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Protocol requirements and diagnostic value of PET/MR imaging for liver metastasis detection

Reiner, Caecilia ; Stolzmann, Paul ; Husmann, Lars ; Burger, Irene ; Hüllner, Martin ; Schaefer, Niklaus ; Schneider, Paul ; von Schulthess, Gustav ; Veit-Haibach, Patrick

In: European Journal of Nuclear Medicine and Molecular Imaging, 2014, vol. 41, no. 4, p. 649-658

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    Titre
    • Protocol requirements and diagnostic value of PET/MR imaging for liver metastasis detection
    Auteur
    • Reiner, Caecilia. Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
    • Stolzmann, Paul. Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
    • Husmann, Lars. Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
    • Burger, Irene. Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
    • Hüllner, Martin. Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
    • Schaefer, Niklaus. Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
    • Schneider, Paul. Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
    • von Schulthess, Gustav. Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
    • Veit-Haibach, Patrick. Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
    Type de document
    • Postprint
    Langue
    • Inglese
    Publié dans
    • European Journal of Nuclear Medicine and Molecular Imaging, 2014, vol. 41, no. 4, p. 649-658. Springer Berlin Heidelberg
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:325643
    Summary
    Purpose: To compare the accuracy of PET/MR imaging with that of FDG PET/CT and to determine the MR sequences necessary for the detection of liver metastasis using a trimodality PET/CT/MR set-up. Methods: Included in this single-centre IRB-approved study were 55 patients (22 women, age 61 ± 11years) with suspected liver metastases from gastrointestinal cancer. Imaging using a trimodality PET/CT/MR set-up (time-of-flight PET/CT and 3-T whole-body MR imager) comprised PET, low-dose CT, contrast-enhanced (CE) CT of the abdomen, and MR with T1-W/T2-W, diffusion-weighted (DWI), and dynamic CE imaging. Two readers evaluated the following image sets for liver metastasis: PET/CT (set A), PET/CECT (B), PET/MR including T1-W/T2-W (C), T1-W/T2-W with either DWI (D) or CE imaging (E), and a combination (F). The accuracy of each image set was determined by receiver-operating characteristic analysis using image set B as the standard of reference. Results: Of 120 liver lesions in 21/55 patients (38%), 79 (66%) were considered malignant, and 63/79 (80%) showed abnormal FDG uptake. Accuracies were 0.937 (95% CI 89.5-97.9%) for image set A, 1.00 (95% CI 99.9-100.0%) for set C, 0.998 (95% CI 99.4-100.0%) for set D, 0.997 (95% CI 99.3-100.0%) for set E, and 0.995 (95% CI 99.0-100.0%) for set F. Differences were significant for image sets D-F (P < 0.05) when including lesions without abnormal FDG uptake. As shown by follow-up imaging after 50-177days, the use of image sets D and both sets E and F led to the detection of metastases in one and three patients, respectively, and further metastases in the contralateral lobe in two patients negative on PET/CECT (P = 0.06). Conclusion: PET/MR imaging with T1-W/T2-W sequences results in similar diagnostic accuracy for the detection of liver metastases to PET/CECT. To significantly improve the characterization of liver lesions, we recommend the use of dynamic CE imaging sequences. PET/MR imaging has a diagnostic impact on clinical decision making.