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PET/MRI assessment of lung nodules in primary abdominal malignancies: sensitivity and outcome analysis

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Abstract

Purpose

To evaluate PET/MR lung nodule detection compared to PET/CT or CT, to determine growth of nodules missed by PET/MR, and to investigate the impact of missed nodules on clinical management in primary abdominal malignancies.

Methods

This retrospective IRB-approved study included [18F]-FDG PET/MR in 126 patients. All had standard of care chest imaging (SCI) with diagnostic chest CT or PET/CT within 6 weeks of PET/MR that served as standard of reference. Two radiologists assessed lung nodules (size, location, consistency, position, and [18F]-FDG avidity) on SCI and PET/MR. A side-by-side analysis of nodules on SCI and PET/MR was performed. The nodules missed on PET/MR were assessed on follow-up SCI to ascertain their growth (≥ 2 mm); their impact on management was also investigated.

Results

A total of 505 nodules (mean 4 mm, range 1–23 mm) were detected by SCI in 89/126 patients (66M:60F, mean age 60 years). PET/MR detected 61 nodules for a sensitivity of 28.1% for patient and 12.1% for nodule, with higher sensitivity for > 7 mm nodules (< 30% and > 70% respectively, p < 0.05). 75/337 (22.3%) of the nodules missed on PET/MR (follow-up mean 736 days) demonstrated growth. In patients positive for nodules at SCI and negative at PET/MR, missed nodules did not influence patients’ management.

Conclusions

Sensitivity of lung nodule detection on PET/MR is affected by nodule size and is lower than SCI. 22.3% of missed nodules increased on follow-up likely representing metastases. Although this did not impact clinical management in study group with primary abdominal malignancy, largely composed of extra-thoracic advanced stage cancers, with possible different implications in patients without extra-thoracic spread.

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Data availability

Data of this study are available upon a reasonable request from the corresponding author, Onofrio Catalano. They are not publicly available due to privacy restrictions.

Abbreviations

[18F]-FDG :

 2-deoxy-2-[18F]fluoro-D-glucose

HASTE:

T2-weighted half-Fourier single-shot turbo spine-echo

LAVA:

Liver accelerated volume acquisition

SCI:

Standard of care chest imaging

UTE:

Ultrashort echo time sequence

VIBE:

Volume-interpolated breath-hold examination

WB:

Whole-body

BP:

Bed position

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Authors and Affiliations

  1. Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA

    Pierpaolo Biondetti, Rita M. Lahoud, Felipe S. Furtado, Bruce R. Rosen, Eric W. Zhang, Umar Mahmood, Subba R. Digumarthy, Jo-Anne O. Shepard & Onofrio A. Catalano

  2. Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, 60 Staniford St, Boston, MA, USA

    Mark G. Vangel

  3. Athinoula A Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    Bruce R. Rosen, Umar Mahmood & Onofrio A. Catalano

  4. Department of Nuclear Medicine, Assuta Medical Centers, Tel Aviv, Israel

    David Groshar

  5. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    David Groshar

  6. Department of Nuclear Medicine. Grupo HM Hospitales, Madrid, Spain

    Lina G. Canamaque

  7. Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany

    Lale Umutlu

Authors
  1. Pierpaolo Biondetti
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  13. Onofrio A. Catalano
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Corresponding author

Correspondence to Onofrio A. Catalano.

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The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Human Research Committee of our Institutional Review Board and is compliant with the Health Insurance Portability and Accountability Act.

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Written informed consent was waived by the Institutional Review Board due to the retrospective nature of the study.

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This article is part of the Topical Collection on Oncology - Chest

Key points

• Overall PET/MR demonstrated a sensitivity of 12.1% (95% CI 9.4% to 15.2%) and a specificity of 69.8% (95% CI 55.7% to 81.7%).

• PET/MR detection of nodules was influenced by size (< 15% for ≤ 5 mm, > 70% for > 7 mm, p=0.001) and unaffected by other factors such as lobar location and density. The mean size of the nodules missed on PET/MR was 3.6 mm.

• 22.3% (75/337) of the nodules missed by PET/MR grew by ≥ 2 mm. However, upon review, the detection of these nodules would not have influenced management in any patient as they already had established stage IV disease, or the presence of small lung nodules would not have affected debulking or definitive surgery.

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Biondetti, P., Vangel, M.G., Lahoud, R.M. et al. PET/MRI assessment of lung nodules in primary abdominal malignancies: sensitivity and outcome analysis. Eur J Nucl Med Mol Imaging 48, 1976–1986 (2021). https://doi.org/10.1007/s00259-020-05113-1

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