Value of retrospective image fusion of 18F-FDG PET and MRI for preoperative staging of head and neck cancer: Comparison with PET/CT and contrast-enhanced neck MRI

Kanda, Tomonori; Kitajima, Kazuhiro; Suenaga, Yusaku; Konishi, J; Sasaki, Ryohei; Morimoto, Koichi; Saito, Miki; Otsuki, Naoki; Nibu, Ken‐ichi; Sugimura, Kazuro

doi:10.1016/j.ejrad.2013.06.025

Cited by 66 publications

(47 citation statements)

References 17 publications

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“…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: 91%

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: Discussionmentioning

confidence: 91%

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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“…46,47 Recently, there have been several reports of the possible superiority of PET/CE-CT over standard PET/CT in different clinical settings, including better local 48 and nodal analysis. 49 Other studies, 50,51 confirmed the high accuracy of nodal staging by PET/CT, in particular, if CE-CT is used during PET protocol.…”

Section: Lymph Node Involvement (Nodal Staging)mentioning

confidence: 85%

“…Consequently, the discussion about potential applications of this new hybrid technology in oncological imaging and especially in the HN has been generated. 130 The feasibility 131 and diagnostic performance (sensitivity, specificity and accuracy) of clinical PET/MRI have been demonstrated in a significant number of studies, 51,85 but technological and logistic challenges, such as errors in attenuation correction and long scan duration continue to be a major focus of the PET/ MRI literature. 132 PET/MRI has many potential advantages over PET/CT (including perineural spread of tumours and the infiltration of important anatomical landmarks, such as the pre-vertebral fascia and great vessel walls; lower radiation exposure, higher soft-tissue contrast and several functional techniques).…”

Section: Positron Emission Tomography/mri: Adding New Possibilitiesmentioning

confidence: 99%

Role of fluorine-18 fluorodeoxyglucose PET/CT in head and neck oncology: the point of view of the radiation oncologist

Cacicedo¹,

Navarro²,

Hoyo³

et al. 2016

BJR

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Squamous cell carcinoma is the most common malignant tumour of the head and neck. The initial TNM staging, the evaluation of the tumour response during treatment, and the long-term surveillance are crucial moments in the approach to head and neck squamous cell carcinoma (HNSCC). Thus, at each of these moments, the choice of the best diagnostic tool providing the more precise and larger information is crucial. Positron emission tomography with fluorine-18 fludeoxyglucose integrated with CT ( 18

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“…Relatively good image quality can be achieved in head, thorax, and pelvic area [15]. In head and neck cancer, accurate T staging by fused PET/MRI was superior to that by PET/CT (87 % vs. 67 %) and N staging by PET/MRI was superior to that by MRI (77 % vs. 63 %) [16]. The level of diagnostic confidence was higher in fused PET/MRI than in PET/ CT (85.9 % vs. 70.3 %) [17].…”

Section: Retrospective Image Fusion Of Pet and Mrimentioning

confidence: 99%

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

Kwon

Becker

Goo

et al. 2016

Nucl Med Mol Imaging

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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.

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Value of retrospective image fusion of 18F-FDG PET and MRI for preoperative staging of head and neck cancer: Comparison with PET/CT and contrast-enhanced neck MRI

Cited by 66 publications

References 17 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?

Role of fluorine-18 fluorodeoxyglucose PET/CT in head and neck oncology: the point of view of the radiation oncologist

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

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