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Diagnostic performance of [18F]-FDG PET/MR in evaluating colorectal cancer: a systematic review and meta-analysis

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

To calculate the diagnostic performance of [18F]-FDG PET/MR in colorectal cancer (CRC).

Methods

This study was designed following the PRISMA-DTA guidelines. To be included, published original articles (until December 31, 2021) that met the following criteria were considered eligible: (1) evaluated [18F]-FDG PET/MR as the diagnostic method to detect CRC; (2) compared [18F]-FDG PET/MR with histopathology as the reference standard, or clinical/imaging composite follow-up when pathology was not available; (3) provided adequate crude data for meta-analysis. The diagnostic pooled measurements were calculated at patient and lesion levels. Regarding sub-group analysis, diagnostic measurements were calculated in “TNM staging,” “T staging,” “N staging,” “M staging,” and “liver metastasis” sub-groups. Additionally, we calculated the pooled performances in “rectal cancer: patient-level” and “rectal cancer: lesion-level” sub-groups. A hierarchical method was used to pool the performances. The bivariate model was conducted to find the summary points. Analyses were performed using STATA 16.

Results

A total of 1534 patients from 18 studies were entered. The pooled sensitivities in CRC lesion detection (tumor, lymph nodes, and metastases) were 0.94 (95%CI: 0.89–0.97) and 0.93 (95%CI: 0.82–0.98) at patient-level and lesion-level, respectively. The pooled specificities were 0.89 (95%CI: 0.84–0.93) and 0.95 (95%CI: 0.90–0.98) at patient-level and lesion-level, respectively. In sub-groups, the highest sensitivity (0.97, 95%CI: 0.86–0.99) and specificity (0.99, 95%CI: 0.84–1.00) were calculated for “M staging” and “rectal cancer: lesion-level,” respectively. The lowest sensitivity (0.81, 95%CI: 0.65–0.91) and specificity (0.79, 95%CI: 0.52–0.93) were calculated for “N staging” and “T staging,” respectively.

Conclusion

This meta-analysis showed an overall high diagnostic performance for [18F]-FDG PET/MR in detecting CRC lesions/metastases. Thus, this modality can play a significant role in several clinical scenarios in CRC staging and restaging. Specifically, one of the main strengths of this modality is ruling out the existence of CRC lesions/metastases. Finally, the overall diagnostic performance was not found to be affected in the post-treatment setting.

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Data availability

The detailed data generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Siegel RL, et al. Colorectal cancer statistics, 2020. CA: a cancer journal for clinicians. 2020. 70(3): 145–164.

  2. Granados-Romero JJ, et al. Colorectal cancer: a review. Int J Res Med Sci. 2017;5(11):4667–76.

    Article  Google Scholar 

  3. Keum N, Giovannucci E. Global burden of colorectal cancer: emerging trends, risk factors and prevention strategies. Nat Rev Gastroenterol Hepatol. 2019;16(12):713–32.

    Article  PubMed  Google Scholar 

  4. Hadjipetrou A, et al. Colorectal cancer, screening and primary care: a mini literature review. World J Gastroenterol. 2017;23(33):6049.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Biller LH, Schrag D. Diagnosis and treatment of metastatic colorectal cancer: a review. JAMA. 2021;325(7):669–85.

    Article  CAS  PubMed  Google Scholar 

  6. Balyasnikova S, Brown G. Imaging advances in colorectal cancer. Curr Colorectal Cancer Rep. 2016;12(3):162–9.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Goiffon R, O'Shea A, Harisinghani M. Advances in radiological staging of colorectal cancer. Clin Radiol. 2021.

  8. Edge SB, et al. AJCC cancer staging manual, vol. 7. New York: Springer; 2010.

    Google Scholar 

  9. Barral M, et al. Diffusion-weighted magnetic resonance imaging in colorectal cancer. J Visc Surg. 2016;153(5):361–9.

    Article  CAS  PubMed  Google Scholar 

  10. Scheenen TW, Zamecnik P. The role of magnetic resonance imaging in (future) cancer staging: note the nodes. Invest Radiol. 2021;56(1):42.

    Article  PubMed  Google Scholar 

  11. García-Figueiras R, et al. Advanced imaging of colorectal cancer: from anatomy to molecular imaging. Insights Imaging. 2016;7(3):285–309.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Mainenti PP, et al. Colorectal cancer: parametric evaluation of morphological, functional and molecular tomographic imaging. World J Gastroenterol. 2019;25(35):5233.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Maffione AM, et al. Is It Time to introduce PET/CT in colon cancer guidelines? Clin Nucl Med. 2020;45(7):525–30.

    Article  PubMed  Google Scholar 

  14. Lee DH, Lee JM. Whole-body PET/MRI for colorectal cancer staging: Is it the way forward? J Magn Reson Imaging. 2017;45(1):21–35.

    Article  PubMed  Google Scholar 

  15. Salameh J-P, et al. Preferred reporting items for systematic review and meta-analysis of diagnostic test accuracy studies (PRISMA-DTA): explanation, elaboration, and checklist. Bmj. 2020;370.

  16. Higgins JP, et al. Cochrane handbook for systematic reviews of interventions. 2019: John Wiley & Sons.

  17. Dwamena B. MIDAS: Stata module for meta-analytical integration of diagnostic test accuracy studies. 2009.

  18. Harbord RM, Whiting P. Metandi: meta-analysis of diagnostic accuracy using hierarchical logistic regression. Stand Genomic Sci. 2009;9(2):211–29.

    Google Scholar 

  19. Mirshahvalad SA, Chavoshi M, Hekmat S. Diagnostic performance of prone-only myocardial perfusion imaging versus coronary angiography in the detection of coronary artery disease: a systematic review and meta-analysis. J Nucl Cardiol. 2022;29(3):1339–51.

    Article  PubMed  Google Scholar 

  20. Amorim BJ, et al. Clinical impact of PET/MR in treated colorectal cancer patients. Eur J Nucl Med Mol Imaging. 2019;46(11):2260–9.

    Article  PubMed  Google Scholar 

  21. Brendle 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(1):123–32.

    Article  CAS  PubMed  Google Scholar 

  22. Catalano OA, et al. Colorectal cancer staging: comparison of whole-body PET/CT and PET/MR. Abdominal Radiology. 2017;42(4):1141–51.

    Article  PubMed  Google Scholar 

  23. Catalano OA, et al. Improving staging of rectal cancer in the pelvis: the role of PET/MRI. Eur J Nucl Med Mol Imaging. 2021;48(4):1235–45.

    Article  PubMed  Google Scholar 

  24. Crimì F, et al. 18F-FDG PET/MRI for rectal cancer TNM restaging after preoperative chemoradiotherapy: initial experience. Dis Colon Rectum. 2020;63(3):310–8.

    Article  PubMed  Google Scholar 

  25. Ferri V, et al. Quantitative analysis of 18-FDG-PET/MRI to assess pathological complete response following neoadjuvant radiochemotherapy in locally advanced rectal cancer. A prospective preliminary study. Acta Oncologica. 2019;58(9):1246–9.

    Article  PubMed  Google Scholar 

  26. Furtado FS, et al. Clinical impact of PET/MRI in oligometastatic colorectal cancer. Br J Cancer. 2021;125(7):975–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Kam MH, et al. Comparison of magnetic resonance imaging-fluorodeoxyglucose positron emission tomography fusion with pathological staging in rectal cancer. Br J Surg. 2010;97(2):266–8.

    Article  CAS  PubMed  Google Scholar 

  28. Kang B, et al. Added value of integrated whole-body PET/MRI for evaluation of colorectal cancer: comparison with contrast-enhanced MDCT. Am J Roentgenol. 2016;206(1):W10–20.

    Article  Google Scholar 

  29. Lee SJ, et al. Clinical performance of whole-body 18F-FDG PET/Dixon-VIBE, T1-weighted, and T2-weighted MRI protocol in colorectal cancer. Clin Nucl Med. 2015;40(8):e392–8.

    Article  PubMed  Google Scholar 

  30. Lee DH, et al. Colorectal cancer liver metastases: diagnostic performance and prognostic value of pet/mr imaging. Radiology. 2016;280(3):782–92.

    Article  PubMed  Google Scholar 

  31. Li Y, et al. 18 f-fdg pet/mr versus mr alone in whole-body primary staging and restaging of patients with rectal cancer: what is the benefit of pet? J Clin Med. 2020;9(10):1–11.

    Article  Google Scholar 

  32. Paspulati RM, et al. Comparison of hybrid FDG PET/MRI compared with PET/CT in colorectal cancer staging and restaging: a pilot study. Abdom Imaging. 2015;40(6):1415–25.

    Article  PubMed  Google Scholar 

  33. Plodeck V, et al. FDG-PET/MRI in patients with pelvic recurrence of rectal cancer: first clinical experiences. Eur Radiol. 2019;29(1):422–8.

    Article  PubMed  Google Scholar 

  34. Plodeck V, et al. Diagnostic performance of 18F-fluorodeoxyglucose-PET/MRI versus MRI alone in the diagnosis of pelvic recurrence of rectal cancer. Abdominal Radiology. 2021;46(11):5086–94.

    Article  PubMed  Google Scholar 

  35. Queiroz MA, et al. Diagnostic accuracy of FDG-PET/MRI versus pelvic MRI and thoracic and abdominal CT for detecting synchronous distant metastases in rectal cancer patients. Eur J Nucl Med Mol Imaging. 2021;48(1):186–95.

    Article  PubMed  Google Scholar 

  36. Yoon JH, et al. Initial M staging of rectal cancer: FDG PET/MRI with a hepatocyte-specific contrast agent versus contrast-enhanced CT. Radiology. 2020;294(2):310–9.

    Article  PubMed  Google Scholar 

  37. Zhou N, et al. The value of 18F-FDG PET/CT and abdominal PET/MRI as a one-stop protocol in patients with potentially resectable colorectal liver metastases. Frontiers in oncology. 2021;11.

  38. Page MJ, The PRISMA, et al. statement: an updated guideline for reporting systematic reviews. BMJ. 2020;2021:372.

    Google Scholar 

  39. Benson AB, et al. Colon cancer, version 2.2021, NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw. 2021;19(3):329–59.

    Article  Google Scholar 

  40. Fraum TJ, Fowler KJ, McConathy J. PET/MRI: emerging clinical applications in oncology. Acad Radiol. 2016;23(2):220–36.

    Article  PubMed  Google Scholar 

  41. Crimì F, et al. [18F]FDG PET/MRI in rectal cancer. Ann Nucl Med. 2021;35(3):281–90.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Spick C, Herrmann K, Czernin J. 18F-FDG PET/CT and PET/MRI perform equally well in cancer: evidence from studies on more than 2,300 patients. J Nucl Med. 2016;57(3):420–30.

    Article  CAS  PubMed  Google Scholar 

  43. Al-Nabhani KZ, et al. Qualitative and quantitative comparison of PET/CT and PET/MR imaging in clinical practice. J Nucl Med. 2014;55(1):88–94.

    Article  CAS  PubMed  Google Scholar 

  44. Bailey JJ, et al. Does extended PET acquisition in PET/MRI rectal cancer staging improve results? Am J Roentgenol. 2018;211(4):896–900.

    Article  Google Scholar 

  45. Beiderwellen KJ, et al. Simultaneous 68Ga-DOTATOC PET/MRI in patients with gastroenteropancreatic neuroendocrine tumors: initial results. Invest Radiol. 2013;48(5):273–9.

    Article  CAS  PubMed  Google Scholar 

  46. García-Figueiras R, et al. Advanced imaging techniques in evaluation of colorectal cancer. Radiographics. 2018;38(3):740–65.

    Article  PubMed  Google Scholar 

  47. Beets-Tan RG, Oyen WJ, Valentini V. Imaging and interventional radiology for radiation oncology. 2020;Springer.

  48. Colosio A, et al. Value of diffusion-weighted and gadolinium-enhanced MRI for the diagnosis of pelvic recurrence from colorectal cancer. J Magn Reson Imaging. 2014;40(2):306–13.

    Article  PubMed  Google Scholar 

  49. Colosio A, et al. Local colorectal cancer recurrence: pelvic MRI evaluation. Abdom Imaging. 2013;38(1):72–81.

    Article  CAS  PubMed  Google Scholar 

  50. Liu L, et al. Correlation of MRI-detected extramural vascular invasion with regional lymph node metastasis in rectal cancer. Clin Imaging. 2016;40(3):456–60.

    Article  PubMed  Google Scholar 

  51. Wei M-Z, Zhao Z-H, Wang J-Y. The diagnostic accuracy of magnetic resonance imaging in restaging of rectal cancer after preoperative chemoradiotherapy: a meta-analysis and systematic review. J Comput Assist Tomogr. 2020;44(1):102–10.

    Article  PubMed  Google Scholar 

  52. Fraum TJ, et al. PET/MRI for gastrointestinal imaging: current clinical status and future prospects. Gastroenterol Clin North Am. 2018;47(3):691–714.

    Article  PubMed  Google Scholar 

  53. Lu Y-Y, et al. A systematic review and meta-analysis of pretherapeutic lymph node staging of colorectal cancer by 18F-FDG PET or PET/CT. Nucl Med Commun. 2012;33(11):1127–33.

    Article  PubMed  Google Scholar 

  54. Li XT, et al. Evaluating local lymph node metastasis with magnetic resonance imaging, endoluminal ultrasound and computed tomography in rectal cancer: a meta-analysis. Colorectal Dis. 2015;17(6):O129–35.

    Article  PubMed  Google Scholar 

  55. Soussan M, et al. Comparison of FDG-PET/CT and MR with diffusion-weighted imaging for assessing peritoneal carcinomatosis from gastrointestinal malignancy. Eur Radiol. 2012;22(7):1479–87.

    Article  PubMed  Google Scholar 

  56. Niekel MC, Bipat S, Stoker J. Diagnostic imaging of colorectal liver metastases with CT, MR imaging, FDG PET, and/or FDG PET/CT: a meta-analysis of prospective studies including patients who have not previously undergone treatment. Radiology. 2010;257(3):674–84.

    Article  PubMed  Google Scholar 

  57. Choi SH, et al. Diagnostic performance of CT, gadoxetate disodium-enhanced MRI, and PET/CT for the diagnosis of colorectal liver metastasis: systematic review and meta-analysis. J Magn Reson Imaging. 2018;47(5):1237–50.

    Article  PubMed  Google Scholar 

  58. Tsili AC, et al. Imaging of colorectal cancer liver metastases using contrast-enhanced US, multidetector CT, MRI, and FDG PET/CT: a meta-analysis. Acta Radiol. 2021;62(3):302–12.

    Article  PubMed  Google Scholar 

  59. Maffione AM, et al. Diagnostic accuracy and impact on management of 18 F-FDG PET and PET/CT in colorectal liver metastasis: a meta-analysis and systematic review. Eur J Nucl Med Mol Imaging. 2015;42(1):152–63.

    Article  CAS  PubMed  Google Scholar 

  60. Donati OF, et al. Value of retrospective fusion of PET and MR images in detection of hepatic metastases: comparison with F-18-FDG PET/CT and Gd-EOB-DTPA-enhanced MRI. J Nucl Med. 2010;51(5):692–9.

    Article  PubMed  Google Scholar 

  61. Zhang L, et al. Diagnostic performance of contrast-enhanced ultrasound and magnetic resonance imaging for detecting colorectal liver metastases: a systematic review and meta-analysis. Dig Liver Dis. 2019;51(9):1241–8.

    Article  PubMed  Google Scholar 

  62. Chung WS, et al. Comparison of gadoxetic acid-enhanced dynamic imaging and diffusion-weighted imaging for the preoperative evaluation of colorectal liver metastases. J Magn Reson Imaging. 2011;34(2):345–53.

    Article  PubMed  Google Scholar 

  63. Macera A, et al. Staging of colorectal liver metastases after preoperative chemotherapy. Diffusion-weighted imaging in combination with Gd-EOB-DTPA MRI sequences increases sensitivity and diagnostic accuracy. Eur Radiol. 2013;23(3):739–47.

    Article  PubMed  Google Scholar 

  64. Li X-T, et al. Evaluating rectal tumor staging with magnetic resonance imaging, computed tomography, and endoluminal ultrasound: a meta-analysis. Medicine. 2016;95(44).

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Authors and Affiliations

  1. Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Canada

    Seyed Ali Mirshahvalad, Ricarda Hinzpeter, Andres Kohan, Roshini Kulanthaivelu, Claudia Ortega, Ur Metser & Patrick Veit-Haibach

  2. Sunnybrook Health Sciences Center, Toronto, Canada

    Reut Anconina

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  1. Seyed Ali Mirshahvalad
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Correspondence to Seyed Ali Mirshahvalad.

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Patrick Veit-Haibach has received travel support and IIS grants from Siemens Healthineers in the last 3 years outside of this work. Ur Metser is advisor for POINT.

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Mirshahvalad, S.A., Hinzpeter, R., Kohan, A. et al. Diagnostic performance of [18F]-FDG PET/MR in evaluating colorectal cancer: a systematic review and meta-analysis. Eur J Nucl Med Mol Imaging 49, 4205–4217 (2022). https://doi.org/10.1007/s00259-022-05871-0

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