Comparison of 18F-FDG PET/MRI and MRI for pre-therapeutic tumor staging of patients with primary cancer of the uterine cervix

  • Theresia SarabhaiEmail author
  • Benedikt M. Schaarschmidt
  • Axel Wetter
  • Julian Kirchner
  • Bahriye Aktas
  • Michael Forsting
  • Verena Ruhlmann
  • Ken Herrmann
  • Lale Umutlu
  • Johannes Grueneisen
Original Article



The aim of the present study was to assess and compare the diagnostic performance of integrated PET/MRI and MRI alone for local tumor evaluation and whole-body tumor staging of primary cervical cancers. In addition, the corresponding impact on further patient management of the two imaging modalities was assessed.


A total of 53 consecutive patients with histopathological verification of a primary cervical cancer were prospectively enrolled for a whole-body 18F-FDG PET/MRI examination. Two experienced physicians analyzed the MRI data, in consensus, followed by a second reading session of the PET/MRI datasets. The readers were asked to perform a dedicated TNM staging in accordance with the 7th edition of the AJCC staging manual. Subsequently, the results of MRI and PET/MRI were discussed in a simulated interdisciplinary tumor board and therapeutic decisions based on both imaging modalities were recorded. Results from histopathology and cross-sectional imaging follow-up served as the reference standard.


PET/MRI allowed for a correct determination of the T stage in 45/53 (85%) cases, while MRI alone enabled a correct identification of the tumor stage in 46/53 (87%) cases. In 24 of the 53 patients, lymph node metastases were present. For the detection of nodal-positive patients, sensitivity, specificity and accuracy of PET/MRI were 83%, 90% and 87%, respectively. The respective values for MRI alone were 71%, 83% and 77%. In addition, PET/MRI showed higher values for the detection of distant metastases than MRI alone (sensitivity: 87% vs. 67%, specificity: 92% vs. 90%, diagnostic accuracy: 91% vs. 83%). Among the patients with discrepant staging results in the two imaging modalities, PET/MRI enabled correct treatment recommendations for a higher number (n = 9) of patients than MRI alone (n = 3).


The present results demonstrate the successful application of integrated PET/MRI imaging for whole-body tumor staging of cervical cancer patients, enabling improved treatment planning when compared to MRI alone.


PET/MRI MRI Whole-body staging Cervical cancer 


Compliance with ethical standards

Conflict 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 GmbH Germany 2017

Authors and Affiliations

  • Theresia Sarabhai
    • 1
    Email author
  • Benedikt M. Schaarschmidt
    • 2
  • Axel Wetter
    • 1
  • Julian Kirchner
    • 2
  • Bahriye Aktas
    • 3
  • Michael Forsting
    • 1
  • Verena Ruhlmann
    • 4
  • Ken Herrmann
    • 4
  • Lale Umutlu
    • 1
  • Johannes Grueneisen
    • 1
  1. 1.Department of Diagnostic and Interventional Radiology and NeuroradiologyUniversity Hospital Essen, University of Duisburg-EssenEssenGermany
  2. 2.Department of Diagnostic and Interventional Radiology, Medical FacultyUniversity DusseldorfDusseldorfGermany
  3. 3.Department of Obstetrics and GynecologyUniversity Hospital Essen, University of Duisburg-EssenEssenGermany
  4. 4.Department of Nuclear MedicineUniversity Hospital Essen, University of Duisburg-EssenEssenGermany

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