Aida Steiner1,2, Sara Narva3, Irina Rinta-Kiikka4, Sakari Hietanen3, Johanna Hynninen3, Johanna Virtanen5. 1. Department of Radiology, Turku University Hospital and University of Turku, PO Box 52, 20521, Turku, Finland. aikast@utu.fi. 2. Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA. aikast@utu.fi. 3. Department of Obstetrics and Gynecology, Turku University Hospital, PO Box 52, 20521, Turku, Finland. 4. Department of Radiology, Tampere University Hospital, PO Box 2000, 33521, Tampere, Finland. 5. Department of Radiology, Turku University Hospital and University of Turku, PO Box 52, 20521, Turku, Finland.
Abstract
BACKGROUND: The use of PET/MRI for gynecological cancers is emerging. The purpose of this study was to assess the additional diagnostic value of PET over MRI alone in local and whole-body staging of cervical cancer, and to evaluate the benefit of standardized uptake value (SUV) and apparent diffusion coefficient (ADC) in staging. METHODS: Patients with histopathologically-proven cervical cancer and whole-body 18F-FDG PET/MRI obtained before definitive treatment were retrospectively registered. Local tumor spread, nodal involvement, and distant metastases were evaluated using PET/MRI or MRI dataset alone. Histopathology or clinical consensus with follow-up imaging were used as reference standard. Tumor SUVmax and ADC were measured and SUVmax/ADC ratio calculated. Area under the curve (AUC) was determined to predict diagnostic performance and Mann-Whitney U test was applied for group comparisons. RESULTS: In total, 33 patients who underwent surgery (n = 23) or first-line chemoradiation (n = 10) were included. PET/MRI resulted in higher AUC compared with MRI alone in detecting parametrial (0.89 versus 0.73), vaginal (0.85 versus 0.74), and deep cervical stromal invasion (0.96 versus 0.74), respectively. PET/MRI had higher diagnostic confidence than MRI in identifying patients with radical cone biopsy and no residual at hysterectomy (sensitivity 89% versus 44%). PET/MRI and MRI showed equal AUC for pelvic nodal staging (both 0.73), whereas AUC for distant metastases was higher using PET/MRI (0.80 versus 0.67). Tumor SUVmax/ADC ratio, but not SUVmax or ADC alone, was significantly higher in the presence of metastatic pelvic lymph nodes (P < 0.05). CONCLUSIONS: PET/MRI shows higher accuracy than MRI alone for determining local tumor spread and distant metastasis emphasizing the added value of PET over MRI alone in staging of cervical cancer. Tumor SUVmax/ADC ratio may predict pelvic nodal involvement.
BACKGROUND: The use of PET/MRI for gynecological cancers is emerging. The purpose of this study was to assess the additional diagnostic value of PET over MRI alone in local and whole-body staging of cervical cancer, and to evaluate the benefit of standardized uptake value (SUV) and apparent diffusion coefficient (ADC) in staging. METHODS:Patients with histopathologically-proven cervical cancer and whole-body 18F-FDGPET/MRI obtained before definitive treatment were retrospectively registered. Local tumor spread, nodal involvement, and distant metastases were evaluated using PET/MRI or MRI dataset alone. Histopathology or clinical consensus with follow-up imaging were used as reference standard. Tumor SUVmax and ADC were measured and SUVmax/ADC ratio calculated. Area under the curve (AUC) was determined to predict diagnostic performance and Mann-Whitney U test was applied for group comparisons. RESULTS: In total, 33 patients who underwent surgery (n = 23) or first-line chemoradiation (n = 10) were included. PET/MRI resulted in higher AUC compared with MRI alone in detecting parametrial (0.89 versus 0.73), vaginal (0.85 versus 0.74), and deep cervical stromal invasion (0.96 versus 0.74), respectively. PET/MRI had higher diagnostic confidence than MRI in identifying patients with radical cone biopsy and no residual at hysterectomy (sensitivity 89% versus 44%). PET/MRI and MRI showed equal AUC for pelvic nodal staging (both 0.73), whereas AUC for distant metastases was higher using PET/MRI (0.80 versus 0.67). Tumor SUVmax/ADC ratio, but not SUVmax or ADC alone, was significantly higher in the presence of metastatic pelvic lymph nodes (P < 0.05). CONCLUSIONS:PET/MRI shows higher accuracy than MRI alone for determining local tumor spread and distant metastasis emphasizing the added value of PET over MRI alone in staging of cervical cancer. Tumor SUVmax/ADC ratio may predict pelvic nodal involvement.
Entities:
Keywords:
3 T MRI; ADC; Cervical cancer; PET/MRI; SUV; Staging
Authors: D Cibula; N R Abu-Rustum; L Dusek; M Zikán; A Zaal; L Sevcik; G G Kenter; D Querleu; R Jach; A S Bats; G Dyduch; P Graf; J Klat; J Lacheta; C J L M Meijer; E Mery; R Verheijen; R P Zweemer Journal: Gynecol Oncol Date: 2011-11-25 Impact factor: 5.482
Authors: Maarten G Thomeer; Cees Gerestein; Sandra Spronk; Helena C van Doorn; Els van der Ham; Myriam G Hunink Journal: Eur Radiol Date: 2013-03-01 Impact factor: 5.315
Authors: Karsten Beiderwellen; Johannes Grueneisen; Verena Ruhlmann; Paul Buderath; Bahriye Aktas; Philipp Heusch; Oliver Kraff; Michael Forsting; Thomas C Lauenstein; Lale Umutlu Journal: Eur J Nucl Med Mol Imaging Date: 2014-09-16 Impact factor: 9.236