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Whole-Body Nonenhanced PET/MR versus PET/CT in the Staging and Restaging of Cancers: Preliminary Observations


Huellner, Martin W; Appenzeller, Philippe; Kuhn, Félix P; Husmann, Lars; Pietsch, Carsten M; Burger, Irene A; Porto, Miguel; Delso, Gaspar; von Schulthess, Gustav K; Veit-Haibach, Patrick (2014). Whole-Body Nonenhanced PET/MR versus PET/CT in the Staging and Restaging of Cancers: Preliminary Observations. Radiology:140090.

Abstract

Purpose To assess the diagnostic performance of whole-body non-contrast material-enhanced positron emission tomography (PET)/magnetic resonance (MR) imaging and PET/computed tomography (CT) for staging and restaging of cancers and provide guidance for modality and sequence selection. Materials and Methods This study was approved by the institutional review board and national government authorities. One hundred six consecutive patients (median age, 68 years; 46 female and 60 male patients) referred for staging or restaging of oncologic malignancies underwent whole-body imaging with a sequential trimodality PET/CT/MR system. The MR protocol included short inversion time inversion-recovery (STIR), Dixon-type liver accelerated volume acquisition (LAVA; GE Healthcare, Waukesha, Wis), and respiratory-gated periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER; GE Healthcare) sequences. Primary tumors (n = 43), local lymph node metastases (n = 74), and distant metastases (n = 66) were evaluated for conspicuity (scored 0-4), artifacts (scored 0-2), and reader confidence on PET/CT and PET/MR images. Subanalysis for lung lesions (n = 46) was also performed. Relevant incidental findings with both modalities were compared. Interreader agreement was analyzed with intraclass correlation coefficients and κ statistics. Lesion conspicuity, image artifacts, and incidental findings were analyzed with nonparametric tests. Results Primary tumors were less conspicuous on STIR (3.08, P = .016) and LAVA (2.64, P = .002) images than on CT images (3.49), while findings with the PROPELLER sequence (3.70, P = .436) were comparable to those at CT. In distant metastases, the PROPELLER sequence (3.84) yielded better results than CT (2.88, P < .001). Subanalysis for lung lesions yielded similar results (primary lung tumors: CT, 3.71; STIR, 3.32 [P = .014]; LAVA, 2.52 [P = .002]; PROPELLER, 3.64 [P = .546]). Readers classified lesions more confidently with PET/MR than PET/CT. However, PET/CT showed more incidental findings than PET/MR (P = .039), especially in the lung (P < .001). MR images had more artifacts than CT images. Conclusion PET/MR performs comparably to PET/CT in whole-body oncology and neoplastic lung disease, with the use of appropriate sequences. Further studies are needed to define regionalized PET/MR protocols with sequences tailored to specific tumor entities. © RSNA, 2014 Online supplemental material is available for this article.

Abstract

Purpose To assess the diagnostic performance of whole-body non-contrast material-enhanced positron emission tomography (PET)/magnetic resonance (MR) imaging and PET/computed tomography (CT) for staging and restaging of cancers and provide guidance for modality and sequence selection. Materials and Methods This study was approved by the institutional review board and national government authorities. One hundred six consecutive patients (median age, 68 years; 46 female and 60 male patients) referred for staging or restaging of oncologic malignancies underwent whole-body imaging with a sequential trimodality PET/CT/MR system. The MR protocol included short inversion time inversion-recovery (STIR), Dixon-type liver accelerated volume acquisition (LAVA; GE Healthcare, Waukesha, Wis), and respiratory-gated periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER; GE Healthcare) sequences. Primary tumors (n = 43), local lymph node metastases (n = 74), and distant metastases (n = 66) were evaluated for conspicuity (scored 0-4), artifacts (scored 0-2), and reader confidence on PET/CT and PET/MR images. Subanalysis for lung lesions (n = 46) was also performed. Relevant incidental findings with both modalities were compared. Interreader agreement was analyzed with intraclass correlation coefficients and κ statistics. Lesion conspicuity, image artifacts, and incidental findings were analyzed with nonparametric tests. Results Primary tumors were less conspicuous on STIR (3.08, P = .016) and LAVA (2.64, P = .002) images than on CT images (3.49), while findings with the PROPELLER sequence (3.70, P = .436) were comparable to those at CT. In distant metastases, the PROPELLER sequence (3.84) yielded better results than CT (2.88, P < .001). Subanalysis for lung lesions yielded similar results (primary lung tumors: CT, 3.71; STIR, 3.32 [P = .014]; LAVA, 2.52 [P = .002]; PROPELLER, 3.64 [P = .546]). Readers classified lesions more confidently with PET/MR than PET/CT. However, PET/CT showed more incidental findings than PET/MR (P = .039), especially in the lung (P < .001). MR images had more artifacts than CT images. Conclusion PET/MR performs comparably to PET/CT in whole-body oncology and neoplastic lung disease, with the use of appropriate sequences. Further studies are needed to define regionalized PET/MR protocols with sequences tailored to specific tumor entities. © RSNA, 2014 Online supplemental material is available for this article.

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Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Nuclear Medicine
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:6 August 2014
Deposited On:27 Aug 2014 17:05
Last Modified:14 Feb 2018 21:29
Publisher:Radiological Society of North America
ISSN:0033-8419
OA Status:Closed
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1148/radiol.14140090
PubMed ID:25102372

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