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Feasibility and diagnostic performance of hybrid PET/MRI compared with PET/CT for gynecological malignancies: a prospective pilot study

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Abstract

Purpose

The purpose of the study was to assess the feasibility and diagnostic performance of FDG-PET/MR imaging compared to PET/CT for staging of patients with a gynecological malignancy.

Methods

25 patients with a gynecological malignancy were prospectively enrolled into this pilot study. Patients underwent sequential full-body PET/CT and PET/MR of the abdomen and pelvis after administration of a single dose of F-18 FDG. PET/MRI and PET/CT images were independently reviewed by two expert radiologists. Readers were blinded to the results of the other imaging procedures. Clinical and pathologic information was abstracted from medical charts.

Results

18 patients were included in the final analysis with a median age of 62 years (range 31–88). 61% of patients (11/18) had cervical cancer, while the remaining patients had endometrial cancer. PET/MRI as compared to PET/CT detected all primary tumors, 7/7 patients with regional lymph nodes, and 1/1 patient with an abdominal metastasis. Two patients had additional lymph nodes outside of the abdominopelvic cavity detected on PET/CT that were not seen on PET/MRI, whereas 6 patients had parametrial invasion and one patient had invasion of the bladder seen on PET/MRI not detected on PET/CT. Five cervical cancer patients had discordant clinical vs. radiographic staging based on PET/MRI detection of soft tissue involvement. Management changed for two patients who had clinical stage IB1 and radiographic stage IIB cervical cancer.

Conclusions

PET/MRI is feasible and has at least comparable diagnostic ability to PET/CT for identification of primary cervical and endometrial tumors and regional metastases. PET/MRI may be superior to PET/CT for initial radiographic assessment of cervical cancers.

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Authors and Affiliations

  1. Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1170, New York, NY, 10029, USA

    Melissa Schwartz, Valentin Kolev, Konstantin Zakashansky, Monica Prasad-Hayes & Linus Chuang

  2. Division of Nuclear Medicine, Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Somali C. Gavane, Jad Bou-Ayache, Bachir Taouli & Lale Kostakoglu

Authors
  1. Melissa Schwartz
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  2. Somali C. Gavane
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  3. Jad Bou-Ayache
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  4. Valentin Kolev
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  5. Konstantin Zakashansky
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  6. Monica Prasad-Hayes
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  7. Bachir Taouli
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  8. Linus Chuang
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  9. Lale Kostakoglu
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Corresponding author

Correspondence to Melissa Schwartz.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Electronic supplementary material

Below is the link to the electronic supplementary material.

S1 Figure

PT10 PET/CT images. A 60 year old woman with clinical stage IIIB moderately differentiated squamous cell carcinoma of the cervix. Fused PET-CT(A) and CT (B) of the pelvis demonstrating a cervical (arrow) mass without definite evidence of urinary bladder invasion. Supplementary material 1 (PDF 178 kb)

S2 Figure

PT10 PET/MR images. Axial MRI T2 fat suppressed (A), axial fused T2 fat suppressed PET/MRI (B), axial MRI T2 (C), axial T2 fused PET/MRI (D), and sagittal MRI T1 post contrast (E) images showing cervical mass (arrow) and clear invasion of the bladder base (circle) on both T2 and T1 post contrast sequences. Supplementary material 2 (PDF 204 kb)

S3 Figure

PT15 PET/CT images. A 50 year old woman with clinical stage IB1 small cell carcinoma of the cervix. Axial CT (A) and axial fused PET CT of the pelvis (B) demonstrating a hypermetabolic mass. Supplementary material 3 (PDF 194 kb)

S4 Figure

PT15 PET/MR images. Axial MRI T2 weighted (A) and axial T2 weighted fused PET/MRI (B) showing a cervical mass (arrow) with clear parametrial invasion (circle). Supplementary material 4 (PDF 146 kb)

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Schwartz, M., Gavane, S.C., Bou-Ayache, J. et al. Feasibility and diagnostic performance of hybrid PET/MRI compared with PET/CT for gynecological malignancies: a prospective pilot study. Abdom Radiol 43, 3462–3467 (2018). https://doi.org/10.1007/s00261-018-1665-2

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  • DOI: https://doi.org/10.1007/s00261-018-1665-2

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