Skip to main content
SpringerLink
Log in

Comparison of hybrid FDG PET/MRI compared with PET/CT in colorectal cancer staging and restaging: a pilot study

  • Published:
Abdominal Imaging Aims and scope Submit manuscript

Abstract

Purpose

We report our initial clinical experience from a pilot study to compare the diagnostic accuracy of hybrid PET/MRI with PET/CT in colorectal cancer and discuss potential PET/MRI workflow solutions for colorectal cancer.

Methods

Patients underwent both FDG PET/CT and PET/MRI (Ingenuity TF PET/MRI, Philips Healthcare) for rectal cancer staging or colorectal cancer restaging. The PET acquisition of PET/MRI was similar to that of PET/CT whereas the MRI protocol was selected individually based on the patient’s medical history. One nuclear medicine physician reviewed the PET/CT studies and one radiologist reviewed the PET/MRI studies independently. The diagnostic accuracy of each modality was determined in consensus, using available medical records as a reference.

Results

Of the 12 patients enrolled, two were for initial staging and ten for restaging. The median scan delay between the two modalities was 60 min. The initial imaging was PET/CT in nine patients and PET/MRI in three patients. When PET/CT was performed first, the SUV values of the 16 FDG avid lesions were greater at PET/MRI than at PET/CT. In contrast, when PET/MRI was performed first, the SUV values of the seven FDG avid lesions were greater at PET/CT than at PET/MRI. PET/MRI provided more detailed T staging than PET/CT. On a per-patient basis, with both patient groups combined for the evaluation of N and M staging/restaging, the true positive rate was 5/7 (71%) for PET/CT and 6/7 (86%) for PET/MRI, and true negative rate was 5/5 (100%) for both modalities. On a per-lesion basis, PET/CT identified 26 of 29 (90%) tumor lesions that were correctly detected by PET/MRI. Our proposed workflow allows for comprehensive cancer staging including integrated local and whole-body assessment.

Conclusions

Our initial experience shows a high diagnostic accuracy of PET/MRI in T staging of rectal cancer compared with PET/CT. In addition, PET/MRI shows at least comparable accuracy in N and M staging as well as restaging to PET/CT. However, the small sample size limits the generalizability of the results. It is expected that PET/MRI would yield higher diagnostic accuracy than PET/CT considering the high soft tissue contrast provided by MRI compared with CT, but larger studies are necessary to fully assess the benefit of PET/MRI in colorectal cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

REFERENCES

  1. O’Neill BD, Brown G, Heald RJ, Cunningham D, Tait DM (2007) Non-operative treatment after neoadjuvant chemoradiotherapy for rectal cancer. Lancet Oncol 8(7):625–633. doi:10.1016/S1470-2045(07)70202-4

    Article  PubMed  Google Scholar 

  2. Dewhurst CE, Mortele KJ (2013) Magnetic resonance imaging of rectal cancer. Radiol Clin N Am 51(1):121–131. doi:10.1016/j.rcl.2012.09.012

    Article  PubMed  Google Scholar 

  3. Huebner RH, Park KC, Shepherd JE, et al. (2000) A meta-analysis of the literature for whole-body FDG PET detection of recurrent colorectal cancer. J Nucl Med 41(7):1177–1189

    CAS  PubMed  Google Scholar 

  4. Cohade C, Osman M, Leal J, Wahl RL (2003) Direct comparison of (18)F-FDG PET and PET/CT in patients with colorectal carcinoma. J Nucl Med 44(11):1797–1803

    PubMed  Google Scholar 

  5. Therasse P, Arbuck SG, Eisenhauer EA, et al. (2000) New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 92(3):205–216

    Article  CAS  PubMed  Google Scholar 

  6. Monteil J, Mahmoudi N, Leobon S, et al. (2009) Chemotherapy response evaluation in metastatic colorectal cancer with FDG PET/CT and CT scans. Anticancer Res 29(7):2563–2568

    CAS  PubMed  Google Scholar 

  7. Kluza E, Rozeboom ED, Maas M, et al. (2013) T2 weighted signal intensity evolution may predict pathological complete response after treatment for rectal cancer. Eur Radiol 23(1):253–261. doi:10.1007/s00330-012-2578-z

    Article  PubMed  Google Scholar 

  8. Antoch G, Vogt FM, Freudenberg LS, et al. (2003) Whole-body dual-modality PET/CT and whole-body MRI for tumor staging in oncology. JAMA 290(24):3199–3206. doi:10.1001/jama.290.24.3199

    Article  CAS  PubMed  Google Scholar 

  9. Denecke T, Rau B, Hoffmann KT, et al. (2005) Comparison of CT, MRI and FDG-PET in response prediction of patients with locally advanced rectal cancer after multimodal preoperative therapy: is there a benefit in using functional imaging? Eur Radiol 15(8):1658–1666. doi:10.1007/s00330-005-2658-4

    Article  CAS  PubMed  Google Scholar 

  10. Schmidt GP, Baur-Melnyk A, Haug A, et al. (2009) Whole-body MRI at 1.5 T and 3 T compared with FDG-PET-CT for the detection of tumour recurrence in patients with colorectal cancer. Eur Radiol 19(6):1366–1378. doi:10.1007/s00330-008-1289-y

    Article  CAS  PubMed  Google Scholar 

  11. Zaidi H, Ojha N, Morich M, et al. (2011) Design and performance evaluation of a whole-body Ingenuity TF PET-MRI system. Phys Med Biol 56(10):3091–3106. doi:10.1088/0031-9155/56/10/013

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Kalemis A, Delattre BM, Heinzer S (2013) Sequential whole-body PET/MR scanner: concept, clinical use, and optimisation after two years in the clinic. The manufacturer’s perspective. Magma 26(1):5–23. doi:10.1007/s10334-012-0330-y

    Article  CAS  PubMed  Google Scholar 

  13. Kaur H, Choi H, You YN, et al. (2012) MR imaging for preoperative evaluation of primary rectal cancer: practical considerations. Radiographics 32(2):389–409. doi:10.1148/Rg.322115122

    Article  PubMed  Google Scholar 

  14. Drzezga A, Souvatzoglou M, Eiber M, et al. (2012) First clinical experience with integrated whole-body PET/MR: comparison to PET/CT in patients with oncologic diagnoses. J Nucl Med 53(6):845–855. doi:10.2967/jnumed.111.098608

    Article  PubMed  Google Scholar 

  15. Wiesmuller M, Quick HH, Navalpakkam B, et al. (2013) Comparison of lesion detection and quantitation of tracer uptake between PET from a simultaneously acquiring whole-body PET/MR hybrid scanner and PET from PET/CT. Eur J Nucl Med Mol Imaging 40(1):12–21. doi:10.1007/s00259-012-2249-y

    Article  PubMed  Google Scholar 

  16. Gould MK, Maclean CC, Kuschner WG, Rydzak CE, Owens DK (2001) Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a meta-analysis. JAMA 285(7):914–924

    Article  CAS  PubMed  Google Scholar 

  17. Donati OF, Hany TF, Reiner CS, et al. (2010) Value of retrospective fusion of PET and MR images in detection of hepatic metastases: comparison with 18F-FDG PET/CT and Gd-EOB-DTPA-enhanced MRI. J Nucl Med 51(5):692–699. doi:10.2967/jnumed.109.068510

    Article  PubMed  Google Scholar 

  18. Kohan AA, Kolthammer JA, Vercher-Conejero JL, et al. (2013) N staging of lung cancer patients with PET/MRI using a three-segment model attenuation correction algorithm: initial experience. Eur Radiol 23(11):3161–3169. doi:10.1007/s00330-013-2914-y

    Article  CAS  PubMed  Google Scholar 

  19. Lee JW, Kim SK, Lee SM, Moon SH, Kim TS (2011) Detection of hepatic metastases using dual-time-point FDG PET/CT scans in patients with colorectal cancer. Mol Imaging Biol 13(3):565–572. doi:10.1007/s11307-010-0394-x

    Article  PubMed  Google Scholar 

  20. Chong V (2004) The skull base in oncologic imaging. Cancer Imaging 4(1):5–6. doi:10.1102/1470-7330.2003.0024

    Article  CAS  PubMed Central  Google Scholar 

  21. Santini D, Tampellini M, Vincenzi B, et al. (2012) Natural history of bone metastasis in colorectal cancer: final results of a large Italian bone metastases study. Ann Oncol 23(8):2072–2077. doi:10.1093/annonc/mdr572

    Article  CAS  PubMed  Google Scholar 

  22. Kershah S, Partovi S, Traughber BJ, et al. (2013) Comparison of standardized uptake values in normal structures between PET/CT and PET/MRI in an oncology patient population. Mol Imaging Biol 15(6):776–785. doi:10.1007/s11307-013-0629-8

    Article  PubMed  Google Scholar 

  23. Kumar R, Loving VA, Chauhan A, et al. (2005) Potential of dual-time-point imaging to improve breast cancer diagnosis with (18)F-FDG PET. J Nucl Med 46(11):1819–1824

    PubMed  Google Scholar 

  24. Chonde DB, Abolmaali N, Arabasz G, Guimaraes AR, Catana C (2013) Effect of MRI acoustic noise on cerebral fludeoxyglucose uptake in simultaneous MR-PET imaging. Investig Radiol 48(5):302–312. doi:10.1097/RLI.0b013e3182839fbc

    Article  CAS  Google Scholar 

  25. Yasuda S, Takechi M, Ono M, et al. (2012) The effect of glucagon on FDG uptake in skeletal muscle. Tokai J Exp Clin Med 37(1):11–13

    CAS  PubMed  Google Scholar 

  26. Hu Z, Ojha N, Renisch S, Schulz V, Torres I, Buhl A, Pal D, Muswick G, Penatzer J, Guo T, et al. (2009) MR-based attenuation correction for a whole-body sequential PET/MR system. IEEE Nucl Sci Conf Rec:3508–3512

  27. Aime S, Caravan P (2009) Biodistribution of gadolinium-based contrast agents, including gadolinium deposition. J Magn Reson Imaging 30(6):1259–1267. doi:10.1002/jmri.21969

    Article  PubMed Central  PubMed  Google Scholar 

  28. Froehlich JM, Daenzer M, von Weymarn C, et al. (2009) Aperistaltic effect of hyoscine N-butylbromide versus glucagon on the small bowel assessed by magnetic resonance imaging. Eur Radiol 19(6):1387–1393. doi:10.1007/s00330-008-1293-2

    Article  PubMed  Google Scholar 

Download references

Acknowledgement

This study was sponsored by Philips Healthcare. We thank the staff at Philips Healthcare, Cleveland, Ohio, and especially Antonis Kalemis for his technical and scientific discussion.

Author information

Authors and Affiliations

  1. Department of Radiology, UH Case Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA

    Raj Mohan Paspulati, Sasan Partovi & Karin A. Herrmann

  2. Department of Medicine-Hematology and Oncology, UH Case Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA

    Smitha Krishnamurthi

  3. Department of Surgery-Colorectal, UH Case Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA

    Conor P. Delaney

  4. Radiology Department, UPMC Presbyterian, 200 Lothrop St, Pittsburgh, 15213, PA, USA

    Nghi C. Nguyen

Authors
  1. Raj Mohan Paspulati
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sasan Partovi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Karin A. Herrmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Smitha Krishnamurthi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Conor P. Delaney
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nghi C. Nguyen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Raj Mohan Paspulati.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Paspulati, R.M., Partovi, S., Herrmann, K.A. et al. Comparison of hybrid FDG PET/MRI compared with PET/CT in colorectal cancer staging and restaging: a pilot study. Abdom Imaging 40, 1415–1425 (2015). https://doi.org/10.1007/s00261-015-0474-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-015-0474-0

Keywords

Search

Navigation