European Radiology

, Volume 25, Issue 5, pp 1267–1278 | Cite as

Computed tomography, magnetic resonance imaging and FDG positron emission tomography in the management of vulvar malignancies

  • Gigin Lin
  • Chao-Yu Chen
  • Feng-Yuan Liu
  • Lan-Yan Yang
  • Huei-Jean Huang
  • Yi-Ting Huang
  • Shih-Ming Jung
  • Hung-Hsueh Chou
  • Chyong-Huey LaiEmail author
  • Koon-Kwan NgEmail author



To prospectively evaluate the value of CT or MRI (CT/MRI) and PET in the management of vulvar malignancies.


Abdominal and pelvic CT/MRI and whole-body 18 F-FDG (fluorodeoxyglucose) PET or PET/CT (collectively designated PET hereafter) were performed. Lesion status was determined by the pathological findings or clinical follow-up. The diagnostic efficacy was evaluated by receiver operating characteristic (ROC) curve analysis. The clinical impact of PET was determined on a per scan basis.


Twenty-three patients were enrolled, and 38 PET examinations were performed. CT/MRI and PET studies were used for primary staging (n = 17), monitoring the response (n = 7) and restaging after recurrence (n = 14). In primary staging, there was no significant difference between CT/MRI and PET in detecting metastatic inguinal lymph nodes (ILN). CT/MRI was significantly more efficacious than PET in detecting pelvic lymph node (PLN) or distant metastasis (p = 0.007 by ROC per patient basis). PET findings resulted in two positive impacts and one negative impact for both primary staging and restaging.


False-positive PLN or distant metastasis PET findings are not uncommon, and hence should be interpreted with caution. PET can be supportive when metastatic ILN/PLN or distant metastasis is suspected on CT/MRI.

Key Points

False-positive metastatic PLN or distant metastasis PET findings are not uncommon.

CT/MRI has value in the management of vulvar malignancies.

PET can be supportive when metastasis is suspected by CT/MRI.


Positron emission tomography Vulvar malignancies Computed tomography 18 F-FDG fluorodeoxyglucose Magnetic resonance imaging 

Abbreviations and acronyms


apparent diffusion coefficient


the American Joint Committee on Cancer


the area under the curve


concurrent chemoradiation


computed tomography


the International Federation of Gynecology and Obstetrics

18 F-FDG



inguinal lymph nodes


lymph nodes


magnetic resonance imaging


negative predictive value


positron emission tomography


PET integrated computed tomography


pelvic lymph nodes


positive predictive value


receiver operating characteristic curve




standardised uptake value


maximum standardised uptake values


echo time


repetition time

Gigin Lin

Chao-Yu Chen and Feng-Yuan Liu contributed equally to this paper.



We would like to thank ATS Medical Editing and Review Solutions for providing language editing services.

The scientific guarantor of this publication is Koon-Kwan Ng. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This study received funding by CMRPG290262 and CMRPG381132 from the Chang Gung Medical Foundation and the Department of Health-Taiwan (DOH102-TD-C-111-006). Lan-Yan Yang provided statistical analysis for this manuscript. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective study/diagnostic or prognostic study/performed at one institution


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Copyright information

© European Society of Radiology 2014

Authors and Affiliations

  • Gigin Lin
    • 1
    • 8
  • Chao-Yu Chen
    • 2
  • Feng-Yuan Liu
    • 3
    • 8
  • Lan-Yan Yang
    • 4
    • 8
  • Huei-Jean Huang
    • 2
    • 8
  • Yi-Ting Huang
    • 5
    • 8
  • Shih-Ming Jung
    • 6
  • Hung-Hsueh Chou
    • 2
    • 8
  • Chyong-Huey Lai
    • 2
    • 8
    Email author
  • Koon-Kwan Ng
    • 1
    • 7
    • 8
    Email author
  1. 1.Department of Medical Imaging and InterventionChang Gung Memorial Hospital and Chang Gung University College of MedicineTaoyuanTaiwan
  2. 2.Department of Obstetrics and GynecologyChang Gung Memorial Hospital and Chang Gung University College of MedicineTaoyuanTaiwan
  3. 3.Department of Nuclear MedicineChang Gung Memorial Hospital and Chang Gung University College of MedicineTaoyuanTaiwan
  4. 4.Biostatistics and Informatics Unit, Clinical Trial CenterChang Gung Memorial HospitalTaoyuanTaiwan
  5. 5.Department of Radiation OncologyChang Gung Memorial Hospital and Chang Gung University College of MedicineTaoyuanTaiwan
  6. 6.Department of PathologyChang Gung Memorial Hospital and Chang Gung University College of MedicineTaoyuanTaiwan
  7. 7.Department of Diagnostic RadiologyKeelung Chang Gung Memorial HospitalKeelungTaiwan
  8. 8.Gynecologic Cancer Research CenterChang Gung Memorial HospitalTaoyuanTaiwan

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