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Comparison of diagnostic accuracy between [18F]FDG PET/MRI and contrast-enhanced MRI in T staging for oral tongue cancer

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Annals of Nuclear Medicine Aims and scope Submit manuscript

Abstract

Objective

Integrated PET/MRI with [18F]FDG is advantageous in that it enables simultaneous PET and MR imaging with higher soft-tissue contrast, multiplanar image acquisition, and functional imaging capability without using fat suppression and gadolinium-based contrast agents (GBCAs). The aims of this study were to demonstrate the feasibility of [18F]FDG PET/MRI for assessing the extent of the primary tumor (T) in oral tongue cancer (OTC) based on the 8th edition of American Joint Committee on Cancer (AJCC) cancer staging system, and to compare the diagnostic accuracy between [18F]FDG PET/MRI and contrast-enhanced MRI (ceMRI).

Methods

18 patients with biopsy-proven operable OTC underwent preoperative regional [18F]FDG PET/MRI and ceMRI within 2 weeks. For [18F]FDG PET/MRI, rainbow-colored PET images were overlaid on the corresponding MR images. Tumor size and the depth of invasion (DOI) were visually measured on [18F]FDG PET/MRI and ceMRI. The size, DOI, and clinical T stage were evaluated using the final surgical pathology as the reference.

Results

Of the 18 OTCs, one was not detected by ceMRI due to metal artifacts from an artificial denture, and another due to superficial type (pathological DOI = 0 mm). Tumor sizes measured by ceMRI and [18F]FDG PET/MRI had significant positive correlations with the pathological size (r = 0.80 and r = 0.90, respectively), and DOIs measured by ceMRI and [18F]FDG PET/MRI had significant positive correlations with the pathological DOI (r = 0.74 and r = 0.64, respectively). The means ± SD of size (mm) were 20.4 ± 9.1, 22.9 ± 10.9, and 26.2 ± 10.0, and those of DOI (mm) were 7.1 ± 2.5, 6.9 ± 2.2, and 5.8 ± 3.2 for ceMRI, [18F]FDG PET/MRI, and pathology, respectively. A significant difference was observed in tumor size between ceMRI and pathology (p < 0.05), whereas no significant differences were observed between any other sizes, DOIs, or T stages. The accuracy for T status was 72% (13/18 including 2 undetectable cases) for ceMRI and 89% (16/18) for [18F]FDG PET/MRI.

Conclusions

Although shallow DOIs are often overestimated, regional [18F]FDG PET/MRI without fat suppression and gadolinium enhancement is comparable to and may be substituted for ceMRI in preoperative T staging for OTC patients, reducing metal artifacts and avoiding the adverse effects of GBCAs.

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Abbreviations

PET:

Positron emission tomography

MRI:

Magnetic resonance imaging

[18F]FDG:

2-[18F]-Fluoro-2-deoxy-d-glucose

GBCAs:

Gadolinium-based contrast agents

ceMRI:

Contrast-enhanced MRI

CT:

Computed tomography

AJCC:

American Joint Committee on Cancer

OCC:

Oral cavity cancer

OTC:

Oral tongue cancer

DOI:

Depth of invasion

T:

The extent of the primary tumor

TOF:

Time of flight

PSF:

Point spread function

OSEM:

Ordered subset expectation maximization

SUV:

Standardized uptake value

T2WI:

T2-Weighted imaging

ANOVA:

Analysis of variance

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Acknowledgements

The authors thank the staff of the Department of Radiology and Biological Imaging Research Center, University of Fukui, for their clinical and technical support.

Funding

This study was partly funded by Grants-in-Aid for scientific research from the Japan Society for the Promotion of Science (19K08170, 19K09904) and the Takeda Science Foundation.

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Authors and Affiliations

  1. Department of Otolaryngology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan

    Masafumi Kanno, Norihiko Narita, Yumi Ito & Shigeharu Fujieda

  2. Biomedical Imaging Research Center, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji-cho, Fukui, 910-1193, Japan

    Tetsuya Tsujikawa, Akira Makino & Hidehiko Okazawa

  3. Division of Surgical Pathology, University of Fukui, Fukui, Japan

    Yoshiaki Imamura

  4. Department of Radiology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan

    Hirohiko Kimura

Authors
  1. Masafumi Kanno
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  2. Tetsuya Tsujikawa
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  3. Norihiko Narita
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  4. Yumi Ito
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  8. Hidehiko Okazawa
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  9. Shigeharu Fujieda
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Correspondence to Tetsuya Tsujikawa.

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Kanno, M., Tsujikawa, T., Narita, N. et al. Comparison of diagnostic accuracy between [18F]FDG PET/MRI and contrast-enhanced MRI in T staging for oral tongue cancer. Ann Nucl Med 34, 952–959 (2020). https://doi.org/10.1007/s12149-020-01526-y

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  • DOI: https://doi.org/10.1007/s12149-020-01526-y

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