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Value of Primary Rectal Tumor PET/MRI in the Prediction of Synchronic Metastatic Disease

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A Correction to this article was published on 04 January 2022

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Abstract

Purpose

To analyze the associations between positron emission tomography (PET)/magnetic resonance imaging (MRI) features for primary rectal tumors and metastases.

Procedures

Between November 2016 and April 2018, 101 patients with rectal adenocarcinoma were included in this prospective study (NCT02537340) for whole-body PET/MRI for baseline staging. Two readers analyzed the PET/MRI; they assessed the semiquantitative PET features of the primary tumor and the N- and M-stages. Another reader analyzed the MRI features for locoregional staging. The reference standard for confirming metastatic disease was biopsy or imaging follow-up. Non-parametric tests were used to compare the PET/MRI features of the participants with or without metastatic disease. Binary logistic regression was used to evaluate the associations between the primary tumor PET/MRI features and metastatic disease.

Results

A total of 101 consecutive participants (median age 62 years; range: 33–87 years) were included. Metastases were detected in 35.6% (36 of 101) of the participants. Among the PET/MRI features, higher tumor lesion glycolysis (352.95 vs 242.70; P = .46) and metabolic tumor volume (36.15 vs 26.20; P = .03) were more frequent in patients with than in those without metastases. Additionally, patients with metastases had a higher incidence of PET-positive (64% vs 32%; P = .009) and MRI-positive (56% vs 32%; P = .03) mesorectal lymph nodes, extramural vascular invasion (86% vs 49%; P > .001), and involvement of mesorectal fascia (64% vs 42%; P = .04); there were also differences between the mrT stages of these two groups (P = .008). No differences in the maximum standardized uptake values for the primary tumors in patients with and without metastases were observed (18.9 vs 19.1; P = .56). Multivariable logistic regression showed that extramural vascular invasion on MRI was the only significant predictor (adjusted odds ratio, 3.8 [95% CI: 1.1, 13.9]; P = .001).

Conclusion

PET/MRI facilitated the identification of participants with a high risk of metastatic disease, though these findings were based mainly on MRI features.

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Funding

GE Healthcare partially financed this study, covering the costs of the PET/MRI, including the dose of fluorine-18 deoxyglucose (18F-FDG).

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Authors and Affiliations

  1. Nuclear Medicine Division, Department of Radiology and Oncology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Doutor Ovidio Pires de Campos, 872, Sao Paulo, SP, 05403-010, Brazil

    Marcelo A. Queiroz & Carlos A. Buchpiguel

  2. Department of Radiology and Oncology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil

    Cinthia D. Ortega, Felipe R. Ferreira, Fernanda C. Capareli & Giovanni G. Cerri

  3. Department of Surgery, Division of Colorectal Surgery, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil

    Sergio C. Nahas

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  1. Marcelo A. Queiroz
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  2. Cinthia D. Ortega
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  3. Felipe R. Ferreira
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  4. Fernanda C. Capareli
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  5. Sergio C. Nahas
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Corresponding author

Correspondence to Marcelo A. Queiroz.

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Ethics Approval and Consent to Participate

The institutional review board approved this prospective study, and all participants signed an informed consent form. This study is registered on clinicaltrials.gov with the identification number NCT02537340.

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The authors declare that they have no conflict of interest.

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Queiroz, M.A., Ortega, C.D., Ferreira, F.R. et al. Value of Primary Rectal Tumor PET/MRI in the Prediction of Synchronic Metastatic Disease. Mol Imaging Biol 24, 453–463 (2022). https://doi.org/10.1007/s11307-021-01674-1

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