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Conspicuity of FDG-Avid Osseous Lesions on PET/MRI Versus PET/CT: a Quantitative and Visual Analysis

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Abstract

Background

Because standard MRI-based attenuation correction (AC) does not account for the attenuation of photons by cortical bone, PET/MRI may have reduced sensitivity for FDG-avid focal bone lesions (FFBLs). This study evaluates whether MRI-based AC compromises detection of FFBLs, by comparing their conspicuity both quantitatively and qualitatively on PET/MRI versus PET/CT.

Methods

One hundred ninety general oncology patients underwent whole-body PET/CT followed by whole-body PET/MRI, utilizing the same FDG dose. Thirteen patients with a total of 50 FFBLs were identified. Using automated contouring software, a volumetric contour was generated for each FFBL. Adjacent regions of normal background bone (BB) were selected manually. For each contour, SUV-max and SUV-mean were determined. Lesion-to-background SUV ratios served as quantitative metrics of conspicuity. Additionally, two blinded readers evaluated the relative conspicuity of FFBLs on PET images derived from MRI-based AC versus CT-based AC. Visibility of an anatomic correlate for FFBLs on the corresponding CT and MR images was also assessed.

Results

SUV-mean was lower on PET/MRI for both FFBLs (-6.5 %, p = 0.009) and BB (-20.5 %, p < 0.001). SUV-max was lower on PET/MRI for BB (-14.2 %, p = 0.002) but not for FFBLs (-6.2 %, p = 0.068). The ratio of FFBL SUV-mean to BB SUV-mean was higher for PET/MRI (+29.5 %, p < 0.001). Forty of 50 lesions (80 %) were visually deemed to be of equal or greater conspicuity on PET images derived from PET/MRI. Thirty-five of 50 FFBLs (70 %) had CT correlates, while 40/50 FFBLs (80 %) had a correlate on at least one MRI sequence. The mean interval from tracer administration to imaging was longer (p < 0.001) for PET/MRI (127 v. 62 min).

Conclusions

Both FFBLs and BB had lower mean SUVs on PET/MRI than PET/CT. This finding was likely in part due to differences in the handling of cortical bone by MRI-based AC versus CT-based AC. Despite this systematic bias, FFBLs had greater conspicuity on PET/MRI, both qualitatively and quantitatively. This difference was likely due to the longer tracer uptake times for PET/MRI, which allowed for more tracer accumulation by FFBLs and more tracer washout from BB. Our results suggest that whole-body PET/MRI and PET/CT provide comparable sensitivity for detection of FDG-avid focal bone lesions.

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References

  1. Kanda T, Kitajima K, Suenaga Y, Konishi J, Sasaki R, Morimoto K, et al. Value of retrospective image fusion of 18F-FDG PET and MRI for preoperative staging of head and neck cancer: comparison with PET/CT and contrast-enhanced neck MRI. Eur J Radiol. 2013;82:2005–10.

    Article  PubMed  Google Scholar 

  2. Plathow C, Aschoff P, Lichy MP, Eschmann S, Hehr T, Brink I, et al. Positron emission tomography/computed tomography and whole-body magnetic resonance imaging in staging of advanced nonsmall cell lung cancer--initial results. Investig Radiol. 2008;43:290–7.

    Article  Google Scholar 

  3. Kitajima K, Suenaga Y, Ueno Y, Kanda T, Maeda T, Deguchi M, et al. Fusion of PET and MRI for staging of uterine cervical cancer: comparison with contrast-enhanced (18)F-FDG PET/CT and pelvic MRI. Clin Imaging. 2014;38:464–9.

    Article  PubMed  Google Scholar 

  4. Kitajima K, Suenaga Y, Ueno Y, Kanda T, Maeda T, Takahashi S, et al. 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. 2013;82:1672–6.

    Article  PubMed  Google Scholar 

  5. Mundy GR. Metastasis to bone: causes, consequences and therapeutic opportunities. Nat Rev Cancer. 2002;2:584–93.

    Article  CAS  PubMed  Google Scholar 

  6. Rosenthal DI. Radiologic diagnosis of bone metastases. Cancer. 1997;80:1595–607.

    Article  CAS  PubMed  Google Scholar 

  7. Schmidt GP, Schoenberg SO, Schmid R, Stahl R, Tiling R, Becker CR, et al. Screening for bone metastases: whole-body MRI using a 32-channel system versus dual-modality PET-CT. Eur Radiol. 2007;17:939–49.

    Article  PubMed  Google Scholar 

  8. Hofmann M, Bezrukov I, Mantlik F, Aschoff P, Steinke F, Beyer T, et al. MRI-based attenuation correction for whole-body PET/MRI: quantitative evaluation of segmentation- and atlas-based methods. J Nucl Med. 2011;52:1392–9.

  9. Samarin A, Burger C, Wollenweber SD, Crook DW, Burger IA, Schmid DT, et al. PET/MR imaging of bone lesions--implications for PET quantification from imperfect attenuation correction. Eur J Nucl Med Mol Imaging. 2012;39:1154–60.

    Article  PubMed  Google Scholar 

  10. Eiber M, Takei T, Souvatzoglou M, Mayerhoefer ME, Fürst S, Gaertner FC, et al. Performance of whole-body integrated 18F-FDG PET/MR in comparison to PET/CT for evaluation of malignant bone lesions. J Nucl Med. 2014;55:191–7.

    Article  PubMed  Google Scholar 

  11. Beiderwellen K, Huebner M, Heusch P, Grueneisen J, Ruhlmann V, Nensa F, et al. Whole-body [18F]FDG PET/MRI vs. PET/CT in the assessment of bone lesions in oncological patients: initial results. Eur Radiol. 2014;24:2023–30.

    Article  PubMed  Google Scholar 

  12. Chmura Kraemer H, Periyakoil VS, Noda A. Kappa coefficients in medical research. Stat Med. 2002;21:2109–29.

    Article  PubMed  Google Scholar 

  13. Heusch P, Buchbender C, Beiderwellen K, Nensa F, Hartung-Knemeyer V, Lauenstein TC, et al. Standardized uptake values for [18F] FDG in normal organ tissues: comparison of whole-body PET/CT and PET/MRI. Eur J Radiol. 2013;82:870–6.

    Article  PubMed  Google Scholar 

  14. Drzezga A, Souvatzoglou M, Eiber M, Beer AJ, Fürst S, Martinez-Möller A, et al. First clinical experience with integrated whole-body PET/MR: comparison to PET/CT in patients with oncologic diagnoses. J Nucl Med. 2012;53:845–55.

    Article  PubMed  Google Scholar 

  15. Aznar MC, Sersar R, Saabye J, Ladefoged CN, Andersen FL, Rasmussen JH, et al. Whole-body PET/MRI: the effect of bone attenuation during MR-based attenuation correction in oncology imaging. Eur J Radiol. 2014;83:1177–83.

    Article  CAS  PubMed  Google Scholar 

  16. Hofmann M, Steinke F, Scheel V, Charpiat G, Farquhar J, Aschoff P, et al. MRI-based attenuation correction for PET/MRI: a novel approach combining pattern recognition and atlas registration. J Nucl Med. 2008;49:1875–83.

    Article  PubMed  Google Scholar 

  17. Berker Y, Franke J, Salomon A, Palmowski M, Donker HCW, Temur Y, et al. MRI-based attenuation correction for hybrid PET/MRI systems: a 4-class tissue segmentation technique using a combined ultrashort-echo-time/Dixon MRI sequence. J Nucl Med. 2012;53:796–804.

  18. Roy S, Wang W-T, Carass A, Prince JL, Butman JA, Pham DL. PET attenuation correction using synthetic CT from ultrashort echo-time MR imaging. J Nucl Med. 2014;55:2071–7.

  19. Marshall HR, Patrick J, Laidley D, Prato FS, Butler J, Théberge J, et al. Description and assessment of a registration-based approach to include bones for attenuation correction of whole-body PET/MRI. Med Phys. 2013;40:082509.

    Article  PubMed  Google Scholar 

  20. Kumar R, Loving VA, Chauhan A, Zhuang H, Mitchell S, Alavi A. Potential of dual-time-point imaging to improve breast cancer diagnosis with (18)F-FDG PET. J Nucl Med. 2005;46:1819–24.

    PubMed  Google Scholar 

  21. Schillaci O. Use of dual-point fluorodeoxyglucose imaging to enhance sensitivity and specificity. Semin Nucl Med. 2012;42:267–80.

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors would like to thank Karishma Furtado, MPH, of the Washington University School of Public Health for her assistance with the statistical analysis.

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Authors and Affiliations

  1. Mallinckrodt Institute of Radiology, Washington University School of Medicine, Campus Box 8131, 510 S. Kingshighway Blvd., Saint Louis, MO, 63110, USA

    Tyler J. Fraum, Kathryn J. Fowler & Jonathan McConathy

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  1. Tyler J. Fraum
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  2. Kathryn J. Fowler
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  3. Jonathan McConathy
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Correspondence to Tyler J. Fraum.

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Conflict of Interest

TJF – None; KJF – Research Support, Bracco Group; JM – Research Support, Eli Lilly & Co.; Research Consultant, General Electric Healthcare; Research Consultant, Blue Earth Diagnostics Ltd.; Research Consultant, Siemens AG

Ethical Statement

The study was approved by an institutional review board or equivalent and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All subjects in the study gave written informed consent or the institutional review board waived the need to obtain informed consent.

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Fraum, T.J., Fowler, K.J. & McConathy, J. Conspicuity of FDG-Avid Osseous Lesions on PET/MRI Versus PET/CT: a Quantitative and Visual Analysis. Nucl Med Mol Imaging 50, 228–239 (2016). https://doi.org/10.1007/s13139-016-0403-3

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  • DOI: https://doi.org/10.1007/s13139-016-0403-3

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