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European Radiology

, Volume 24, Issue 8, pp 2023–2030 | Cite as

Whole-body [18F]FDG PET/MRI vs. PET/CT in the assessment of bone lesions in oncological patients: initial results

  • Karsten Beiderwellen
  • Michael Huebner
  • Philipp Heusch
  • Johannes Grueneisen
  • Verena Ruhlmann
  • Felix Nensa
  • Hilmar Kuehl
  • Lale Umutlu
  • Sandra Rosenbaum-Krumme
  • Thomas C. Lauenstein
Molecular Imaging

Abstract

Objectives

To compare [18 F]FDG PET/MRI with PET/CT for the assessment of bone lesions in oncologic patients.

Methods

This prospective study included 67 patients with solid tumours scheduled for PET/CT with [18 F]FDG who also underwent a whole-body PET/MRI scan. The datasets (PET/CT, PET/MRI) were rated by two readers regarding lesion conspicuity (four-point scale) and diagnostic confidence (five-point scale). Median scores were compared using the Wilcoxon test.

Results

Bone metastases were present in ten patients (15 %), and benign bone lesions in 15 patients (22 %). Bone metastases were predominantly localized in the pelvis (18 lesions, 38 %) and the spine (14 lesions, 29 %). Benign bone lesions were exclusively osteosclerotic and smaller than the metastases (mean size 6 mm vs. 23 mm). While PET/CT allowed identification of 45 of 48 bone metastases (94 %), PET/MRI allowed identification of all bone metastases (100 %). Conspicuity of metastases was high for both modalities with significantly better results using PET/MRI (p < 0.05). Diagnostic confidence in lesion detection was high for both modalities without a significant difference. In benign lesions, conspicuity and diagnostic confidence were significantly higher with PET/CT (p < 0.05).

Conclusions

[18 F]FDG PET/MRI shows high potential for the assessment of bone metastases by offering superior lesion conspicuity when compared to PET/CT. In hypersclerotic, benign bone lesions PET/CT still sets the reference.

Key Points

PET/MRI and PET/CT are of equal value for the identification of disease-positive patients

PET/MRI offers higher lesion conspicuity as well as diagnostic confidence

PET/MRI is an attractive new alternative for the assessment of bone metastases

Key words

PET/MRI PET/CT Bone metastases Oncology [18 F]FDG 

Notes

Acknowledgements

The scientific guarantor of this article is Thomas C. Lauenstein. The authors of this article declare relationships with the following companies: Bayer Healthcare (Lale Umutlu, consultant),and Siemens Healthcare (Hilmar Kuehl, speaker honoraria). This study received funding from the German Research Foundation (DFG, Deutsche Forschungsgemeinschaft; funding AN 397/3-1). One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, diagnostic study, performed at one institution.

We wish to thank the technical staff for their excellent work, especially Sebastian Blex, Samantha Horry, Julia Joos and Madeleine Fink.

References

  1. 1.
    Rubens RD (1998) Bone metastases – the clinical problem. Eur J Cancer 34:210–213PubMedCrossRefGoogle Scholar
  2. 2.
    Even-Sapir E (2005) Imaging of malignant bone involvement by morphologic, scintigraphic, and hybrid modalities. J Nucl Med 46:1356–1367PubMedGoogle Scholar
  3. 3.
    Savelli G, Maffioli L, Maccauro M, de Deckere E, Bombardieri E (2001) Bone scintigraphy and the added value of SPECT (single photon emission tomography) in detecting skeletal lesions. Q J Nucl Med 45:27–37PubMedGoogle Scholar
  4. 4.
    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 290:3199–3206PubMedCrossRefGoogle Scholar
  5. 5.
    Taira AV, Herfkens RJ, Gambhir SS, Quon A (2007) Detection of bone metastases: assessment of integrated FDG PET/CT imaging. Radiology 243:204–211PubMedCrossRefGoogle Scholar
  6. 6.
    Uchida K, Nakajima H, Miyazaki T et al (2013) (18)F-FDG PET/CT for diagnosis of osteosclerotic and osteolytic vertebral metastatic lesions: comparison with bone scintigraphy. Asian Spine J 7:96–103PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Lauenstein TC, Freudenberg LS, Goehde SC et al (2002) Whole-body MRI using a rolling table platform for the detection of bone metastases. Eur Radiol 12:2091–2099PubMedCrossRefGoogle Scholar
  8. 8.
    Schmidt GP, Schoenberg SO, Schmid R et al (2007) Screening for bone metastases: whole-body MRI using a 32-channel system versus dual-modality PET-CT. Eur Radiol 17:939–949PubMedCrossRefGoogle Scholar
  9. 9.
    Iagaru A, Young P, Mittra E, Dick DW, Herfkens R, Gambhir SS (2013) Pilot prospective evaluation of 99mTc-MDP scintigraphy, 18 F NaF PET/CT, 18 F FDG PET/CT and whole-body MRI for detection of skeletal metastases. Clin Nucl Med 38:e290–e296PubMedCrossRefGoogle Scholar
  10. 10.
    Antoch G, Bockisch A (2009) Combined PET/MRI: a new dimension in whole-body oncology imaging? Eur J Nucl Med Mol Imaging 36(Suppl 1):113–120CrossRefGoogle Scholar
  11. 11.
    Martinez-Moller A, Souvatzoglou M, Delso G et al (2009) Tissue classification as a potential approach for attenuation correction in whole-body PET/MRI: evaluation with PET/CT data. J Nucl Med 50:520–526PubMedCrossRefGoogle Scholar
  12. 12.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174PubMedCrossRefGoogle Scholar
  13. 13.
    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 53:845–855PubMedCrossRefGoogle Scholar
  14. 14.
    Wetter A, Lipponer C, Nensa F et al (2013) Simultaneous 18 F choline positron emission tomography/magnetic resonance imaging of the prostate: initial results. Invest Radiol 48:256–262PubMedCrossRefGoogle Scholar
  15. 15.
    Beiderwellen KJ, Poeppel TD, Hartung-Knemeyer V et al (2013) Simultaneous 68Ga-DOTATOC PET/MRI in patients with gastroenteropancreatic neuroendocrine tumors: initial results. Invest Radiol 48:273–279PubMedCrossRefGoogle Scholar
  16. 16.
    Hartung-Knemeyer V, Rosenbaum-Krumme S, Buchbender C et al (2012) Malignant pheochromocytoma imaging with 124ImIBG PET/MR. J Clin Endocrinol Metab 97:3833–3834PubMedCrossRefGoogle Scholar
  17. 17.
    Platzek I, Beuthien-Baumann B, Schneider M et al (2013) PET/MRI in head and neck cancer: initial experience. Eur J Nucl Med Mol Imaging 40:6–11PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Choi J, Raghavan M (2012) Diagnostic imaging and image-guided therapy of skeletal metastases. Cancer Control 19:102–112PubMedGoogle Scholar
  19. 19.
    Avery R, Kuo PH (2013) 18 F sodium fluoride PET/CT detects osseous metastases from breast cancer missed on FDG PET/CT with marrow rebound. Clin Nucl Med 38:746–748PubMedCrossRefGoogle Scholar
  20. 20.
    Lan X, Zhang Y, Wu Z, Jia Q, Wei H, Gao Z (2008) The value of dual time point (18)F-FDG PET imaging for the differentiation between malignant and benign lesions. Clin Radiol 63:756–764PubMedCrossRefGoogle Scholar
  21. 21.
    Marshall HR, Patrick J, Laidley D et al (2013) Description and assessment of a registration-based approach to include bones for attenuation correction of whole-body PET/MRI. Med Phys 40:082509PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2014

Authors and Affiliations

  • Karsten Beiderwellen
    • 1
  • Michael Huebner
    • 1
  • Philipp Heusch
    • 3
  • Johannes Grueneisen
    • 1
  • Verena Ruhlmann
    • 2
  • Felix Nensa
    • 1
  • Hilmar Kuehl
    • 1
  • Lale Umutlu
    • 1
  • Sandra Rosenbaum-Krumme
    • 2
  • Thomas C. Lauenstein
    • 1
  1. 1.Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital EssenUniversity of Duisburg-EssenEssenGermany
  2. 2.Department of Nuclear Medicine, University Hospital EssenUniversity of Duisburg-EssenEssenGermany
  3. 3.Department of Diagnostic and Interventional Radiology, Medical FacultyUniversity of DuesseldorfDuesseldorfGermany

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