Whole-body staging of female patients with recurrent pelvic malignancies: Ultra-fast 18F-FDG PET/MRI compared to 18F-FDG PET/CT and CT

by Julian Kirchner, Lino Morris Sawicki, Saravanabavaan Suntharalingam, Johannes Grueneisen, Verena Ruhlmann, Bahriye Aktas, Cornelius Deuschl, Ken Herrmann, Gerald Antoch, Michael Forsting, Lale Umutlu

Objectives

To evaluate the diagnostic feasibility of an ultra-fast ¹⁸F-FDG PET/MRI protocol, including T2-w and contrast-enhanced T1-w imaging as well as metabolic assessment (PET) in comparison to ¹⁸F-FDG PET/CT and CT for whole-body staging of female patients with suspected recurrence of pelvic malignancies.

Methods

43 female patients with suspected tumor recurrence were included in this study. Suspicion was based on clinical follow-up and abnormal findings on imaging follow-up. All patients underwent a PET/CT and a subsequent PET/MRI examination. Two readers were asked to evaluate ultra-fast PET/MRI, PET/CT as well as CT datasets of PET/CT separately for suspect lesions regarding lesion count, lesion localization and lesion characterization. Statistical analyses were performed both, on a per-patient and a per-lesion basis.

Results

Tumor relapse was present in 38 of the 43 patients. Based on CT readings 25/38 tumor relapses were correctly identified. PET/CT enabled correct identification of 37/38 patients, PET/MRI correctly identified 36 of the 38 patients with recurrent cancer. On a lesion-based analysis PET/MRI enabled the correct detection of more lesions, comprising a lesion-based sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of 50%, 58%, 76%, 31%, and 53% for CT, 97%, 83%, 93%, 94%, and 92% for PET/CT and 98%, 83%, 94%, 94%, and 94% for PET/MRI, respectively. Mean scan duration of ultra-fast PET/MRI, PET/CT and whole-body CT amounted to 18.5 ± 1 minutes, 18.2 ± 1 minutes and 3.5 minutes, respectively.

Conclusion

Ultra-fast PET/MRI provides equivalent diagnostic performance and examination time when compared to PET/CT and superior diagnostic performance to CT in restaging female patients suspected to have recurrent pelvic cancer.

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