Abstract
Purpose
The purpose of this study was to determine whether [68Ga]DOTATATE PET/MRI with diffusion-weighted imaging (DWI) can replace or complement [18F]FDG PET/CT in patients with radioactive-iodine (RAI)-refractory differentiated thyroid cancer (DTC).
Methods
The study population comprised 12 patients with elevated thyroglobulin and a negative RAI scan after thyroidectomy and RAI remnant ablation who underwent both [18F]FDG PET/CT and [68Ga]DOTATATE PET/MRI within 8 weeks of each other. The presence of recurrent cancer was evaluated on a per-patient, per-organ and per-lesion basis. Histology, and prior and follow-up examinations served as the standard of reference.
Results
Recurrent or metastatic tumour was confirmed in 11 of the 12 patients. [68Ga]DOTATATE PET(/MRI) correctly identified the tumour burden in all 11 patients, whereas in one patient local relapse was missed by [18F]FDG PET/CT. In the lesion-based analysis, overall lesion detection rates were 79/85 (93 %), 69/85 (81 %) and 27/82 (33 %) for [18F]FDG PET/CT, [68Ga]DOTATATE PET/MRI and DWI, respectively. [18F]FDG PET(/CT) was superior to [68Ga]DOTATATE PET(/MRI) in the overall evaluation and in the detection of pulmonary metastases. In the detection of extrapulmonary metastases, [68Ga]DOTATATE PET(/MRI) showed a higher sensitivity than [18F]FDG PET(/CT), at the cost of lower specificity. DWI achieved only poor sensitivity and was significantly inferior to [18F]FDG PET in the lesion-based evaluation in the detection of both extrapulmonary and pulmonary metastases.
Conclusion
[18F]FDG PET/CT was more sensitive than [68Ga]DOTATATE PET/MRI in the evaluation of RAI-refractory DTC, mostly because of its excellent ability to detect lung metastases. In the evaluation of extrapulmonary lesions, [68Ga]DOTATATE PET(/MRI) was more sensitive and [18F]FDG PET(/CT) more specific. Furthermore, DWI did not provide additional information and cannot replace [18F]FDG PET for postoperative monitoring of patients with suspected RAI-refractory DTC.
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References
Middendorp M, Selkinski I, Happel C, Kranert WT, Grunwald F. Comparison of positron emission tomography with [18F]FDG and [68Ga]DOTATOC in recurrent differentiated thyroid cancer: preliminary data. Q J Nucl Med Mol Imaging. 2010;54:76–83.
Versari A, Sollini M, Frasoldati A, Fraternali A, Filice A, Froio A, et al. Differentiated thyroid cancer: a new perspective with radiolabeled somatostatin analogues for imaging and treatment of patients. Thyroid. 2014;24:715–26.
Baur A, Dietrich O, Reiser M. Diffusion-weighted imaging of bone marrow: current status. Eur Radiol. 2003;13:1699–708.
Matoba M, Tonami H, Kondou T, Yokota H, Higashi K, Toga H, et al. Lung carcinoma: diffusion-weighted MR imaging – preliminary evaluation with apparent diffusion coefficient. Radiology. 2007;243:570–7.
Nagamachi S, Wakamatsu H, Kiyohara S, Nishii R, Mizutani Y, Fujita S, et al. Comparison of diagnostic and prognostic capabilities of (18)F-FDG-PET/CT, (131)I-scintigraphy, and diffusion-weighted magnetic resonance imaging for postoperative thyroid cancer. Jpn J Radiol. 2011;29:413–22.
Nakanishi K, Kobayashi M, Nakaguchi K, Kyakuno M, Hashimoto N, Onishi H, et al. Whole-body MRI for detecting metastatic bone tumor: diagnostic value of diffusion-weighted images. Magn Reson Med Sci. 2007;6:147–55.
Schueller-Weidekamm C, Schueller G, Kaserer K, Scheuba C, Ringl H, Weber M, et al. Diagnostic value of sonography, ultrasound-guided fine-needle aspiration cytology, and diffusion-weighted MRI in the characterization of cold thyroid nodules. Eur J Radiol. 2010;73:538–44.
Brandmaier P, Purz S, Bremicker K, Hockel M, Barthel H, Kluge R, et al. Simultaneous [18F]FDG-PET/MRI: correlation of apparent diffusion coefficient (ADC) and standardized uptake value (SUV) in primary and recurrent cervical cancer. PLoS One. 2015;10, e0141684.
Gawlitza M, Purz S, Kubiessa K, Boehm A, Barthel H, Kluge R, et al. In vivo correlation of glucose metabolism, Cell density and microcirculatory parameters in patients with head and neck cancer: initial results using simultaneous PET/MRI. PLoS One. 2015;10, e0134749.
Han M, Kim SY, Lee SJ, Choi JW. The correlations between MRI perfusion, diffusion parameters, and 18F-FDG PET metabolic parameters in primary head-and-neck cancer: a cross-sectional analysis in single institute. Medicine (Baltimore). 2015;94, e2141.
Mosavi F, Wassberg C, Selling J, Molin D, Ahlstrom H. Whole-body diffusion-weighted MRI and (18)F-FDG PET/CT can discriminate between different lymphoma subtypes. Clin Radiol. 2015;70:1229–36.
Sachpekidis C, Mosebach J, Freitag MT, Wilhelm T, Mai EK, Goldschmidt H, et al. Application of (18)F-FDG PET and diffusion weighted imaging (DWI) in multiple myeloma: comparison of functional imaging modalities. Am J Nucl Med Mol Imaging. 2015;5:479–92.
Xu H, Xu K, Wang R, Liu X. Primary pulmonary diffuse large B-cell lymphoma on FDG PET/CT-MRI and DWI. Medicine (Baltimore). 2015;94, e1210.
Brendle C, Schwenzer NF, Rempp H, Schmidt H, Pfannenberg C, la Fougere C, et al. Assessment of metastatic colorectal cancer with hybrid imaging: comparison of reading performance using different combinations of anatomical and functional imaging techniques in PET/MRI and PET/CT in a short case series. Eur J Nucl Med Mol Imaging. 2016;43:123–32.
Choi SH, Paeng JC, Sohn CH, Pagsisihan JR, Kim YJ, Kim KG, et al. Correlation of 18F-FDG uptake with apparent diffusion coefficient ratio measured on standard and high b value diffusion MRI in head and neck cancer. J Nucl Med. 2011;52:1056–62.
Ho KC, Lin G, Wang JJ, Lai CH, Chang CJ, Yen TC. Correlation of apparent diffusion coefficients measured by 3T diffusion-weighted MRI and SUV from FDG PET/CT in primary cervical cancer. Eur J Nucl Med Mol Imaging. 2009;36:200–8.
Haugen BR, Alexander EK, Bible KC, Doherty G, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26:1–133.
Luster M, Clarke SE, Dietlein M, Lassmann M, Lind P, Oyen WJ, et al. Guidelines for radioiodine therapy of differentiated thyroid cancer. Eur J Nucl Med Mol Imaging. 2008;35:1941–59.
Dietlein M, Dressler J, Eschner W, Grunwald F, Lassmann M, Leisner B, et al. Procedure guidelines for radioiodine therapy of differentiated thyroid cancer (version 3). Nuklearmedizin. 2007;46:213–9.
American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19:1167–214.
Vrachimis A, Burg MC, Wenning C, Allkemper T, Weckesser M, Schafers M, et al. [18F]FDG PET/CT outperforms [18F]FDG PET/MRI in differentiated thyroid cancer. Eur J Nucl Med Mol Imaging. 2016;43:212–20.
Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000;92:205–16.
Sanchez-Crespo A, Andreo P, Larsson SA. Positron flight in human tissues and its influence on PET image spatial resolution. Eur J Nucl Med Mol Imaging. 2004;31:44–51.
Queiroz MA, Hullner M, Kuhn F, Huber G, Meerwein C, Kollias S, et al. PET/MRI and PET/CT in follow-up of head and neck cancer patients. Eur J Nucl Med Mol Imaging. 2014;41:1066–75.
Byun BH, Kong CB, Lim I, Choi CW, Song WS, Cho WH, et al. Combination of 18F-FDG PET/CT and diffusion-weighted MR imaging as a predictor of histologic response to neoadjuvant chemotherapy: preliminary results in osteosarcoma. J Nucl Med. 2013;54:1053–9.
Bonaffini PA, Ippolito D, Casiraghi A, Besostri V, Franzesi CT, Sironi S. Apparent diffusion coefficient maps integrated in whole-body MRI examination for the evaluation of tumor response to chemotherapy in patients with multiple myeloma. Acad Radiol. 2015;22:1163–71.
Park SH, Moon WK, Cho N, Chang JM, Im SA, Park IA, et al. Comparison of diffusion-weighted MR imaging and FDG PET/CT to predict pathological complete response to neoadjuvant chemotherapy in patients with breast cancer. Eur Radiol. 2012;22:18–25.
Acknowledgments
We are grateful to Florian Büther, PhD, for his help with PET physics and the imaging staff of both our departments, in particular Mrs. Anne Kanzog and Mr. Stan Milachowski.
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All procedures were in accordance with the ethical standards of the institutional national and committee on human experimentation and the principles of the 1975 Declaration of Helsinki, as revised in 2008. The institutional review board of the Medical Association of Westphalia-Lippe and the Faculty of Medicine, University of Münster, approved this prospective study.
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Informed consent was obtained from all individual participants recruited for this study.
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Suppl. Figure 1
A 65-year-old patient with local relapse (confirmed by histology) in the left thyroid bed (arrow) detected by [68Ga]DOTATATE PET/MRI (A) and missed by [18F]FDG PET/CT (B). (PPTX 830 kb)
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Vrachimis, A., Stegger, L., Wenning, C. et al. [68Ga]DOTATATE PET/MRI and [18F]FDG PET/CT are complementary and superior to diffusion-weighted MR imaging for radioactive-iodine-refractory differentiated thyroid cancer. Eur J Nucl Med Mol Imaging 43, 1765–1772 (2016). https://doi.org/10.1007/s00259-016-3378-5
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DOI: https://doi.org/10.1007/s00259-016-3378-5