastasis 36 . Despite patient-based sensitivity, specificity and accuracy for detecting pelvic nodal metastasis of 100%, 96% and 97% for both fused PET/MRI, the low number of patients included (30 cases), makes it non recommendable systematic radiological examination for the management of patients with EC.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…Accuracy of CT scan for assessment of the outer half of the myometrium ranges between 62 and 87% and very uneven sensibility and specificity reported (10-83% and 42-100% respectively) [42][43][44] . Concerning cervical stromal invasion, performances of CT scan is insufficient, with low sensibility and PPV (20-25% et 9-14% respectively) 36,38 .…”

Section: Predicitng Lymph Node Metastasismentioning

confidence: 99%

Staging for endometrial cancer: The controversy around lymphadenectomy – Can this be resolved?

Koskas¹,

Rouzier²,

Amant³

2015

Best Practice & Research Clinical Obstetrics & Gynaecol

View full text Add to dashboard Cite

Endometrial cancer remains the most common malignancy of the female genital tract. Lymph node metastasis is one of the most important prognostic factors and stratification into pelvic lymph node invasion (stage IIIC1) and para-aortic lymph node invasion (stage IIIC2) improved the predictive value of the 2009 FIGO classification.Radiological examination such as magnetic resonance imaging and positron emission tomography-computed tomography do not have good enough sensitivity to avoid lymphadenectomy for the assessment of lymph node invasion. Prediction scores are becoming more and more valuable to exclude lymph node metastasis in low risk groups and biomarkers could help to identify patients with high risk lymph node metastatic probability.The therapeutic role of lymph node dissection remains debated. Several endpoints can be considered to evaluate the opportunity of lymphadenectomy in endometrial cancer.Firstly, we compare survival according to the realization, the extent and the numbers of nodes removed during lymphadenectomy. Secondly, we assess the opportunity of lymphadenectomy in order to tailor adjuvant treatment modalities. Thirdly, we analyze the surgical complication rate after pelvic lymphadenectomy.

show abstract

Value of fusion of PET and MRI for staging of endometrial cancer: Comparison with 18F-FDG contrast-enhanced PET/CT and dynamic contrast-enhanced pelvic MRI

Cited by 82 publications

References 11 publications

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

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

FDG Whole-Body PET/MRI in Oncology: a Systematic Review

Staging for endometrial cancer: The controversy around lymphadenectomy – Can this be resolved?

Contact Info

Product

Resources

About