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FDG-PET/MRI for the preoperative diagnosis and staging of peritoneal carcinomatosis: a prospective multireader pilot study

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Abstract

Purpose

To assess the diagnostic performance of FDG-PET/MRI for the preoperative diagnosis and staging of peritoneal carcinomatosis (PC) using surgical Sugarbaker’s PC index (PCI) as the reference in a multireader pilot study.

Methods

Fourteen adult patients (M/F: 3/11, mean age: 57 ± 12 year) with PC were prospectively included in this single-center study. Patients underwent FDG-PET/MRI prior to surgery (mean delay: 14 d, range: 1–63 d). Images were reviewed independently by 2 abdominal radiologists and 2 nuclear medicine physicians. The radiologists assessed contrast-enhanced abdominal MR images, while the nuclear medicine physicians assessed PET images fused with T2-weighted images. The abdomen was divided in 13 regions, scored from 0 to 3. A hybrid FDG-PET/MRI radiological PCI was created by combining the study data. Radiological PCI was compared to the surgical PCI on a per-patient and per-region basis. Inter-reader agreement was evaluated.

Results

Mean surgical PCI was 10 ± 8 (range: 0–24). Inter-reader agreement was almost perfect for all sets for radiologic PCI (Kappa: 0.81–0.98). PCI scores for all reading sets significantly correlated with the surgical PCI score (r range: 0.57–0.74, p range: < 0.001–0.003). Pooled per-patient sensitivity, specificity, and accuracy were 75%/50%/71.4% for MRI, 66.7%/50%/64.3% for FDG-PET, and 91.7%/50%/85.7% for FDG-PET/MRI, without significant difference (p value range 0.13–1). FDG-PET/MRI achieved 100% sensitivity and 100% specificity for a cutoff PCI of 20. Per-region sensitivity and accuracy were lower: 37%/61.8% for MRI, 17.8%/64.3% for FDG-PET, and 52.7%/60.4% for FDG-PET/MRI, with significantly higher sensitivity for FDG-PET/MRI. Per-region specificity was higher for FDG-PET (95%) compared to MRI (78.4%) and FDG-PET/MRI (66.5%).

Conclusion

FDG-PET/MRI achieved an excellent diagnostic accuracy per-patient and weaker performance per-region for detection of PC. The added value of PET/MRI compared to MRI and FDG-PET remains to be determined.

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Abbreviations

ADC:

Apparent diffusion coefficient

CE:

Contrast-enhanced

CT:

Computed tomography

DWI:

Diffusion-weighted imaging

FDG:

Fluorodeoxyglucose

HIPEC:

Hyperthermic intraperitoneal chemotherapy

MRI:

Magnetic resonance imaging

PC:

Peritoneal carcinomatosis

PCI:

Peritoneal cancer index

PET:

Positron emission tomography

SUV:

Standardized uptake value

WI:

Weighted imaging

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Funding

Naik Vietti Violi: Swiss National Science Foundation, fellowship P2LAP3_178053. The authors state no other funding for this work.

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Authors and Affiliations

  1. BioMedical Engineering and Imaging Institute, Icahn School of Medicine Mount Sinai, 1470 Madison Avenue, New York, NY, 10029, USA

    Naik Vietti Violi & Bachir Taouli

  2. Department of Radiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland

    Naik Vietti Violi

  3. Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Somali Gavane, Pamela Argiriadi, Amy Law, Sherif Heiba, Munir Ghesani & Bachir Taouli

  4. Department of Surgery, Rabin Medical Center, Petah Tikva, Israel

    Eliahu Y. Bekhor

  5. Department of Radiology, New York University Langone Medical Center, New York, NY, USA

    James S. Babb

  6. Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Daniel M. Labow

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  1. Naik Vietti Violi
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Correspondence to Bachir Taouli.

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Bachir Taouli: Research support, Bayer, Takeda, Regeneron, Echosens, Siemens, Helio Health. Consultant: Bayer, Guerbet. The other authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

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Vietti Violi, N., Gavane, S., Argiriadi, P. et al. FDG-PET/MRI for the preoperative diagnosis and staging of peritoneal carcinomatosis: a prospective multireader pilot study. Abdom Radiol 48, 3634–3642 (2023). https://doi.org/10.1007/s00261-022-03703-1

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