European Radiology

, Volume 25, Issue 8, pp 2222–2230 | Cite as

PET/MRI and PET/CT in advanced gynaecological tumours: initial experience and comparison

  • Marcelo A. Queiroz
  • Rahel A. Kubik-Huch
  • Nik Hauser
  • Bianka Freiwald-Chilla
  • Gustav von Schulthess
  • Johannes M. Froehlich
  • Patrick Veit-HaibachEmail author
Nuclear Medicine



To compare the diagnostic accuracy of PET/MRI and PET/CT for staging and re-staging advanced gynaecological cancer patients as well as identify the potential benefits of each method in such a population.

Material and methods

Twenty-six patients with suspicious or proven advanced gynaecological cancer (12 ovarian, seven cervical, one vulvar and four endometrial tumours, one uterine metastasis, and one primary peritoneal cancer) underwent whole-body imaging with a sequential trimodality PET/CT/MR system. Images were analysed regarding primary tumour detection and delineation, loco-regional lymph node staging, and abdominal/extra-abdominal distant metastasis detection (last only by PET/CT).


Eighteen (69.2 %) patients underwent PET/MRI for primary staging and eight patients (30.8 %) for re-staging their gynaecological malignancies. For primary tumour delineation, PET/MRI accuracy was statistically superior to PET/CT (p < 0.001). Among the different types of cancer, PET/MRI presented better tumour delineation mainly for cervical (6/7) and endometrial (2/3) cancers. PET/MRI for local evaluation as well as PET/CT for extra-abdominal metastases had therapeutic consequences in three and one patients, respectively. PET/CT detected 12 extra-abdominal distant metastases in 26 patients.


PET/MRI is superior to PET/CT for primary tumour delineation. No differences were found in detection of regional lymph node involvement and abdominal metastases detection.

Key Points

PET/MRI is superior to PET/CT for primary tumour delineation

PET/CT represents a reliable tool to detect extra-abdominal distant metastasis

PET/MRI might be the preferred imaging modality for staging cervical and endometrial tumours

Whole-body staging for detection and evaluation of extra-abdominal metastases is mandatory


PET/CT PET/MRI Advanced gynaecological tumours Staging Re-staging 



The scientific guarantor of this publication is Patrick Veit-Haibach. The authors of this manuscript declare relationships with the following companies: GE Healthcare (P.V.H. and G.v.S), Bayer Healthcare (P.V.H.), Siemens Medical Solutions (P.V.H.) and Guerbet Switzerland (J.M.F.). The others 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 has received funding by GE Healthcare. 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. No animals have been used in the study. None of the study subjects or cohorts have been previously reported. Methodology: prospective, diagnostic or prognostic study/performed at one institution.


  1. 1.
    Iyer VR, Lee SI (2010) MRI, CT, and PET/CT for ovarian cancer detection and adnexal lesion characterization. AJR Am J Roentgenol 194:311–321PubMedCrossRefGoogle Scholar
  2. 2.
    Kitajima K, Suenaga Y, Ueno Y et al (2013) Value of fusion of PET and MRI for staging of endometrial cancer: comparison with 18F-FDG contrast-enhanced PET/CT and dynamic contrast-enhanced pelvic MRI. Eur J Radiol 82:1672–1676PubMedCrossRefGoogle Scholar
  3. 3.
    Antonsen SL, Jensen LN, Loft A et al (2013) MRI, PET/CT and ultrasound in the preoperative staging of endometrial cancer - a multicenter prospective comparative study. Gynecol Oncol 128:300–308PubMedCrossRefGoogle Scholar
  4. 4.
    Gatsonis C, Coakley FV, Snyder B et al (2007) Early Invasive Cervical Cancer: CT and MR Imaging in Preoperative Evaluation. Radiology 245:491–498PubMedCrossRefGoogle Scholar
  5. 5.
    Tsai C-C, Tsai C-S, Ng K-K et al (2003) The impact of image fusion in resolving discrepant findings between FDG-PET and MRI/CT in patients with gynaecological cancers. Eur J Nucl Med Mol Imaging 30:1674–1683PubMedCrossRefGoogle Scholar
  6. 6.
    Hynninen J, Kemppainen J, Lavonius M, Virtanen J, Matomäki J, Oksa S, Carpén O, Grénman S, Seppänen M, Auranen A (2013) A prospective comparison of integrated FDG-PET/contrast-enhanced CT and contrast-enhanced CT for pretreatment imaging of advanced epithelial ovarian cancer. Gynecol Oncol 131(2):389-94Google Scholar
  7. 7.
    Spencer JA, Forstner R, Cunha TM, Kinkel K (2009) ESUR guidelines for MR imaging of the sonographically indeterminate adnexal mass: an algorithmic approach. Eur Radiol 20:25–35CrossRefGoogle Scholar
  8. 8.
    Kinkel K, Forstner R, Danza FM et al (2009) Staging of endometrial cancer with MRI: guidelines of the European Society of Urogenital Imaging. Eur Radiol 19:1565–1574PubMedCrossRefGoogle Scholar
  9. 9.
    Sala E, Rockall A, Rangarajan D, Kubik-Huch RA (2010) The role of dynamic contrast-enhanced and diffusion weighted magnetic resonance imaging in the female pelvis. Eur J Radiol 76:367–385PubMedCrossRefGoogle Scholar
  10. 10.
    Sala E, Rockall A, Kubik-Huch RA (2011) Advances in magnetic resonance imaging of endometrial cancer. Eur Radiol 21:468–473PubMedCrossRefGoogle Scholar
  11. 11.
    Dauwen H, Van Calster B, Deroose CM et al (2013) PET/CT in the staging of patients with a pelvic mass suspicious for ovarian cancer. Gynecol Oncol. doi: 10.1016/j.ygyno.2013.08.020 PubMedGoogle Scholar
  12. 12.
    Risum S, Høgdall C, Loft A (2010) Does the use of diagnostic PET/CT cause stage migration in patients with primary advanced ovarian cancer? Gynecol Oncol 116:395–398PubMedCrossRefGoogle Scholar
  13. 13.
    Amit A, Person O, Keidar Z (2013) FDG PET/CT in monitoring response to treatment in gynecological malignancies. Curr Opin Obstet Gynecol 25:17–22PubMedCrossRefGoogle Scholar
  14. 14.
    Chung HH, Kang KW, Cho JY et al (2010) Role of magnetic resonance imaging and positron emission tomography/computed tomography in preoperative lymph node detection of uterine cervical cancer. Am J Obstet Gynecol 203:156.e1–5CrossRefGoogle Scholar
  15. 15.
    Sala E, Rockall AG, Freeman SJ et al (2013) The added role of MR imaging in treatment stratification of patients with gynecologic malignancies: what the radiologist needs to know. Radiology 266:717–740PubMedCrossRefGoogle Scholar
  16. 16.
    Buchbender C, Heusner TA, Lauenstein TC et al (2012) Oncologic PET/MRI, Part 1: tumors of the Brain, Head and Neck, Chest, Abdomen, and Pelvis. J Nucl Med 53:928–938PubMedCrossRefGoogle Scholar
  17. 17.
    Kuhn FP, Crook DW, Mader CE et al (2013) Discrimination and anatomical mapping of PET-positive lesions: comparison of CT attenuation-corrected PET images with coregistered MR and CT images in the abdomen. Eur J Nucl Med Mol Imaging 40:44–51PubMedCrossRefGoogle Scholar
  18. 18.
    Buchbender C, Heusner TA, Lauenstein TC et al (2012) Oncologic PET/MRI, Part 2: bone Tumors, Soft-Tissue Tumors, Melanoma, and Lymphoma. J Nucl Med 53:1244–1252PubMedCrossRefGoogle Scholar
  19. 19.
    Rockall AG, Cross S, Flanagan S et al (2012) The role of FDG-PET/CT in gynaecological cancers. Cancer Imaging 12:49–65PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Vargas HA, Burger IA, Donati OF et al (2013) Magnetic resonance imaging/positron emission tomography provides a roadmap for surgical planning and serves as a predictive biomarker in patients with recurrent gynecological cancers undergoing pelvic exenteration. Int J Gynecol Cancer 23:1512–1519PubMedCrossRefGoogle Scholar
  21. 21.
    Grueneisen J, Beiderwellen K, Heusch P et al (2014) 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. Investig Radiol 49:808–815CrossRefGoogle Scholar
  22. 22.
    Veit-Haibach P, Kuhn FP, Wiesinger F et al (2013) PET-MR imaging using a tri-modality PET/CT-MR system with a dedicated shuttle in clinical routine. MAGMA 26:25–35PubMedCrossRefGoogle Scholar
  23. 23.
    Boellaard R, O’Doherty MJ, Weber WA et al (2010) FDG PET and PET/CT: EANM procedure guidelines for tumour PET imaging: version 1.0. Eur J Nucl Med Mol Imaging 37:181–200PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Kuhn FP, Wiesinger F, Wollenweber SD, Samarin A, Von Schulthess G SD (2012) Sequential integrated PET/CT-MR system: comparison of image registration accuracy of PET/CT versus PET/MR.Google Scholar
  25. 25.
    Nam EJ, Yun MJ, Oh YT et al (2010) Diagnosis and staging of primary ovarian cancer: correlation between PET/CT, Doppler US, and CT or MRI. Gynecol Oncol 116:389–394PubMedCrossRefGoogle Scholar
  26. 26.
    Burger IA, Vargas HA, Donati OF et al (2013) The value of 18F-FDG PET/CT in recurrent gynecologic malignancies prior to pelvic exenteration. Gynecol Oncol 129:586–592PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Husain A, Akhurst T, Larson S et al (2007) A prospective study of the accuracy of 18Fluorodeoxyglucose positron emission tomography (18FDG PET) in identifying sites of metastasis prior to pelvic exenteration. Gynecol Oncol 106:177–180PubMedCrossRefGoogle Scholar
  28. 28.
    Yen T-C, Lai C-H (2006) Positron emission tomography in gynecologic cancer. Semin Nucl Med 36:93–104PubMedCrossRefGoogle Scholar
  29. 29.
    Fiaschetti V, Calabria F, Crusco S et al (2011) MR-PET fusion imaging in evaluating adnexal lesions: a preliminary study. Radiol Med 116:1288–1302PubMedCrossRefGoogle Scholar
  30. 30.
    Reinhardt MJ, Ehritt-Braun C, Vogelgesang D et al (2001) Metastatic lymph nodes in patients with cervical cancer: detection with MR imaging and FDG PET. Radiology 218:776–782PubMedCrossRefGoogle Scholar
  31. 31.
    Kim S-K, Choi HJ, Park S-Y et al (2009) Additional value of MR/PET fusion compared with PET/CT in the detection of lymph node metastases in cervical cancer patients. Eur J Cancer 45:2103–2109PubMedCrossRefGoogle Scholar
  32. 32.
    Seo HJ, Kim M, Lee JD, Chung W (2011) Gadoxetate Disodium-Enhanced Magnetic Resonance Imaging Emission Tomography / Computed Tomography for the Detection of Colorectal Liver Metastases. 46:Google Scholar
  33. 33.
    Beiderwellen K, Gomez B, Buchbender C et al (2013) Depiction and characterization of liver lesions in whole body [(18)F]-FDG PET/MRI. Eur J Radiol 82:e669–e675PubMedCrossRefGoogle Scholar
  34. 34.
    Kolev V, Mironov S, Mironov O et al (2010) Prognostic significance of supradiaphragmatic lymphadenopathy identified on preoperative computed tomography scan in patients undergoing primary cytoreduction for advanced epithelial ovarian cancer. Int J Gynecol Cancer 20:979–984PubMedCrossRefGoogle Scholar
  35. 35.
    Hynninen J, Auranen A, Carpén O et al (2012) FDG PET/CT in staging of advanced epithelial ovarian cancer: frequency of supradiaphragmatic lymph node metastasis challenges the traditional pattern of disease spread. Gynecol Oncol 126:64–68PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2015

Authors and Affiliations

  • Marcelo A. Queiroz
    • 1
    • 5
    • 6
  • Rahel A. Kubik-Huch
    • 2
  • Nik Hauser
    • 3
  • Bianka Freiwald-Chilla
    • 2
  • Gustav von Schulthess
    • 1
    • 5
    • 6
  • Johannes M. Froehlich
    • 4
  • Patrick Veit-Haibach
    • 1
    • 5
    • 6
    Email author
  1. 1.Department Medical Radiology, Nuclear MedicineUniversity Hospital ZurichZurichSwitzerland
  2. 2.Department of RadiologyKantonsspital Baden AGBadenSwitzerland
  3. 3.Department of GynaecologyKantonsspital Baden AGBadenSwitzerland
  4. 4.Guerbet AGZurichSwitzerland
  5. 5.Department Medical Radiology, Diagnostic and Interventional RadiologyUniversity Hospital ZurichZurichSwitzerland
  6. 6.University of ZurichZurichSwitzerland

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