Implementation of FAST-PET/MRI for whole-body staging of female patients with recurrent pelvic malignancies: A comparison to PET/CT
Introduction
Within the last 15 years, hybrid imaging, in terms of positron emission tomography/computed tomography (PET/CT) imaging, has been successfully introduced into oncologic imaging for (re) staging of numerous tumor entities, combining the assessment of valuable metabolic and anatomical information for the identification of cancer lesions [1], [2], [3]. While the hybrid nature of PET/CT has been shown beneficial compared to other cross-sectional imaging techniques for the detection of metastatic sites [4], [5], it also causes one of its major disadvantages, by means of an increased radiation dose due to the combination of PET and whole-body full-dose CT [6], [7].
The implementation of integrated positron emission tomography/magnetic resonance imaging (PET/MRI) scanners enables high-quality assessment of cancer patients by combining the diagnostic advantages of simultaneous whole-body PET and whole-body MR imaging [8], [9]. MRI, as part of this new emerging imaging technique, provides high-resolution anatomical information with excellent soft tissue contrast under the avoidance of potentially harmful ionizing radiation exposure. Current publications demonstrate the comparable diagnostic performance of integrated PET/MRI and PET/CT for staging and restaging of numerous tumor entities, including gynecological cancers [10], [11], [12]. However, up to current status, one major disadvantage of PET/MRI studies lies in a markedly prolonged examination time, mainly caused by the acquisition of a substantial number of MR sequences. Hence, with regard to patient comfort, well-considered and suitable MR imaging protocols are required.
Thus, the aim of this trial was to evaluate the diagnostic ability of a FAST-protocol for whole-body PET/MR imaging, including high-resolution morphological (T1w- and T2w sequences), functional (diffusion-weighted imaging, DWI) as well as metabolic (PET) assessment for restaging female patients with pelvic malignancies in comparison to PET/CT.
Section snippets
Patients
The present study was approved by the institutional review board. 39 female patients suspect for a recurrence of a pelvic malignancy were enrolled in this retrospective trial. All patients underwent a clinically indicated whole-body PET/CT and subsequently an additional whole-body PET/MRI examination after informed and written consent was obtained. Suspicion for a tumor recurrence was determined based on clinical follow-up as well as abnormal findings in cross-sectional imaging follow-up (CT,
Patient based analysis
PET/CT and subsequent PET/MRI examinations were completed successfully in all 24 patients. Table 2 gives an overview of the mean scan duration of a whole-body PET/CT, a standard whole-body PETMRI examination as well as of the FAST-PET/MRI protocol, applied for restaging patients suspect for a recurrent pelvic malignancy.
The estimated mean effective dose of a full-dose whole-body PET/CT examination amounted to 20.7 ± 4.1 mSv, with the CT-component amounting to 16.0 ± 4.0 mSv (77.3%) and the
Discussion
Our study results demonstrate the feasibility and high diagnostic value of the applied FAST-PET/MRI protocol for restaging female patients suspect for a recurrent pelvic malignancy. On a lesion-based analysis, FAST-PET/MRI and PET/CT yielded an equivalently high diagnostic performance for the detection and visualization of tumor recurrences. Furthermore, the implementation of a FAST-PET/MRI protocol enables high-quality restaging of gynecological cancer patients within only slightly longer scan
Conflict of interest
All authors declare that they have no conflict of interest.
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2020, Clinical ImagingCitation Excerpt :Also, there is distortion of normal anatomic architecture after treatment, making it difficult to detect small recurrent tumor and limiting the diagnostic sensitivity of conventional cross-sectional imaging modalities. In our meta-analysis, 3 studies compared the diagnostic performance of PET/MR and PET/CT in recurrent pelvic malignancies [9,11,14]. Of which, Grueneisen et al., reported similar numbers of tumor recurrence detection (20 out of 21) by PET/CT and PET/MR. The lesion-based sensitivity and specificity rates, PPV, NPV and diagnostic accuracy in the detection of malignant lesions were not significantly different for PET/CT and PET/MRI (82% vs. 85%, 91% vs. 87%, 97% vs. 96%, 58% vs. 63%, and 84% vs. 86%, respectively; P > 0.05) [11].
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2019, Seminars in Nuclear MedicineCitation Excerpt :When compared with PET/CT, PET/MRI has been shown to facilitate a comparable whole-body staging performance in patients with tumor recurrences of female pelvic malignancies.58-60 Only minor differences between the two modalities were described regarding the delineation of suspect lesions in dependence of their localization.9 While PET/CT was shown to yield a higher detection rate of pulmonary lesions, PET/MRI offered a higher accuracy for the identification and characterization of liver metastases and better detectability of bone metastases when compared to PET/CT.57,61-63
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