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Research ArticleImaging

18F-FDG PET/MRI Primary Staging of Cervical Cancer: A Pilot Study with PET/CT Comparison

Nghi C. Nguyen, Sushil Beriwal, Chan-Hong Moon, Alessandro Furlan, James M. Mountz and Balasubramanya Rangaswamy
Journal of Nuclear Medicine Technology December 2020, 48 (4) 331-335; DOI: https://doi.org/10.2967/jnmt.120.247080
Nghi C. Nguyen
1Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania; and
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Sushil Beriwal
2Department of Radiation Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania
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Chan-Hong Moon
1Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania; and
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Alessandro Furlan
1Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania; and
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James M. Mountz
1Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania; and
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Balasubramanya Rangaswamy
1Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania; and
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    FIGURE 1.

    A 49-y-old woman with history of poorly differentiated squamous cell carcinoma of cervix, FIGO stage IIB (patient 5). (A) Axial CT (enhanced) (left) and PET/CT (right). (B) Axial MRI (T2-weighted turbo spin-echo, unenhanced) (left) and PET/MRI (T2-weighted turbo spin-echo). (C) Sagittal MRI (T1-weighted Dixon-visual background extractor) (left) and PET/MRI (right), 60 s after gadolinium administration. Primary (arrow) measured 3.5 cm and showed extension into right vaginal fornix (T1B) on PET/CT, with PET/MRI demonstrating additional parametrial involvement (arrowhead; T2B). Disease stage was IB (T1B N0 M0) on PET/CT and IIB (T2B N0 M0) on PET/MRI.

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    FIGURE 2.

    A 35-y-old woman with invasive poorly differentiated squamous cell carcinoma of cervix, FIGO stage IIIB (patient 6). (A) Axial PET/CT (unenhanced) (left) and CT (right). (B) Axial PET/MRI (T2-weighted turbo spin-echo) (left) and MRI (right). (C) Sagittal PET/MRI (T1-weighted Dixon–visual background extractor) 60 s after gadolinium enhancement (left), MRI (diffusion-weighted, b700) (middle), and apparent-diffusion-coefficient map (right). 18F-FDG–avid cervical primary, 4.7 cm, is seen well on both PET/CT and PET/MRI. 18F-FDG–avid subcentimeter density in left pelvis on PET/CT (arrow) was thought to be nodal disease (N1), which could not be corroborated on PET/MRI; this finding on PET/CT was most consistent with nonspecific left ureter radioactivity. More importantly, PET/MRI demonstrated peritoneal involvement (M1, arrowhead), which was characterized as parametrial invasion (T2B on CT). Disease stage was IIB (T2B N0 M0) on PET/CT and IVB (T2B N0 M1) on PET/MRI.

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    TABLE 1

    Patient Characteristics; Tumor Stage on FIGO, PET/CT, and PET/MRI; and Impact on Clinical Management

    Patient no.Age (y)FIGO stagePET/CT stagePET/MRI stageImaging commentsChange in clinical management? (PET/CT vs. PET/MRI)
    161IIB (involving vaginal fornix, with suspected parametrial involvement)IVB (T2A N0 M1)IVB (T2B N0 M1)M1, paraaortic LN, on both modalitiesNo (both IVB); concurrent chemotherapy with cisplatin, EBRT to pelvis, and interstitial brachytherapy
    255IIB (extending into parametrium and upper third of vagina)IIIB (T2A N1 M0)IIIB (T2B N1 M0)MRI detection of parametrial involvement, T2BNo (both IIIB); concurrent chemotherapy with cisplatin, pelvic EBRT, and intracavitary brachytherapy
    376IIB (involving parametrium, without sidewall involvement)IIA (T2A N0 M0)IIB (T2B N0 M0)MRI detection of parametrial involvement, T2BNo (IIA vs. IIB); concurrent chemotherapy with cisplatin, pelvic EBRT, and intracavitary brachytherapy
    460IIB (involving upper third of vagina and parametrium)IB (T1B N0 M0)IIB (T2B N0 M0)MRI detection of parametrial involvement, T2BYes; radical hysterectomy with pelvic nodal dissection (IB) vs. concurrent chemotherapy with cisplatin, pelvic EBRT, and intracavitary brachytherapy (IIB)
    549IIB (extending into right fornix and right parametrium)IB (T1B N0 M0)IIB (T2B N0 M0)MRI detection of parametrial involvement, T2BYes; radical hysterectomy with pelvic nodal dissection (IB) vs. concurrent chemotherapy with cisplatin, pelvic EBRT, and intracavitary brachytherapy (IIB)
    636IIIB (involving parametrium with extension to pelvic sidewall)IIB (T2B N0* M0)IVB (T2B N0 M1)MRI detection of peritoneal involvement, M1Yes; concurrent chemotherapy with cisplatin, pelvic EBRT, and intracavitary brachytherapy (IIB) vs. interstitial brachytherapy (IVB)
    • ↵* N0 (focal ureter activity falsely denoted as N1 on PET/CT).

    • EBRT = external-beam radiotherapy.

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Journal of Nuclear Medicine Technology: 48 (4)
Journal of Nuclear Medicine Technology
Vol. 48, Issue 4
December 1, 2020
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18F-FDG PET/MRI Primary Staging of Cervical Cancer: A Pilot Study with PET/CT Comparison
Nghi C. Nguyen, Sushil Beriwal, Chan-Hong Moon, Alessandro Furlan, James M. Mountz, Balasubramanya Rangaswamy
Journal of Nuclear Medicine Technology Dec 2020, 48 (4) 331-335; DOI: 10.2967/jnmt.120.247080

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18F-FDG PET/MRI Primary Staging of Cervical Cancer: A Pilot Study with PET/CT Comparison
Nghi C. Nguyen, Sushil Beriwal, Chan-Hong Moon, Alessandro Furlan, James M. Mountz, Balasubramanya Rangaswamy
Journal of Nuclear Medicine Technology Dec 2020, 48 (4) 331-335; DOI: 10.2967/jnmt.120.247080
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