Advertisement

Integrated PET/MRI for whole-body staging of patients with primary cervical cancer: preliminary results

  • Johannes GrueneisenEmail author
  • Benedikt Michael Schaarschmidt
  • Martin Heubner
  • Bahriye Aktas
  • Sonja Kinner
  • Michael Forsting
  • Thomas Lauenstein
  • Verena Ruhlmann
  • Lale Umutlu
Original Article

Abstract

Purpose

To assess the diagnostic value of integrated PET/MRI for whole-body staging of cervical cancer patients, as well as to investigate a potential association between PET/MRI derived functional parameters and prognostic factors of cervical cancer.

Methods

The present study was approved by the local institutional review board. Twenty-seven patients with histopathologically confirmed cervical cancer were prospectively enrolled in our study. All patients underwent a whole-body PET/MRI examination after written informed consent was obtained. Two radiologists separately evaluated the PET/MRI data sets regarding the determination of local tumor extent of primary cervical cancer lesions, as well as detection of nodal and distant metastases. Furthermore, SUV and ADC values of primary tumor lesions were analyzed and correlated with dedicated prognostic factors of cervical cancer. Results based on histopathology and cross-sectional imaging follow-up served as the reference standard.

Results

PET/MRI enabled the detection of all 27 primary tumor lesions of the uterine cervix and allowed for the correct determination of the T-stage in 23 (85 %) out of the 27 patients. Furthermore, the calculated sensitivity, specificity and diagnostic accuracy for the detection of nodal positive patients (n = 11) were 91 %, 94 % and 93 %, respectively. PET/MRI correctly identified regional metastatic disease (N1-stage) in 8/10 (80 %) patients and non-regional lymph node metastases in 5/5 (100 %) patients. In addition, quantitative analysis of PET and MRI derived functional parameters (SUV; ADC values) revealed a significant correlation with pathological grade and tumor size (p < 0.05).

Conclusions

The present study demonstrates the high potential of integrated PET/MRI for the assessment of primary tumor and the detection of lymph node metastases in patients with cervical cancer. Providing additional prognostic information, PET/MRI may serve as a valuable diagnostic tool for cervical cancer patients in a pretreatment setting.

Keywords

PET/MRI Cervical cancer Primary tumor staging Standardized uptake value Apparent diffusion coefficient 

Notes

Acknowledgments

Lale Umutlu is a consultant for Bayer HealthCare.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no competing interests.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Research Committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90.CrossRefPubMedGoogle Scholar
  2. 2.
    Quinn MA, Benedet JL, Odicino F, Maisonneuve P, Beller U, Creasman WT, et al. Carcinoma of the cervix uteri. FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer. Int J Gynaecol Obstet. 2006;95 Suppl 1:S43–S103.CrossRefPubMedGoogle Scholar
  3. 3.
    Lagasse LD, Creasman WT, Shingleton HM, Ford JH, Blessing JA. Results and complications of operative staging in cervical cancer: experience of the Gynecologic Oncology Group. Gynecol Oncol. 1980;9:90–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Freeman SJ, Aly AM, Kataoka MY, Addley HC, Reinhold C, Sala E. The revised FIGO staging system for uterine malignancies: implications for MR imaging. Radiographics. 2012;32:1805–27.CrossRefPubMedGoogle Scholar
  5. 5.
    Sala E, Wakely S, Senior E, Lomas D. MRI of malignant neoplasms of the uterine corpus and cervix. AJR Am J Roentgenol. 2007;188:1577–87.CrossRefPubMedGoogle Scholar
  6. 6.
    Havrilesky LJ, Kulasingam SL, Matchar DB, et al. FDG-PET for management of cervical and ovarian cancer. Gynecol Oncol. 2005;97:183–91.Google Scholar
  7. 7.
    Antoch G, Saoudi N, Kuehl H, Dahmen G, Mueller SP, Beyer T, et al. Accuracy of whole-body dual-modality fluorine-18-2-fluoro-2-deoxy-D-glucose positron emission tomography and computed tomography (FDG-PET/CT) for tumor staging in solid tumors: comparison with CT and PET. J Clin Oncol. 2004;22:4357–68.CrossRefPubMedGoogle Scholar
  8. 8.
    Bar-Shalom R, Yefremov N, Guralnik L, Gaitini D, Frenkel A, Kuten A, et al. Clinical performance of PET/CT in evaluation of cancer: additional value for diagnostic imaging and patient management. J Nucl Med. 2003;44:1200–9.PubMedGoogle Scholar
  9. 9.
    Wetter A, Lipponer C, Nensa F, Beiderwellen K, Olbricht T, Rubben H, et al. Simultaneous 18F choline positron emission tomography/magnetic resonance imaging of the prostate: initial results. Investig Radiol. 2013;48:256–62.CrossRefGoogle Scholar
  10. 10.
    Pace L, Nicolai E, Luongo A, Aiello M, Catalano OA, Soricelli A, et al. Comparison of whole-body PET/CT and PET/MRI in breast cancer patients: lesion detection and quantitation of 18F-deoxyglucose uptake in lesions and in normal organ tissues. Eur J Radiol. 2014;83:289–96.CrossRefPubMedGoogle Scholar
  11. 11.
    Heusch P, Buchbender C, Kohler J, Nensa F, Beiderwellen K, Kuhl H, et al. Correlation of the apparent diffusion coefficient (ADC) with the standardized uptake value (SUV) in hybrid 18F-FDG PET/MRI in non-small cell lung cancer (NSCLC) lesions: initial results. Röfo. 2013;185:1056–62.PubMedGoogle Scholar
  12. 12.
    Elmi A, Hedgire SS, Covarrubias D, Abtahi SM, Hahn PF, Harisinghani M. Apparent diffusion coefficient as a non-invasive predictor of treatment response and recurrence in locally advanced rectal cancer. Clin Radiol. 2013;68:e524–31.CrossRefPubMedGoogle Scholar
  13. 13.
    Nakamura K, Joja I, Kodama J, Hongo A, Hiramatsu Y. Measurement of SUVmax plus ADCmin of the primary tumour is a predictor of prognosis in patients with cervical cancer. Eur J Nucl Med Mol Imaging. 2012;39:283–90.CrossRefPubMedGoogle Scholar
  14. 14.
    Shanmugan S, Arrangoiz R, Nitzkorski JR, Yu JQ, Li T, Cooper H, et al. Predicting pathological response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer using 18FDG-PET/CT. Ann Surg Oncol. 2012;19:2178–85.CrossRefPubMedGoogle Scholar
  15. 15.
    Antoch G, Stattaus J, Nemat AT, Marnitz S, Beyer T, Kuehl H, et al. Non-small cell lung cancer: dual-modality PET/CT in preoperative staging. Radiology. 2003;229:526–33.CrossRefPubMedGoogle Scholar
  16. 16.
    Kitajima K, Murakami K, Yamasaki E, Domeki Y, Kaji Y, Morita S, et al. Performance of integrated FDG-PET/contrast-enhanced CT in the diagnosis of recurrent uterine cancer: comparison with PET and enhanced CT. Eur J Nucl Med Mol Imaging. 2009;36:362–72.CrossRefPubMedGoogle Scholar
  17. 17.
    Subak LL, Hricak H, Powell CB, Azizi L, Stern JL. Cervical carcinoma: computed tomography and magnetic resonance imaging for preoperative staging. Obstet Gynecol. 1995;86:43–50.CrossRefPubMedGoogle Scholar
  18. 18.
    Sala E, Rockall AG, Freeman SJ, Mitchell DG, Reinhold C. The added role of MR imaging in treatment stratification of patients with gynecologic malignancies: what the radiologist needs to know. Radiology. 2013;266:717–40.CrossRefPubMedGoogle Scholar
  19. 19.
    Lee SI, Catalano OA, Dehdashti F. Evaluation of gynecologic cancer with mr imaging, 18F-FDG PET/CT, and PET/MR imaging. J Nucl Med. 2015;56:436–43.CrossRefPubMedGoogle Scholar
  20. 20.
    Kitajima K, Suenaga Y, Ueno Y, Kanda T, Maeda T, Deguchi M, et al. Fusion of PET and MRI for staging of uterine cervical cancer: comparison with contrast-enhanced (18)F-FDG PET/CT and pelvic MRI. Clin Imaging. 2014;38:464–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Tanaka Y, Sawada S, Murata T. Relationship between lymph node metastases and prognosis in patients irradiated postoperatively for carcinoma of the uterine cervix. Acta Radiol Oncol. 1984;23:455–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Veit P, Ruehm S, Kuehl H, Stergar H, Mueller S, Bockisch A, et al. Lymph node staging with dual-modality PET/CT: enhancing the diagnostic accuracy in oncology. Eur J Radiol. 2006;58:383–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Kim SK, Choi HJ, Park SY, Lee HY, Seo SS, Yoo CW, et al. Additional value of MR/PET fusion compared with PET/CT in the detection of lymph node metastases in cervical cancer patients. Eur J Cancer. 2009;45:2103–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Grueneisen J, Beiderwellen K, Heusch P, Gratz M, Schulze-Hagen A, Heubner M, et al. Simultaneous positron emission tomography/magnetic resonance imaging for whole-body staging in patients with recurrent gynecological malignancies of the pelvis: a comparison to whole-body magnetic resonance imaging alone. Invest Radiol. 2014;49:808–15.Google Scholar
  25. 25.
    Heusch P, Nensa F, Schaarschmidt B, Sivanesapillai R, Beiderwellen K, Gomez B, et al. Diagnostic accuracy of whole-body PET/MRI and whole-body PET/CT for TNM staging in oncology. Eur J Nucl Med Mol Imaging. 2015;42:42–8.Google Scholar
  26. 26.
    Song BI, Lee SW, Jeong SY, Chae YS, Lee WK, Ahn BC, et al. 18F-FDG uptake by metastatic axillary lymph nodes on pretreatment PET/CT as a prognostic factor for recurrence in patients with invasive ductal breast cancer. J Nucl Med. 2012;53:1337–44.CrossRefPubMedGoogle Scholar
  27. 27.
    Fujimoto H, Kazama T, Nagashima T, Sakakibara M, Suzuki TH, Okubo Y, et al. Diffusion-weighted imaging reflects pathological therapeutic response and relapse in breast cancer. Breast Cancer. 2014;21:724–31.Google Scholar
  28. 28.
    Pinker-Domenig K, Baltzer P, Magometschnigg H, Polanec S, Andrezejewski P, Sturdza AE, et al. PET/MRI in cervical cancer: insights into tumor biology. J Clin Oncol. 2015;33:(suppl; abstr 5597).Google Scholar
  29. 29.
    Kidd EA, Siegel BA, Dehdashti F, Grigsby PW. The standardized uptake value for F-18 fluorodeoxyglucose is a sensitive predictive biomarker for cervical cancer treatment response and survival. Cancer. 2007;110:1738–44.CrossRefPubMedGoogle Scholar
  30. 30.
    Kidd EA, Spencer CR, Huettner PC, Siegel BA, Dehdashti F, Rader JS, et al. Cervical cancer histology and tumor differentiation affect 18F-fluorodeoxyglucose uptake. Cancer. 2009;115:3548–54.CrossRefPubMedGoogle Scholar
  31. 31.
    Kuang F, Ren J, Zhong Q, Liyuan F, Huan Y, Chen Z. The value of apparent diffusion coefficient in the assessment of cervical cancer. Eur Radiol. 2013;23:1050–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Johannes Grueneisen
    • 1
    Email author
  • Benedikt Michael Schaarschmidt
    • 2
  • Martin Heubner
    • 3
  • Bahriye Aktas
    • 3
  • Sonja Kinner
    • 1
  • Michael Forsting
    • 1
  • Thomas Lauenstein
    • 1
  • Verena Ruhlmann
    • 4
  • Lale Umutlu
    • 1
  1. 1.Department of Diagnostic and Interventional Radiology and NeuroradiologyUniversity Hospital Essen, University of Duisburg-EssenEssenGermany
  2. 2.Department of Diagnostic and Interventional RadiologyUniversity Hospital Dusseldorf, University of DusseldorfDusseldorfGermany
  3. 3.Department of Obstetrics and GynecologyUniversity Hospital Essen, University of Duisburg-EssenEssenGermany
  4. 4.Department of Nuclear MedicineUniversity Hospital Essen, University of Duisburg-EssenEssenGermany

Personalised recommendations