Integrated 18F–FDG PET/MRI compared to MRI alone for identification of local recurrences of soft tissue sarcomas: a comparison trial

  • Youssef ErfanianEmail author
  • Johannes Grueneisen
  • Julian Kirchner
  • Axel Wetter
  • Lars Erik Podleska
  • Sebastian Bauer
  • Thorsten Poeppel
  • Michael Forsting
  • Ken Herrmann
  • Lale Umutlu
Original Article



To assess and compare the diagnostic accuracy of PET/MRI and MRI alone for the detection of local recurrences of soft tissue sarcomas (STS) after initial surgical resection of the primary tumors.

Material and methods

A total of 41 patients with clinically suspected tumor relapse of STS underwent an 18F–FDG-PET/MRI examination for assessment of local recurrence. Two experienced physicians interpreted the MRI data and subsequently the PET/MRI datasets in two separate reading sessions and were instructed to identify potential local tumor recurrences. Additionally, the diagnostic confidence in each reading for the identification of malignant lesions was determined. A McNemar test was applied to test for differences of both ratings and a Wilcoxon signed-rank test was used to identify differences of the confidence levels. Histopathological verification and follow-up imaging were applied for standard of reference.


Tumor relapse was present in 27/41 patients. Calculated sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy for the detection of local tumor recurrence was 82%, 86%, 92%, 71% and 83% for MRI, and 96%, 79%, 90%, 92% and 90% for PET/MRI (p > 0.05). Furthermore, PET/MRI showed significantly higher confidence levels (p < 0.05) for the determination of malignant lesions.


Our results endorse 18F–FDG PET/MRI to be an excellent imaging method in the evaluation of recurrent STS after surgical excision, yielding superior tumor detection when compared to MRI alone.


Soft tissue sarcoma Integrated PET/MRI Hybrid imaging 


Compliance with ethical standards


Conflicts of interest


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.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Youssef Erfanian
    • 1
    Email author
  • Johannes Grueneisen
    • 1
  • Julian Kirchner
    • 2
  • Axel Wetter
    • 1
  • Lars Erik Podleska
    • 3
  • Sebastian Bauer
    • 4
  • Thorsten Poeppel
    • 5
  • Michael Forsting
    • 1
  • Ken Herrmann
    • 5
  • 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.Sarcoma Surgery Division, Department of General-, Visceral- and Transplantation SurgeryUniversity Hospital Essen, University of Duisburg-EssenEssenGermany
  4. 4.Division of Solid Tumor Translational Oncology, Department of Medical Oncology, West German Cancer CenterUniversity Hospital Essen, University of Duisburg-EssenEssenGermany
  5. 5.Clinic for Nuclear MedicineUniversity Hospital Essen, University of Duisburg-EssenEssenGermany

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