Research ArticleClinical Investigations

Performance of Whole-Body Integrated 18F-FDG PET/MR in Comparison to PET/CT for Evaluation of Malignant Bone Lesions

Matthias Eiber, Toshiki Takei, Michael Souvatzoglou, Marius E. Mayerhoefer, Sebastian Fürst, Florian C. Gaertner, Denys J. Loeffelbein, Ernst J. Rummeny, Sibylle I. Ziegler, Markus Schwaiger and Ambros J. Beer
Journal of Nuclear Medicine February 2014, 55 (2) 191-197; DOI: https://doi.org/10.2967/jnumed.113.123646

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    Images of bone metastases (arrows) in 69-y-old man presenting for staging of oropharyngeal cancer. (A–C) PET/MR examination with coronal PET (A), coronal T1-weighted Dixon in-phase MR sequence (B), and coronal T1-weighted TSE MR sequence (C). (D–F) PET/CT examination with coronal PET (D) and coronal bone (E) and soft-tissue (F) windows of CT dataset. Two metastases in spine show intense uptake in both PET datasets (A and D). Replacement of bone marrow is seen in both T1-weighted Dixon in-phase MR sequence (B) and T1-weighted TSE MR sequence (C), with better lesion delineation in TSE than in VIBE Dixon because of higher in-plane resolution. (E and F) Faint sclerosis is present as anatomic correlate of caudal metastases in both bone window (E) and soft-tissue window (F) on CT, whereas cranial metastasis is depicted only in soft-tissue window.

  • FIGURE 2.
    FIGURE 2.

    PET/MR (A–C) and PET/CT (D–F) images from patient with diffuse osseous manifestation of non-Hodgkin lymphoma. Visually, both datasets provide excellent image quality, as demonstrated by maximum-intensity projection (A and D). Patient is imaged with arms down in PET/MR (A) and arms up in PET/CT (B). This approach is often used because imaging time in PET/MR is lengthy and too uncomfortable for a patient lying with arms up. Quantitative analysis showed lower SUVmean for lesions on PET/MR (121 min after injection) than on PET/CT (85 min after injection). Moderate difference (29.4%) was found for lesions in left rib (PET/MR, 5.99; PET/CT, 7.75; arrows in B and E). Slight difference (10.4%) was observed for lesion in right ilium (PET/MR, 19.86; PET/CT, 22.16; arrows in C and F).

  • FIGURE 3.
    FIGURE 3.

    Correlation of tracer uptake between PET/CT and subsequent PET/MR as assessed by SUVmean. x-axis displays quantitative values obtained by PET/CT, and y-axis displays corresponding values by PET/MR. Both for bone lesions (A) and for regions of normal bone (B), high correlation as expressed by Spearman correlation coefficient is found (R = 0.950 and R = 0.917, P < 0.0001, respectively) between the 2 modalities.

Tables

  • TABLE 1

    Indication for Referrals

    MalignancyAll patients (n = 119)Patients suitable for SUV measurement (n = 84)
    Head and neck squamous cell carcinoma2020
    Breast cancer199
    Gastrointestinal tract cancer1712
    Sarcoma1513
    Malignant lymphoma/leukemia116
    Primary unknown cancer104
    Genitourinary cancer98
    Malignant melanoma95
    Thyroid cancer77
    Lung3—
    Other43
    Total125*87†

    • ↵* 6 patients had history of 2 primary tumors.

    • ↵† 3 patients had history of 2 primary tumors.

  • TABLE 2

    Technical Parameters of Different MR Sequences Used in Study

    SequenceT1-weighted VIBE DixonT1-weighted TSE coronal
    TR/TE (ms)3.60/1.23–2.46*600/8.7
    Slice thickness (mm)3.125
    Gap (%)030
    Matrix192 × 121384 × 230
    Field of view (mm)500450
    % phase field of view10067.2
    Acquisition time (min:s)0:191:11
    Number of excitations11
    iPAT factor22

    • ↵* Fat-saturation techniques with Dixon require 2 repetition times.

    • TR/TE = repetition time/echo time; iPAT = integrated parallel acquisition technique.

  • TABLE 3

    Quality of Anatomic Location and Delineation of Suggestive Lesions

    LocationnLytic/mixed/scleroticCTDixonT1-weighted TSE
    Cervical spine41/3/02.00 ± 0.822.25 ± 0.503.00*
    Thoracic spine160/15/12.50 ± 0.522.81 ± 0.402.94 ± 0.25
    Lumbar spine203/14/32.60 ± 0.512.70 ± 0.473.00*
    Pelvis275/13/92.59 ± 0.512.76 ± 0.552.85 ± 0.36
    Upper extremity or shoulder121/10/12.75 ± 0.452.58 ± 0.522.92 ± 0.29
    Legs61/4/12.50 ± 0.842.66 ± 0.822.67 ± 0.82
    Ribs or sternum112/6/32.63 ± 0.511.72 ± 0.792.36 ± 0.67
    Other20/1/12.50 ± 0.711.50 ± 0.712.50 ± 0.71
    Total9813/66/192.57 ± 0.542.54 ± 0.652.84 ± 0.42

    • ↵* Same results for all lesions, SD = 0.

    • Data are mean ± SD.

  • TABLE 4

    SUVmean and SUVmax for Bone Lesions

    TechniqueSUVmeanSUVmax
    PET/CT5.70 ± 4.708.54 ± 6.96
    PET/MR4.97 ± 4.037.55 ± 6.02
    P<0.0001<0.0001

    • Data are mean ± SD.

  • TABLE 5

    SUVmean and SUVmax for Regions of Normal Bone

    TechniqueSUVmeanSUVmax
    PET/CT1.520 ± 0.6582.300 ± 1.070
    PET/MR1.092 ± 0.7051.820 ± 0.998
    P<0.0001<0.0001

    • Data are mean ± SD.

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