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Lo HZ, Choy KT, Kong JCH. FDG-PET/MRI in colorectal cancer care: an updated systematic review. Abdom Radiol (NY) 2024:10.1007/s00261-024-04460-z. [PMID: 39073608 DOI: 10.1007/s00261-024-04460-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 06/11/2024] [Accepted: 06/15/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE Since its introduction in 2011, FDG-PET/MRI has been advocated as a useful adjunct in colorectal cancer care. However, gaps and limitations in current research remain. This systematic review aims to review the current literature to quantify the utility of FDG-PET/MRI in colorectal cancer care. METHODS An up-to-date review was performed on the available literature between 2000 and 2023 on PubMed, EMBASE, Medline, databases. All studies reporting on the use of FDG-PET/MRI in colorectal cancer care were analyzed. The main outcome measures were accuracy in initial staging, restaging, and detection of metastatic disease in both rectal as well as colon cancers. The secondary outcome was comparing the performance of FDG-PET/MRI versus Standard of Care Imaging (SCI). Finally, the clinical significance of FDG-PET/MRI was measured in the change in management resulting from imaging findings. RESULTS A total of 22 observational studies were included, accounting for 988 patients. When individually compared to current Standard of Care Imaging (SCI)-MRI pelvis for rectal cancer and thoraco-abdominal contrast CT, PET/MRI proved superior in terms of distant metastatic disease detection. This led to as much as 21.0% change in management. However, the technological limitations of PET/MRI were once again highlighted, suggesting SCI should retain its place as first-line imaging. CONCLUSION FDG-PET/MRI appears to be a promising adjunct in staging and restaging of colorectal cancer in carefully selected patients.
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Affiliation(s)
- Hui Zhen Lo
- School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
| | - Kay Tai Choy
- Department of Surgery, Austin Health, Melbourne, VIC, Australia
| | - Joseph Cherng Huei Kong
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
- Department of Colorectal Surgery, Alfred Hospital, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
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2
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Ock J, Moon S, Kim M, Ko BS, Kim N. Evaluation of the accuracy of an augmented reality-based tumor-targeting guide for breast-conserving surgery. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 245:108002. [PMID: 38215659 DOI: 10.1016/j.cmpb.2023.108002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/26/2023] [Accepted: 12/28/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND AND OBJECTIVES Although magnetic resonance imaging (MRI) is commonly used for breast tumor detection, significant challenges remain in determining and presenting the three-dimensional (3D) morphology of tumors to guide breast-conserving surgery. To address this challenge, we have developed the augmented reality-breast surgery guide (AR-BSG) and compared its performance with that of a traditional 3D-printed breast surgical guide (3DP-BSG). METHODS Based on the MRI results of a breast cancer patient, a breast phantom made of skin, body, and tumor was fabricated through 3D printing and silicone-casting. AR-BSG and 3DP-BSG were executed using surgical plans based on the breast phantom's computed tomography scan images. Three operators independently inserted a catheter into the phantom using each guide. Their targeting accuracy was then evaluated using Bland-Altman analysis with limits of agreement (LoA). Differences between the users of each guide were evaluated using the intraclass correlation coefficient (ICC). RESULTS The entry and end point errors associated with AR-BSG were -0.34±0.68 mm (LoA: -1.71-1.01 mm) and 0.81±1.88 mm (LoA: -4.60-3.00 mm), respectively, whereas 3DP-BSG was associated with entry and end point errors of -0.28±0.70 mm (LoA: -1.69-1.11 mm) and -0.62±1.24 mm (LoA: -3.00-1.80 mm), respectively. The AR-BSG's entry and end point ICC values were 0.99 and 0.97, respectively, whereas 3DP-BSG was associated with entry and end point ICC values of 0.99 and 0.99, respectively. CONCLUSIONS AR-BSG can consistently and accurately localize tumor margins for surgeons without inferior guiding accuracy AR-BSG can consistently and accurately localize tumor margins for surgeons without inferior guiding accuracy compared to 3DP-BSG. Additionally, when compared with 3DP-BSG, AR-BSG can offer better spatial perception and visualization, lower costs, and a shorter setup time.
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Affiliation(s)
- Junhyeok Ock
- Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap2-dong, Songpa-gu, Seoul, South Korea
| | - Sojin Moon
- Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap2-dong, Songpa-gu, Seoul, South Korea
| | - MinKyeong Kim
- Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap2-dong, Songpa-gu, Seoul, South Korea
| | - Beom Seok Ko
- Department of Breast Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap2-dong, Songpa-gu, Seoul, South Korea
| | - Namkug Kim
- Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap2-dong, Songpa-gu, Seoul, South Korea; Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap2-dong, Songpa-gu, Seoul, South Korea.
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Jayaprakasam VS, Ince S, Suman G, Nepal P, Hope TA, Paspulati RM, Fraum TJ. PET/MRI in colorectal and anal cancers: an update. Abdom Radiol (NY) 2023; 48:3558-3583. [PMID: 37062021 DOI: 10.1007/s00261-023-03897-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 04/17/2023]
Abstract
Positron emission tomography (PET) in the era of personalized medicine has a unique role in the management of oncological patients and offers several advantages over standard anatomical imaging. However, the role of molecular imaging in lower GI malignancies has historically been limited due to suboptimal anatomical evaluation on the accompanying CT, as well as significant physiological 18F-flurodeoxyglucose (FDG) uptake in the bowel. In the last decade, technological advancements have made whole-body FDG-PET/MRI a feasible alternative to PET/CT and MRI for lower GI malignancies. PET/MRI combines the advantages of molecular imaging with excellent soft tissue contrast resolution. Hence, it constitutes a unique opportunity to improve the imaging of these cancers. FDG-PET/MRI has a potential role in initial diagnosis, assessment of local treatment response, and evaluation for metastatic disease. In this article, we review the recent literature on FDG-PET/MRI for colorectal and anal cancers; provide an example whole-body FDG-PET/MRI protocol; highlight potential interpretive pitfalls; and provide recommendations on particular clinical scenarios in which FDG-PET/MRI is likely to be most beneficial for these cancer types.
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Affiliation(s)
- Vetri Sudar Jayaprakasam
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | - Semra Ince
- Department of Radiology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Garima Suman
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Pankaj Nepal
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Thomas A Hope
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, CA, USA
| | | | - Tyler J Fraum
- Department of Radiology, Washington University School of Medicine, Saint Louis, MO, USA
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Tey J, Tan JK, Tan KK, Soon YY, Loi HY, Mohamed JSA, Bakulbhai PA, Ang B, Liang TY. Restaging of rectal cancer with hybrid positron emission tomography magnetic resonance imaging after preoperative chemoradiotherapy. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023; 52:289-295. [PMID: 38904510 DOI: 10.47102/annals-acadmedsg.2022378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
Introduction This study determines the sensitivity and specificity of positron emission tomography/magnetic resonance imaging (PET/MRI) parameters in predicting treatment response in patients with localised rectal cancer who have undergone preoperative chemoradiotherapy (CRT). Method Patients with stage I-III adenocarcinoma of the rectum planned for preoperative CRT followed by surgery were recruited. Patients had PET/MRI scans at baseline and 6-8 weeks post-CRT. Functional MRI and PET parameters were assessed for their diagnostic accuracy for tumour regression grade (TRG). Nonparametric receiver operating characteristic analysis was employed to determine the area under the ROC curve (AUC), and the sensitivity and specificity of each quantile cut-off. Results A total of 31 patients were recruited, of whom 20 completed study protocol. All patients included had mid or lower rectal tumours. There were 16 patients (80%) with node-positive disease at presentation. The median time to surgery was 75.5 days (range 52-106 days). Histopathological assessment revealed 20% good responders (TRG 1/2), and the remaining 80% of patients had a poor response (TRG 3/4). When predicting good responders, the AUC values for percent maximum thickness reduction and percent apparent diffusion coefficient (ADC) change were 0.82 and 0.73, respectively. A maximum thickness reduction cut-off of >47% and a percent ADC change of >20% yielded a sensitivity and specificity of 75%/95% and 75%/73%, respectively. Conclusion Parameters such as percent maximum thickness reduction and percent ADC change may be useful for predicting good responders in patients undergoing preoperative CRT for rectal cancer. Larger studies are warranted to establish the utility of PET/MRI in rectal cancer staging.
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Affiliation(s)
- Jeremy Tey
- Department of Radiation Oncology, National University Cancer Institute, Singapore
| | - Jarrod Kh Tan
- Division of Colorectal Surgery, Department of Surgery, National University of Singapore
| | - Ker-Kan Tan
- Division of Colorectal Surgery, Department of Surgery, National University of Singapore
| | - Yu Yang Soon
- Department of Radiation Oncology, National University Cancer Institute, Singapore
| | - Hoi Yin Loi
- Department of Nuclear Medicine, National University Hospital, Singapore
| | | | | | - Bertrand Ang
- Department of Radiology, National University Hospital, Singapore
| | - Thian Yee Liang
- Department of Radiology, National University Hospital, Singapore
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Ren Q, Chen Y, Shao X, Guo L, Xu X. Lymph nodes primary staging of colorectal cancer in 18F-FDG PET/MRI: a systematic review and meta-analysis. Eur J Med Res 2023; 28:162. [PMID: 37143144 PMCID: PMC10157899 DOI: 10.1186/s40001-023-01124-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/23/2023] [Indexed: 05/06/2023] Open
Abstract
OBJECTIVE To assess the diagnostic efficacy of 18F-FDG PET/MRI for lymph node (LN) metastasis primary staging in patients with colorectal cancer (CRC). METHODS This study was conducted and reported in accordance with the PRISMA-DTA statement. Electronic databases (PubMed, Embase, Cochrane Library) were searched for studies on 18F-FDG PET/MRI for diagnosing LN metastasis. The pooled sensitivity (SEN), specificity (SPE), and area under the curve (AUC) were applied to assess the diagnostic performance. Heterogeneity was identified and processed using meta-regression and sensitivity analysis. All data analyses were performed via STATA 15 and Meta-Disc 1.4 software. RESULTS There were finally 7 studies included, involving a total of 184 patients. The Spearman rank correlation coefficient was 0.108 (P = 0.818), with no threshold-effect observed. The pooled SEN was 0.81 (95%CI 0.66-0.90) and the SPE was 0.89 (95% CI 0.73-0.96). In sub-groups, prospective groups demonstrated to have the highest SEN of 0.92 (95%CI 0.79-1.00). The studies conducted by Catalano et al. and Kang et al. were considered to be potential sources of heterogeneity. CONCLUSION 18F-FDG PET/MRI has shown remarkable diagnostic performance in identification of LN metastases in newly diagnosed CRC patients. It would be of great application value for the primary staging of CRC lymph node metastases.
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Affiliation(s)
- Qingwei Ren
- Department of Gastroenterology, Dongyang Hospital of Traditional Chinese Medicine, Dongyang, China
| | - Yanyan Chen
- Department of Medical Oncology, Dongyang Women & Children Hospital, No. 40, Wuning East Road, Dongyang, 322100, China.
| | - Xuejun Shao
- Department of Gastroenterology, Dongyang Hospital of Traditional Chinese Medicine, Dongyang, China
| | - Lanzhong Guo
- Department of Medical Oncology, Dongyang Women & Children Hospital, No. 40, Wuning East Road, Dongyang, 322100, China
| | - Xinxin Xu
- Department of Gastroenterology, Dongyang Hospital of Traditional Chinese Medicine, Dongyang, China
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Chen MZ, Zhang X, Mui M, Kong JCH, Heriot AG, Ellis-Clark J. Retrospective audit: Utility of PET scan in routine preoperative rectal cancer staging. ANZ J Surg 2023; 93:617-621. [PMID: 36117452 DOI: 10.1111/ans.18058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 08/30/2022] [Accepted: 09/02/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Accurate staging for rectal cancer is pertinent with recent introduction of rectum-sparing approaches for patients showing complete clinical response on restaging. Positron emission tomography(PET) is used in detection of recurrence or metastasis, but its value in routine preoperative rectal cancer staging remains unclear. Studies report that preoperative PET altered the stage in 39% and changed the management in 17-27% of patients. Our study aims to look at the utility of PET in routine preoperative staging of rectal cancer within 2 two colorectal units, and to determine if PET did result in a change in management. METHODS Patients in Nepean Hospital (NSW) and Peter MacCallum Cancer Centre (VIC) who were diagnosed with rectal cancer between 1 January 2017 and 31 December 2021 were included in this retrospective study. All patients who did not have a PET scan were excluded. PET scan results were then compared with MRI and CT results. RESULTS Three hundred and fifty-seven patients were included in the study. 30.3% of the patients had Stage 3 rectal cancer. 71.7% received neoadjuvant therapy. PET scan provided additional information in 55.5% of patients when compared with CT and MRI alone; 18.2% of the PET findings resulted in an altered management for the patient. CONCLUSION PET scan can be a valuable tool in accurate staging, especially for ambiguous or equivocal lesions on CT. Our study demonstrated that additional information from PET scan resulted in an altered management plan in 18.2% of the patients. PET/MRI as a newer modality may be more accurate with reduced radiation exposure.
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Affiliation(s)
- Michelle Zhiyun Chen
- Department of Colorectal Surgery, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Xinyi Zhang
- Department of Colorectal Surgery, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Milton Mui
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Joseph C H Kong
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
- Department of Surgery, Central Clinical School, Monash University, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Alexander G Heriot
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Jodie Ellis-Clark
- Department of Colorectal Surgery, Nepean Hospital, Kingswood, New South Wales, Australia
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Tabari A, Chan SM, Omar OMF, Iqbal SI, Gee MS, Daye D. Role of Machine Learning in Precision Oncology: Applications in Gastrointestinal Cancers. Cancers (Basel) 2022; 15:cancers15010063. [PMID: 36612061 PMCID: PMC9817513 DOI: 10.3390/cancers15010063] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/14/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
Gastrointestinal (GI) cancers, consisting of a wide spectrum of pathologies, have become a prominent health issue globally. Despite medical imaging playing a crucial role in the clinical workflow of cancers, standard evaluation of different imaging modalities may provide limited information. Accurate tumor detection, characterization, and monitoring remain a challenge. Progress in quantitative imaging analysis techniques resulted in "radiomics", a promising methodical tool that helps to personalize diagnosis and treatment optimization. Radiomics, a sub-field of computer vision analysis, is a bourgeoning area of interest, especially in this era of precision medicine. In the field of oncology, radiomics has been described as a tool to aid in the diagnosis, classification, and categorization of malignancies and to predict outcomes using various endpoints. In addition, machine learning is a technique for analyzing and predicting by learning from sample data, finding patterns in it, and applying it to new data. Machine learning has been increasingly applied in this field, where it is being studied in image diagnosis. This review assesses the current landscape of radiomics and methodological processes in GI cancers (including gastric, colorectal, liver, pancreatic, neuroendocrine, GI stromal, and rectal cancers). We explain in a stepwise fashion the process from data acquisition and curation to segmentation and feature extraction. Furthermore, the applications of radiomics for diagnosis, staging, assessment of tumor prognosis and treatment response according to different GI cancer types are explored. Finally, we discussed the existing challenges and limitations of radiomics in abdominal cancers and investigate future opportunities.
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Affiliation(s)
- Azadeh Tabari
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
- Correspondence:
| | - Shin Mei Chan
- Yale University School of Medicine, 330 Cedar Street, New Haven, CT 06510, USA
| | - Omar Mustafa Fathy Omar
- Center for Vascular Biology, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Shams I. Iqbal
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Michael S. Gee
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Dania Daye
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
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Rooney S, Meyer J, Afzal Z, Ashcroft J, Cheow H, De Paepe KN, Powar M, Simillis C, Wheeler J, Davies J, Joshi H. The Role of Preoperative Imaging in the Detection of Lateral Lymph Node Metastases in Rectal Cancer: A Systematic Review and Diagnostic Test Meta-analysis. Dis Colon Rectum 2022; 65:1436-1446. [PMID: 36102825 DOI: 10.1097/dcr.0000000000002537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Different techniques exist for the imaging of lateral lymph nodes in rectal cancer. OBJECTIVE This study aimed to compare the diagnostic accuracy of pelvic MRI, 18 F-FDG-PET/CT, and 18 F-FDG-PET/MRI for the identification of lateral lymph node metastases in rectal cancer. DATA SOURCES Data sources include PubMed, Embase, Cochrane Library, and Google Scholar. STUDY SELECTION All studies evaluating the diagnostic accuracy of pelvic MRI, 18 F-FDG-PET/CT, and 18 F-FDG-PET/MRI for the preoperative detection of lateral lymph node metastasis in patients with rectal cancer were selected. INTERVENTIONS The interventions were pelvic MRI, 18 F-FDG-PET/CT, and/or 18 F-FDG-PET/MRI. MAIN OUTCOME MEASURES Definitive histopathology was used as a criterion standard. RESULTS A total of 20 studies (1,827 patients) were included out of an initial search yielding 7,360 studies. The pooled sensitivity of pelvic MRI was 0.88 (95% CI, 0.85-0.91), of 18 F-FDG-PET/CT was 0.83 (95% CI, 0.80-0.86), and of 18 F-FDG-PET/MRI was 0.72 (95% CI, 0.51-0.87) for the detection of lateral lymph node metastasis. The pooled specificity of pelvic MRI was 0.85 (95% CI, 0.78-0.90), of 18 F-FDG-PET/CT was 0.95 (95% CI, 0.86-0.98), and of 18 F-FDG-PET/MRI was 0.90 (95% CI, 0.78-0.96). The area under the curve was 0.88 (95% CI, 0.85-0.91) for pelvic MRI and was 0.83 (95% CI, 0.80-0.86) for 18 F-FDG-PET/CT. LIMITATIONS Heterogeneity in terms of patients' populations, definitions of suspect lateral lymph nodes, and administration of neoadjuvant treatment. CONCLUSIONS For the preoperative identification of lateral lymph node metastasis in rectal cancer, this review found compelling evidence that pelvic MRI should constitute the imaging modality of choice. In contrast, to confirm the presence of lateral lymph node metastasis, 18 F-FDG-PET/MRI modalities allow discarding false positive cases because of increased specificity. PROSPERO REGISTRATION NUMBER CRD42020200319.
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Affiliation(s)
- Siobhan Rooney
- Department of Surgery, Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Jeremy Meyer
- Department of Surgery, Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland
- Medical School, University of Geneva, Geneva, Switzerland
| | - Zeeshan Afzal
- Department of Surgery, Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - James Ashcroft
- Department of Surgery, Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Heok Cheow
- Department of Nuclear Medicine/Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Katja N De Paepe
- Department of Nuclear Medicine/Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Michael Powar
- Department of Surgery, Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Constantinos Simillis
- Department of Surgery, Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - James Wheeler
- Department of Surgery, Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Justin Davies
- Department of Surgery, Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Medical School, University of Cambridge, United Kingdom
| | - Heman Joshi
- Department of Surgery, Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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Diagnostic performance of [ 18F]-FDG PET/MR in evaluating colorectal cancer: a systematic review and meta-analysis. Eur J Nucl Med Mol Imaging 2022; 49:4205-4217. [PMID: 35705874 DOI: 10.1007/s00259-022-05871-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/09/2022] [Indexed: 02/07/2023]
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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10
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Boktor RR, Lee ST, Scott AM. PET/CT imaging in colorectal carcinoma. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00033-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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11
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Kokaine L, Gardovskis A, Gardovskis J. Evaluation and Predictive Factors of Complete Response in Rectal Cancer after Neoadjuvant Chemoradiation Therapy. ACTA ACUST UNITED AC 2021; 57:medicina57101044. [PMID: 34684080 PMCID: PMC8537499 DOI: 10.3390/medicina57101044] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/16/2021] [Accepted: 09/23/2021] [Indexed: 12/18/2022]
Abstract
The response to neoadjuvant chemoradiation therapy is an important prognostic factor for locally advanced rectal cancer. Although the majority of the patients after neoadjuvant therapy are referred to following surgery, the clinical data show that complete clinical or pathological response is found in a significant proportion of the patients. Diagnostic accuracy of confirming the complete response has a crucial role in further management of a rectal cancer patient. As the rate of clinical complete response, unfortunately, is not always consistent with pathological complete response, accurate diagnostic parameters and predictive markers of tumor response may help to guide more personalized treatment strategies and identify potential candidates for nonoperative management more safely. The management of complete response demands interdisciplinary collaboration including oncologists, radiotherapists, radiologists, pathologists, endoscopists and surgeons, because the absence of a multidisciplinary approach may compromise the oncological outcome. Prediction and improvement of rectal cancer response to neoadjuvant therapy is still an active and challenging field of further research. This literature review is summarizing the main, currently known clinical information about the complete response that could be useful in case if encountering such condition in rectal cancer patients after neoadjuvant chemoradiation therapy, using as a source PubMed publications from 2010–2021 matching the search terms “rectal cancer”, “neoadjuvant therapy” and “response”.
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Affiliation(s)
- Linda Kokaine
- Department of Surgery, Riga Stradins University, Dzirciema Street 16, LV-1007 Riga, Latvia; or
- Pauls Stradins Clinical University Hospital, Pilsoņu Street 13, LV-1002 Riga, Latvia
- Correspondence: (L.K.); (J.G.); Tel.: +371-2635-9472 (L.K.)
| | - Andris Gardovskis
- Department of Surgery, Riga Stradins University, Dzirciema Street 16, LV-1007 Riga, Latvia; or
- Pauls Stradins Clinical University Hospital, Pilsoņu Street 13, LV-1002 Riga, Latvia
| | - Jānis Gardovskis
- Department of Surgery, Riga Stradins University, Dzirciema Street 16, LV-1007 Riga, Latvia; or
- Pauls Stradins Clinical University Hospital, Pilsoņu Street 13, LV-1002 Riga, Latvia
- Correspondence: (L.K.); (J.G.); Tel.: +371-2635-9472 (L.K.)
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12
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Lee SW, Jeong SY, Kim K, Kim SJ. Direct comparison of F-18 FDG PET/CT and MRI to predict pathologic response to neoadjuvant treatment in locally advanced rectal cancer: a meta-analysis. Ann Nucl Med 2021; 35:1038-1047. [PMID: 34109555 DOI: 10.1007/s12149-021-01639-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 06/06/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of the current study was to compare the diagnostic accuracies of F-18 FDG PET/CT and MRI for prediction of pathologic responses to neoadjuvant treatment (NAT) in locally advanced rectal cancer (LARC) patients based on a systematic review and meta-analyses. METHODS The PubMed, Cochrane, and Embase databases were searched to identify studies that conducted direct comparisons of the diagnostic performance of F-18 FDG PET/CT and MRI for the prediction of pathologic response to NAT in patients with LARC from the earliest available date of indexing up to July 31, 2020. We determined the sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR + and LR -), and we constructed summary receiver operating characteristic curves. RESULTS In nine studies (427 patients), the pooled sensitivity of F-18 FDG PET/CT was 0.79 (95% CI 0.71-0.86) and the pooled specificity was 0.74 (95% CI 0.60-0.84). LR syntheses yielded an overall LR + of 3.1 (95% CI 1.9-5.0) and an LR - of 0.28 (95% CI 0.18-0.43). The pooled diagnostic odds ratio (DOR) was 11 (95% CI 5-26). The pooled sensitivity of MRI was 0.89 (95% CI 0.77-0.95) and the pooled specificity was 0.66 (95% CI 0.55-0.76). LR syntheses yielded an overall LR + of 2.6 (95% CI 1.9-3.6) and an LR - of 0.17 (95% CI 0.08-0.37). The pooled DOR was 15 (95% CI 6-42). In meta-regression analysis, no variable was identified as the source of the study heterogeneity. CONCLUSION F-18 FDG PET/CT and MRI showed similar diagnostic performances for the prediction of pathologic responses to NAT in patients with LARC. However, each modality can be a complement to other rather than being used singly.
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Affiliation(s)
- Sang-Woo Lee
- Department of Nuclear Medicine, Kyungpook National University Chilgok Hospital and School of Medicine, Daegu, 41404, Republic of Korea
| | - Shin Young Jeong
- Department of Nuclear Medicine, Kyungpook National University Chilgok Hospital and School of Medicine, Daegu, 41404, Republic of Korea
| | - Keunyoung Kim
- Department of Nuclear Medicine, Pusan National University Hospital, Busan, 49241, Republic of Korea
| | - Seong-Jang Kim
- Department of Nuclear Medicine, College of Medicine, Pusan National University Yangsan Hospital, Yangsan, 50612, Republic of Korea.
- BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, 50612, Republic of Korea.
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13
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Abstract
PET/MR imaging is in routine clinical use and is at least as effective as PET/CT for oncologic and neurologic studies with advantages with certain PET radiopharmaceuticals and applications. In addition, whole body PET/MR imaging substantially reduces radiation dosages compared with PET/CT which is particularly relevant to pediatric and young adult population. For cancer imaging, assessment of hepatic, pelvic, and soft-tissue malignancies may benefit from PET/MR imaging. For neurologic imaging, volumetric brain MR imaging can detect regional volume loss relevant to cognitive impairment and epilepsy. In addition, the single-bed position acquisition enables dynamic brain PET imaging without extending the total study length which has the potential to enhance the diagnostic information from PET.
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Affiliation(s)
- Farshad Moradi
- Department of Radiology, Stanford University, 300 Pasteur Drive, H2200, Stanford, CA 94305, USA.
| | - Andrei Iagaru
- Department of Radiology, Stanford University, 300 Pasteur Drive, H2200, Stanford, CA 94305, USA
| | - Jonathan McConathy
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, JT 773, Birmingham, AL 35249, USA
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14
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Furtado FS, Suarez-Weiss KE, Vangel M, Clark JW, Cusack JC, Hong T, Blaszkowsky L, Wo J, Striar R, Umutlu L, Daldrup-Link HE, Groshar D, Rocco R, Bordeianou L, Anderson MA, Mojtahed A, Qadan M, Ferrone C, Catalano OA. Clinical impact of PET/MRI in oligometastatic colorectal cancer. Br J Cancer 2021; 125:975-982. [PMID: 34282295 DOI: 10.1038/s41416-021-01494-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/08/2021] [Accepted: 07/08/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Oligometastatic colorectal cancer (CRC) is potentially curable and demands individualised strategies. METHODS This single-centre retrospective study investigated if positron emission tomography (PET)/magnetic resonance imaging (MR) had a clinical impact on oligometastatic CRC relative to the standard of care imaging (SCI). Adult patients with oligometastatic CRC on SCI who also underwent PET/MR between 3/2016 and 3/2019 were included. The exclusion criterion was lack of confirmatory standard of reference, either surgical pathology, intraoperative gross confirmation or imaging follow-up. SCI consisted of contrast-enhanced (CE) computed tomography (CT) of the chest/abdomen/pelvis, abdominal/pelvic CE-MR, and/or CE whole-body PET/CT with diagnostic quality (i.e. standard radiation dose) CT. Follow-up was evaluated until 3/2020. RESULTS Thirty-one patients constituted the cohort, 16 (52%) male, median patient age was 53 years (interquartile range: 49-65 years). PET/MR and SCI results were divergent in 19% (95% CI 9-37%) of the cases, with PET/MR leading to management changes in all of them. The diagnostic accuracy of PET/MR was 90 ± 5%, versus 71 ± 8% for SCI. In a pairwise analysis, PET/MR outperformed SCI when compared to the reference standard (p = 0.0412). CONCLUSIONS These findings suggest the potential usefulness of PET/MR in the management of oligometastatic CRC.
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Affiliation(s)
- Felipe S Furtado
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, MA, USA
| | | | - Mark Vangel
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, MA, USA.,Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeffrey W Clark
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - James C Cusack
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Theodore Hong
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lawrence Blaszkowsky
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Newton-Wellesley Hospital, Newton, MA, USA
| | - Jennifer Wo
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Robin Striar
- Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, MA, USA
| | | | | | - David Groshar
- Assuta Medical Centers, Tel Aviv, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ricciardi Rocco
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Mark A Anderson
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Motaz Qadan
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Cristina Ferrone
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Onofrio A Catalano
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. .,Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, MA, USA.
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15
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T2-weighted, apparent diffusion coefficient and 18F-FDG PET histogram analysis of rectal cancer after preoperative chemoradiotherapy. Tech Coloproctol 2021; 25:569-577. [PMID: 33792823 PMCID: PMC8079287 DOI: 10.1007/s10151-021-02440-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/20/2021] [Indexed: 11/05/2022]
Abstract
Background The aim of our study was to investigate the correlation among T2-weighted (T2w) images, apparent diffusion coefficient (ADC) maps, 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) images, histogram analysis and the pathological response in locally advanced rectal cancer (LARC) after preoperative chemoradiotherapy (pCRT). Methods Patients with LARC were prospectively enrolled between February 2015 and August 2018 and underwent PET/magnetic resonance imaging (MRI). MRI included T2w and diffusion-weighted imaging (DWI)-sequences. ADC maps and PET images were matched to the T2w images. Voxel-based standardized uptake values (SUVs,) ADC and T2w-signal-intensity values were collected from the volumes of interest (VOIs) and mean, skewness and kurtosis were calculated. Spearman’s correlation coefficient was applied to evaluate the correlation among the variables and tumor regression grade (TRG), T stage, N stage and fibrosis. Results Twenty-two patients with biopsy-proven LARC in the low or mid rectum were enrolled [17 males, mean age was 69 years (range 49–85 years)]. Seven patients experienced complete regression (TRG1). A significant positive correlation was found between SUV mean values (ρ = 0.480; p = 0.037) and TRG. No other significant correlations were found. Conclusions Histogram analysis of SUV values is a predictor of TRG in LARC.
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16
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Ward RD, Amorim B, Li W, King J, Umutlu L, Groshar D, Harisinghani M, Catalano O. Abdominal and pelvic 18F-FDG PET/MR: a review of current and emerging oncologic applications. Abdom Radiol (NY) 2021; 46:1236-1248. [PMID: 32949272 DOI: 10.1007/s00261-020-02766-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 12/12/2022]
Abstract
Positron emission tomography (PET) using fluorodeoxyglucose (18F-FDG) combined with magnetic resonance imaging (MR) is an emerging hybrid modality that has shown utility in evaluating abdominal and pelvic disease entities. Together, the high soft tissue contrast and metabolic/functional imaging capabilities make this modality ideal for oncologic imaging in many organ systems. Its clinical utility continues to evolve and future research will help solidify its role in oncologic imaging. In this manuscript, we aim to (1) provide an overview of the various PET/MR systems, describing the strengths and weaknesses of each system, and (2) review the oncologic applications for 18F-FDG PET/MR in the abdomen and pelvis.
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Affiliation(s)
- Ryan D Ward
- Cleveland Clinic, Department of Abdominal Imaging, 9500 Euclid Ave, L10, Cleveland, OH, 44195, USA
| | - Barbara Amorim
- Division of Nuclear Medicine, University of Campinas, Rua Vital Brasil 251, Campinas, Brazil
| | - Weier Li
- Department of Abdominal Imaging, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Joseph King
- Department of Abdominal Imaging, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany
| | - David Groshar
- Assuta Medical Center, Habrzel 20, 6971028, Tel-Aviv, Israel
- Sackler School of Medicine, Tel-Aviv, Israel
| | - Mukesh Harisinghani
- Department of Abdominal Imaging, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Onofrio Catalano
- Department of Abdominal Imaging, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114, USA.
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17
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Crimì F, Valeggia S, Baffoni L, Stramare R, Lacognata C, Spolverato G, Albertoni L, Spimpolo A, Evangelista L, Zucchetta P, Cecchin D, Pucciarelli S. [18F]FDG PET/MRI in rectal cancer. Ann Nucl Med 2021; 35:281-290. [PMID: 33517562 PMCID: PMC7902586 DOI: 10.1007/s12149-021-01580-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/05/2021] [Indexed: 02/06/2023]
Abstract
We conducted a systematic literature review on the use of [18F]FDG PET/MRI for staging/restaging rectal cancer patients with PubMed, Scopus, and Web of Science, based on the PRISMA criteria. Three authors screened all titles and abstracts and examined the full texts of all the identified relevant articles. Studies containing aggregated or duplicated data, review articles, case reports, editorials, and letters were excluded. Ten reports met the inclusion criteria. Four studies examined T staging and one focused on local recurrences after surgery; the reported sensitivity (94-100%), specificity (73-94%), and accuracy (92-100%) varied only slightly from one study to another. The sensitivity, specificity, and accuracy of [18F]FDG PET/MRI for N staging were 90-93%, 92-94%, and 42-92%. [18F]FDG PET/MRI detected malignant nodes better than MRI, resulting in treatment change. For M staging, [18F]FDG PET/MRI outperformed [18F]FDG PET/CT and CT in detecting liver metastases, whereas it performed worse for lung metastases. The results of this review suggest that [18F]FDG PET/MRI should be used for rectal cancer restaging after chemoradiotherapy and to select patients for rectum-sparing approaches thanks to its accuracy in T and N staging. For M staging, it should be associated at least with a chest CT scan to rule out lung metastases.
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Affiliation(s)
- Filippo Crimì
- Department of Medicine DIMED, Institute of Radiology, Padova University Hospital, Via Nicolò Giustiniani 2, 35128, Padova, Italy
| | - Silvia Valeggia
- Department of Medicine DIMED, Institute of Radiology, Padova University Hospital, Via Nicolò Giustiniani 2, 35128, Padova, Italy
| | - Luca Baffoni
- Department of Medicine DIMED, Institute of Radiology, Padova University Hospital, Via Nicolò Giustiniani 2, 35128, Padova, Italy
| | - Roberto Stramare
- Department of Medicine DIMED, Institute of Radiology, Padova University Hospital, Via Nicolò Giustiniani 2, 35128, Padova, Italy
| | - Carmelo Lacognata
- Radiology Unit, Padova University Hospital, Via Nicolò Giustiniani 2, 35128, Padova, Italy
| | - Gaya Spolverato
- Department of Surgical, Oncological and Gastroenterological Sciences DiSCOG, 1st Surgical Clinic, Padova University Hospital, Via Nicolò Giustiniani 2, 35128, Padova, Italy
| | - Laura Albertoni
- Department of Medicine DIMED, Surgical Pathology and Cytopathology Unit, Padova University Hospital, Via Nicolò Giustiniani 2, 35128, Padova, Italy
| | - Alessandro Spimpolo
- Department of Medicine DIMED, Nuclear Medicine Unit, Padova University Hospital, Via Nicolò Giustiniani 2, 35128, Padova, Italy.
| | - Laura Evangelista
- Department of Medicine DIMED, Nuclear Medicine Unit, Padova University Hospital, Via Nicolò Giustiniani 2, 35128, Padova, Italy
| | - Pietro Zucchetta
- Department of Medicine DIMED, Nuclear Medicine Unit, Padova University Hospital, Via Nicolò Giustiniani 2, 35128, Padova, Italy
| | - Diego Cecchin
- Department of Medicine DIMED, Nuclear Medicine Unit, Padova University Hospital, Via Nicolò Giustiniani 2, 35128, Padova, Italy
| | - Salvatore Pucciarelli
- Department of Surgical, Oncological and Gastroenterological Sciences DiSCOG, 1st Surgical Clinic, Padova University Hospital, Via Nicolò Giustiniani 2, 35128, Padova, Italy
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18
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Vali Y, Yang B, Olsen M, Leeflang MMG, Bossuyt PMM. Reporting of test comparisons in diagnostic accuracy studies: A literature review. Res Synth Methods 2020; 12:357-367. [PMID: 33217225 PMCID: PMC8246725 DOI: 10.1002/jrsm.1469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/29/2020] [Accepted: 11/17/2020] [Indexed: 12/22/2022]
Abstract
Comparative accuracy studies evaluate the relative performance of two or more diagnostic tests. As any other form of research, such studies should be reported in an informative manner, to allow replication and to be useful for decision‐making. In this study we aimed to assess whether and how components of test comparisons were reported in comparative accuracy studies. We evaluated 100 comparative accuracy studies, published in 2015, 2016 or 2017, randomly sampled from 238 comparative accuracy systematic reviews. We extracted information on 20 reporting items, pertaining to the identification of the test comparison, its validity, and the actual results of the comparison. About a third of the studies (n = 36) did not report the comparison as a study objective or hypothesis. Although most studies (n = 86) reported how participants had been allocated to index tests, we could often not evaluate whether test interpreters had been blinded to the results of other index tests (n = 40; among 59 applicable studies), nor could we identify the sequence of index tests (n = 52; among 90 applicable studies) or the methods for comparing measures of accuracy (n = 59). Two‐by‐four table data (revealing the agreement between index tests) were only reported by 9 of 90 paired comparative studies. More than half of the studies (n = 64) did not provide measures of statistical imprecision for comparative accuracy. Our findings suggest that components of test comparisons are frequently missing or incompletely described in comparative accuracy studies included in systematic reviews. Explicit guidance for reporting comparative accuracy studies may facilitate the production of full and informative study reports.
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Affiliation(s)
- Yasaman Vali
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bada Yang
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Maria Olsen
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Mariska M G Leeflang
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Patrick M M Bossuyt
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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19
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Rutegård MK, Båtsman M, Blomqvist L, Rutegård M, Axelsson J, Ljuslinder I, Rutegård J, Palmqvist R, Brännström F, Brynolfsson P, Riklund K. Rectal cancer: a methodological approach to matching PET/MRI to histopathology. Cancer Imaging 2020; 20:80. [PMID: 33129352 PMCID: PMC7603757 DOI: 10.1186/s40644-020-00347-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 09/17/2020] [Indexed: 12/18/2022] Open
Abstract
Purpose To enable the evaluation of locoregional disease in the on-going RECTOPET (REctal Cancer Trial on PET/MRI/CT) study; a methodology to match mesorectal imaging findings to histopathology is presented, along with initial observations. Methods FDG-PET/MRI examinations were performed in twenty-four consecutively included patients with rectal adenocarcinoma. In nine patients, of whom five received neoadjuvant treatment, a postoperative MRI of the surgical specimen was performed. The pathological cut-out was performed according to clinical routine with the addition of photo documentation of each slice of the surgical specimen, meticulously marking the location, size, and type of pathology of each mesorectal finding. This allowed matching individual nodal structures from preoperative MRI, via the specimen MRI, to histopathology. Results Preoperative MRI identified 197 mesorectal nodal structures, of which 92 (47%) could be anatomically matched to histopathology. Of the matched nodal structures identified in both MRI and histopathology, 25% were found to be malignant. These malignant structures consisted of lymph nodes (43%), tumour deposits (48%), and extramural venous invasion (9%). One hundred eleven nodal structures (55%) could not be matched anatomically. Of these, 97 (87%) were benign lymph nodes, and 14 (13%) were malignant nodal structures. Five were malignant lymph nodes, and nine were tumour deposits, all of which had a short axis diameter < 5 mm. Conclusions We designed a method able to anatomically match and study the characteristics of individual mesorectal nodal structures, enabling further research on the impact of each imaging modality. Initial observations suggest that small malignant nodal structures assessed as lymph nodes in MRI often comprise other forms of mesorectal tumour spread. Trial registration Clinical Trials Identifier:NCT03846882.
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Affiliation(s)
- Miriam K Rutegård
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, Umeå, Sweden.
| | - Malin Båtsman
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - Lennart Blomqvist
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, Umeå, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Martin Rutegård
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.,Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Jan Axelsson
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, Umeå, Sweden
| | - Ingrid Ljuslinder
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Jörgen Rutegård
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Richard Palmqvist
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - Fredrik Brännström
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Patrik Brynolfsson
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, Umeå, Sweden
| | - Katrine Riklund
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, Umeå, Sweden
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20
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Queiroz MA, Ortega CD, Ferreira FR, Nahas SC, Cerri GG, Buchpiguel CA. 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 2020; 48:186-195. [PMID: 32561971 DOI: 10.1007/s00259-020-04911-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 06/07/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE We compared the diagnostic accuracy of detecting distant metastases for baseline rectal cancer staging between PET/MRI and conventional staging (CS). MATERIALS AND METHODS This prospective study from November 2016 to April 2018 included 101 rectal adenocarcinoma patients for primary staging. These patients underwent whole-body PET/MRI in addition to CS (pelvic MRI and thoracic and abdominal contrast-enhanced CT). Different readers analyzed CS and PET/MRI findings for primary tumor, nodal, and metastatic staging. The presence, number, and location of metastases were recorded according to the organ involved (non-regional lymph nodes (LNs), liver, lungs, or others). Lesions were defined as positive, negative, or indeterminate. The number of lesions per organ was limited to 10. The McNemar test was used to compare the accuracies. RESULTS PET/MRI exhibited a higher accuracy in detecting metastatic disease than CS in all patients (88.4% vs. 82.6%, p = 0.003) and in patients with extramural vascular invasion (EMVI) (88.9% vs. 85.5%, p = 0.013). The detection rate of PET/MRI was superior to that of CS for all lesions [84.1% vs. 68.9%, p = 0.001], as well as those in the liver (89.2% vs. 84.2%), non-regional LNs (90.0% vs. 36.7%), and lungs (76.4% vs. 66.9%). PET/MRI correctly classified 19/33 (57.5%) patients with indeterminate lesions on CS. CONCLUSION PET/MRI yields higher accuracy than CS for detecting distant synchronous metastases in the baseline staging of patients with rectal cancer and EMVI. PET/MRI exhibited a higher detection rate than CS for identifying non-regional LNs, hepatic lesions, and pulmonary lesions as well as correctly classifying patients with indeterminate lesions. TRIAL REGISTRATION NCT02537340.
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Affiliation(s)
- Marcelo A Queiroz
- 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.
| | - Cinthia D Ortega
- Department of Radiology and Oncology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Felipe R Ferreira
- Department of Radiology and Oncology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Sergio C Nahas
- Department of Surgery, Division of Colorectal Surgery, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Giovanni G Cerri
- Department of Radiology and Oncology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Carlos A Buchpiguel
- 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
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21
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Kalisz KR, Enzerra MD, Paspulati RM. MRI Evaluation of the Response of Rectal Cancer to Neoadjuvant Chemoradiation Therapy. Radiographics 2020; 39:538-556. [PMID: 30844347 DOI: 10.1148/rg.2019180075] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
MRI plays a critical role in the staging and restaging of rectal cancer. Although newly diagnosed early-stage rectal cancers may immediately be amenable to surgical resection, patients with advanced disease first undergo neoadjuvant therapy that consists of a combination of chemotherapy and radiation therapy. Evaluation of rectal cancer after neoadjuvant therapy is best performed with MRI, given its superior soft-tissue contrast and its ability to allow multiplanar imaging and functional evaluation. In this setting, MRI allows accurate evaluation of primary tumor staging, which is determined on the basis of the depth of invasion within and through the rectal wall and the involvement of adjacent organs. MRI can also be used to evaluate posttreatment morphologic components within the tumors, including fibrosis and mucinous changes that have been shown to correlate with the response to treatment. Additional features such as the circumferential resection margin and extramural vascular invasion-factors shown to affect prognosis and local recurrence-are also assessed before and after therapy. Functional assessment with diffusion-weighted MRI and perfusion MRI plays a role in predicting tumor aggressiveness and the likelihood of response to treatment, as well as the extent of residual tumor after therapy. Lymph node staging is also performed at MRI, with assessment of not only lymph node size but also the internal architecture and signal intensity characteristics. ©RSNA, 2019 See discussion on this article by Wasnik and Al-Hawary .
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Affiliation(s)
- Kevin R Kalisz
- From the Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH 44106
| | - Michael D Enzerra
- From the Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH 44106
| | - Raj M Paspulati
- From the Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH 44106
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22
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18F-FDG PET/MRI for Rectal Cancer TNM Restaging After Preoperative Chemoradiotherapy: Initial Experience. Dis Colon Rectum 2020; 63:310-318. [PMID: 31842163 DOI: 10.1097/dcr.0000000000001568] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE F-FDG-PET/MRI is a novel hybrid techinque that has been recently introduced in oncological imaging, showing promising results. The aim of this study is to assess the value of whole-body F-FDG-PET/MRI for predicting the pathological stage of locally advanced rectal cancer after preoperative chemoradiotherapy. DESIGN This was a prospective observational study. SETTINGS The study was conducted at a tertiary care hospital. PATIENTS Thirty-six patients with locally advanced rectal cancer (25 male, median age 68.5 years) were prospectively assessed with PET/MRI and thoracoabdominal CT before and after preoperative chemoradiotherapy. Twenty-seven patients underwent low anterior or abdominoperineal resection. Nine patients with a complete clinical response underwent organ-preserving treatment (8 local excision and 1 watch-and-wait approach) with >1-year follow-up. MAIN OUTCOME MEASURES One radiologist evaluated pelvic MRI and CT. A second radiologist and a nuclear medicine physician jointly assessed PET/MRI. The imaging was compared with histology or follow-up (ypT0 vs T ≥1 and ypN0 vs ypN+ categories). Metastases were confirmed with biopsy or a follow-up CT scan at least at 1 year after preoperative chemoradiotherapy. The sensitivity, specificity, and accuracy values of the imaging techniques were calculated using standard formulas. RESULTS The accuracy for ypT staging was 89% and 92%, and the accuracy for ypN was 86% and 92% for MRI and PET/MRI. Compared with CT, PET/MRI correctly diagnosed 4 of 5 metastases, but it did not detect a lung metastatic nodule. In 11% of the patients, the PET/MRI changed the treatment strategy. LIMITATIONS This study is limited by its small sample size. CONCLUSIONS Although the whole-body PET/MRI was more accurate than the pelvic MRI alone for the prediction of tumor and node response to preoperative chemoradiotherapy, the technique performed worse than CT in detecting small lung metastasis. See Video Abstract at http://links.lww.com/DCR/B108. TOMOGRAFÍA POR EMISIÓN DE POSITRONES DE 18F- FLUORODEOXIGLUCOSA (FDG) / RESONANCIA MAGNÉTICA (TEP/RM) PARA ESTADIFICACIÓN TUMORAL TNM DE CÁNCER DEL RECTO DESPUÉS DE LA QUIMIORRADIOTERAPIA PREOPERATORIA - EXPERIENCIA INICIAL: Evaluar el valor de la tomografía por emisión de positrones de 18F-fluorodeoxiglucosa / resonancia magnética (TEP/RM) para predecir el estadio patológico del cáncer de recto localmente avanzado después de la quimiorradioterapia preoperatoria.Este fue un estudio prospectivo observacional.El estudio se realizó en un hospital de atención terciaria.Treinta y seis pacientes con cáncer rectal localmente avanzado (25 hombres, edad media de 68.5 años) fueron evaluados prospectivamente con TEP/RM y tomografía computarizada (TC) toraco-abdominal antes y después de la quimiorradioterapia preoperatoria. Veintisiete pacientes se sometieron a resección anterior baja o abdominoperineal. Nueve pacientes con una respuesta clínica completa se sometieron a un tratamiento de preservación de órganos (8 escisión local y 1 un enfoque de observar y esperar) con un seguimiento de> 1 año.Un radiólogo evaluó la RM pélvica y la TC. Un segundo radiólogo y un médico de medicina nuclear evaluaron conjuntamente TEP / RM. La imagen se comparó con la histología o el seguimiento (ypT0 vs T ≥1 y ypN0 vs ypN + categorías). Las metástasis se confirmaron con biopsia o una TC de seguimiento al menos 1 año después de la quimiorradioterapia preoperatoria. Los valores de sensibilidad, especificidad y precisión de las técnicas de imagen se calcularon utilizando fórmulas estándar.La precisión para la estadificación ypT fue del 89% y 92%, y la precisión para ypN fue del 86% y 92% para RM y TEP/RM respectivamente. En comparación con la TC, la TEP / RM diagnosticó correctamente 4 de 5 metástasis, pero no detectó un nódulo metastásico pulmonar. En el 11% de los pacientes, la TEP / RM cambió la estrategia de tratamiento.Este estudio está limitado por su pequeño tamaño de muestra.Si bien la TEP / RM de todo el cuerpo fue más precisa que la RM pélvica sola para la predicción de la respuesta tumoral y ganglionar a la quimiorradioterapia preoperatoria, la técnica funcionó peor que la TC para detectar metástasis pulmonares pequeños. Consulte Video Resumen en http://links.lww.com/DCR/B108.
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PET in Gastrointestinal, Pancreatic, and Liver Cancers. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Ferri V, Vicente Lopez E, Quijano Collazo Y, Caruso R, Duran Gimenez Rico H, Ielpo B, Diaz Reques E, Fabra Cabrera I, Malavè Cardozo L, Isernia R, Pinna E, Plaza Hernandezv C, Garcerant M, Garcia Cañamaques L, Perez Dueñas V. 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 Oncol 2019; 58:1246-1249. [PMID: 31144557 DOI: 10.1080/0284186x.2019.1622774] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Valentina Ferri
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Emilio Vicente Lopez
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | | | - Riccardo Caruso
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | | | - Benedetto Ielpo
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Eduardo Diaz Reques
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Isabel Fabra Cabrera
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Luis Malavè Cardozo
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Roberta Isernia
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Eva Pinna
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | | | - Marjorie Garcerant
- Division of Nuclear Medicin, Sanchinarro Hospital, San Pablo University, Madrid, Spain
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Rutegård MK, Båtsman M, Axelsson J, Brynolfsson P, Brännström F, Rutegård J, Ljuslinder I, Blomqvist L, Palmqvist R, Rutegård M, Riklund K. PET/MRI and PET/CT hybrid imaging of rectal cancer - description and initial observations from the RECTOPET (REctal Cancer trial on PET/MRI/CT) study. Cancer Imaging 2019; 19:52. [PMID: 31337428 PMCID: PMC6651930 DOI: 10.1186/s40644-019-0237-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/09/2019] [Indexed: 12/24/2022] Open
Abstract
Purpose The role of hybrid imaging using 18F-fluoro-2-deoxy-D-glucose positron-emission tomography (FDG-PET), computed tomography (CT) and magnetic resonance imaging (MRI) to improve preoperative evaluation of rectal cancer is largely unknown. To investigate this, the RECTOPET (REctal Cancer Trial on PET/MRI/CT) study has been launched with the aim to assess staging and restaging of primary rectal cancer. This report presents the study workflow and the initial experiences of the impact of PET/CT on staging and management of the first patients included in the RECTOPET study. Methods This prospective cohort study, initiated in September 2016, is actively recruiting patients from Region Västerbotten in Sweden. This pilot study includes patients recruited and followed up until December 2017. All patients had a biopsy-verified rectal adenocarcinoma and underwent a minimum of one preoperative FDG-PET/CT and FDG-PET/MRI examination. These patients were referred to the colorectal cancer multidisciplinary team meeting at Umeå University Hospital. All available data were evaluated when making management recommendations. The clinical course was noted and changes consequent to PET imaging were described; surgical specimens underwent dedicated MRI for anatomical matching between imaging and histopathology. Results Twenty-four patients have so far been included in the study. Four patients were deemed unresectable, while 19 patients underwent or were scheduled for surgery; one patient was enrolled in a watch-and-wait programme after restaging. Consequent to taking part in the study, two patients were upstaged to M1 disease: one patient was diagnosed with a solitary hepatic metastasis detected using PET/CT and underwent metastasectomy prior to rectal cancer surgery, while one patient with a small, but metabolically active, lung nodulus experienced no change of management. PET/MRI did not contribute to any recorded change in patient management. Conclusions The RECTOPET study investigating the role of PET/CT and PET/MRI for preoperative staging of primary rectal cancer patients will provide novel data that clarify the value of adding hybrid to conventional imaging, and the role of PET/CT versus PET/MRI. Trial registration NCT03846882.
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Affiliation(s)
- Miriam K Rutegård
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, SE-901 85, Umeå, Sweden.
| | - Malin Båtsman
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - Jan Axelsson
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, SE-901 85, Umeå, Sweden
| | - Patrik Brynolfsson
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, SE-901 85, Umeå, Sweden
| | - Fredrik Brännström
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Jörgen Rutegård
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Ingrid Ljuslinder
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Lennart Blomqvist
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, SE-901 85, Umeå, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Imaging and Physiology, Karolinska University Hospital, Solna, Sweden
| | - Richard Palmqvist
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - Martin Rutegård
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.,Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Katrine Riklund
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, SE-901 85, Umeå, Sweden
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Wasnik AP, Al-Hawary MM. Invited Commentary on “MRI Evaluation of the Response of Rectal Cancer to Neoadjuvant Chemoradiation Therapy”. Radiographics 2019; 39:556-568. [DOI: 10.1148/rg.2019190005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Mahmoud M. Al-Hawary
- Division of Abdominal Imaging, Department of Radiology, and
- Division of Gastroenterology, Department of Internal Medicine, Michigan Medicine, University of Michigan Ann Arbor, Michigan
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27
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Horvat N, Carlos Tavares Rocha C, Clemente Oliveira B, Petkovska I, Gollub MJ. MRI of Rectal Cancer: Tumor Staging, Imaging Techniques, and Management. Radiographics 2019; 39:367-387. [PMID: 30768361 DOI: 10.1148/rg.2019180114] [Citation(s) in RCA: 234] [Impact Index Per Article: 46.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Rectal cancer is prone to local recurrence and systemic metastasis. However, owing to improvements in TNM staging and treatment, including a more widespread use of rectal MRI and increased radiologist awareness of the key rectal cancer TNM staging features, the mortality rate of rectal cancer has been declining over the past few decades in adults over 50 years of age. Currently, rectal MRI plays a key role in the pre- and posttreatment evaluation of rectal cancer, assisting the multidisciplinary team in tailoring the most appropriate treatment option. The benefits achieved with rectal MRI are strictly dependent on obtaining good-quality images, which is important for the characterization of the main anatomic structures and their relationship with the tumor. In primary staging, rectal MRI helps the radiologist (a) describe the tumor location and morphology, (b) provide its T and N categories, (c) detect the presence of extramural vascular invasion, and (d) identify its relationship with surrounding structures, including the sphincter complex and involvement of the mesorectal fascia. These features help diagnose locally advanced rectal tumors (categories T3c-d, T4, N1, and N2), for which neoadjuvant chemoradiotherapy (CRT) is indicated. In restaging after neoadjuvant CRT, in addition to reassessing the features noted during primary staging, rectal MRI can help in the assessment of treatment response, especially with the emergence of nonsurgical approaches such as "watch and wait." ©RSNA, 2019.
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Affiliation(s)
- Natally Horvat
- From the Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H., I.P., M.J.G.); Department of Radiology, Hospital Sírio-Libanês, Adma Jafet 91, 01308-050 Bela Vista, São Paulo, Brazil (N.H., B.C.O.); and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., C.C.T.R., B.C.O.)
| | - Camila Carlos Tavares Rocha
- From the Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H., I.P., M.J.G.); Department of Radiology, Hospital Sírio-Libanês, Adma Jafet 91, 01308-050 Bela Vista, São Paulo, Brazil (N.H., B.C.O.); and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., C.C.T.R., B.C.O.)
| | - Brunna Clemente Oliveira
- From the Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H., I.P., M.J.G.); Department of Radiology, Hospital Sírio-Libanês, Adma Jafet 91, 01308-050 Bela Vista, São Paulo, Brazil (N.H., B.C.O.); and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., C.C.T.R., B.C.O.)
| | - Iva Petkovska
- From the Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H., I.P., M.J.G.); Department of Radiology, Hospital Sírio-Libanês, Adma Jafet 91, 01308-050 Bela Vista, São Paulo, Brazil (N.H., B.C.O.); and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., C.C.T.R., B.C.O.)
| | - Marc J Gollub
- From the Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H., I.P., M.J.G.); Department of Radiology, Hospital Sírio-Libanês, Adma Jafet 91, 01308-050 Bela Vista, São Paulo, Brazil (N.H., B.C.O.); and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., C.C.T.R., B.C.O.)
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Fraum TJ, Fowler KJ, Crandall JP, Laforest RA, Salter A, An H, Jacobs MA, Grigsby PW, Dehdashti F, Wahl RL. Measurement Repeatability of 18F-FDG PET/CT Versus 18F-FDG PET/MRI in Solid Tumors of the Pelvis. J Nucl Med 2019; 60:1080-1086. [PMID: 30733325 PMCID: PMC6681694 DOI: 10.2967/jnumed.118.218735] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 01/09/2019] [Indexed: 12/20/2022] Open
Abstract
Knowledge of the within-subject variability of 18F-FDG PET/MRI measurements is necessary for proper interpretation of quantitative PET or MRI metrics in the context of therapeutic efficacy assessments with integrated PET/MRI scanners. The goal of this study was to determine the test–retest repeatability of these metrics on PET/MRI, with comparison to similar metrics acquired by PET/CT. Methods: This prospective study enrolled subjects with pathology-proven pelvic malignancies. Baseline imaging consisted of PET/CT immediately followed by PET/MRI, using a single 370-MBq 18F-FDG dose. Repeat imaging was performed within 7 d using an identical imaging protocol, with no oncologic therapy between sessions. PET imaging on both scanners consisted of a list-mode acquisition at a single pelvic station. The MRI consisted of 2-point Dixon imaging for attenuation correction, standard sequences for anatomic correlation, and diffusion-weighted imaging. PET data were statically reconstructed using various frame durations and minimizing uptake time differences between sessions. SUV metrics were extracted for both PET/CT and PET/MRI in each imaging session. Apparent diffusion coefficient (ADC) metrics were extracted for both PET/MRI sessions. Results: The study cohort consisted of 14 subjects (13 female, 1 male) with various pelvic cancers (11 cervical, 2 rectal, 1 endometrial). For SUVmax, the within-subject coefficient of variation (wCV) appeared higher for PET/CT (8.5%–12.8%) than PET/MRI (6.6%–8.7%) across all PET reconstructions, though with no significant repeatability differences (all P values ≥ 0.08) between modalities. For lean body mass-adjusted SUVpeak, the wCVs appeared similar for PET/CT (9.9%–11.5%) and PET/MRI (9.2%–11.3%) across all PET reconstructions, again with no significant repeatability differences (all P values ≥ 0.14) between modalities. For PET/MRI, the wCV for ADCmedian of 3.5% appeared lower than the wCVs for SUVmax (6.6%–8.7%) and SULpeak (9.2%–11.3%), though without significant repeatability differences (all P values ≥ 0.23). Conclusion: For solid tumors of the pelvis, the repeatability of the evaluated SUV and ADC metrics on 18F-FDG PET/MRI is both acceptably high and similar to previously published values for 18F-FDG PET/CT and MRI, supporting the use of 18F-FDG PET/MRI for quantitative oncologic treatment response assessments.
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Affiliation(s)
- Tyler J Fraum
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Kathryn J Fowler
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - John P Crandall
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Richard A Laforest
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Amber Salter
- Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri
| | - Hongyu An
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Michael A Jacobs
- Russell H. Morgan Department of Radiology and Radiological Science and Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Perry W Grigsby
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri; and.,Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Farrokh Dehdashti
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri.,Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Richard L Wahl
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri.,Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
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PET/MRI for Gastrointestinal Imaging: Current Clinical Status and Future Prospects. Gastroenterol Clin North Am 2018; 47:691-714. [PMID: 30115444 DOI: 10.1016/j.gtc.2018.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Positron emission tomography (PET)/computed tomography (CT) with 2-deoxy-2-[18F]fluoro-d-glucose (FDG) has become the standard of care for the initial staging and subsequent treatment response assessment for numerous gastrointestinal malignancies. However, it is often supplemented by magnetic resonance imaging (MRI) for local tumor staging. Hybrid PET/MRI scanners, which acquire PET data and MRI data simultaneously, have the potential to provide accurate whole-body staging in a single examination. Furthermore, to address certain limitations of FDG, many new PET tracers have been developed to probe distinctive aspects of tumor biology.
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31
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Catalano O, Kilcoyne A, Signore A, Mahmood U, Rosen B. Lower Gastrointestinal Tract Applications of PET/Computed Tomography and PET/MR Imaging. Radiol Clin North Am 2018; 56:821-834. [PMID: 30119776 DOI: 10.1016/j.rcl.2018.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This article discusses the role of PET/CT and PET/MR imaging in the evaluation of inflammatory and malignant disorders of the lower gastrointestinal tract. This includes a review of the current literature and a discussion of new and emerging research.
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32
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Huo E, Eisenmenger L, Weinstein S. Imaging of the Postoperative Colon. Radiol Clin North Am 2018; 56:835-845. [PMID: 30119777 DOI: 10.1016/j.rcl.2018.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Recognition of postoperative complications is important for the immediate diagnosis and treatment needed for appropriate patient care. Identification of postoperative complications from colon surgery requires not only knowledge of the type of procedure, but also the expected normal postoperative appearance. The purpose of this article is to discuss and review the expected anatomic changes after colorectal surgery, and the appearance of the most common postoperative complications.
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Affiliation(s)
- Eugene Huo
- Department of Radiology, San Francisco VA Medical Center, 4150 Clement Street (114), San Francisco, CA 94121, USA.
| | - Laura Eisenmenger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 513 Parnassus Avenue, Room S-261, Box 0628, San Francisco, CA 94143, USA
| | - Stefanie Weinstein
- Department of Radiology, San Francisco VA Medical Center, 4150 Clement Street (114), San Francisco, CA 94121, USA
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Crimì F, Lacognata C, Cecchin D, Zucchetta P, Pomerri F. Rectal cancer staging: An up-to-date pictorial review. J Med Imaging Radiat Oncol 2018; 62:512-519. [PMID: 29974675 DOI: 10.1111/1754-9485.12759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 05/29/2018] [Indexed: 11/29/2022]
Abstract
Colorectal cancer is the third most common malignancy worldwide, and rectal cancer (RC) accounts for 29% of all cases. Local staging of RC is crucial for the purposes of addressing patients appropriately to surgery alone or to preoperative chemoradiotherapy (pCRT) followed by total mesorectal excision (TME). Combined pCRT and TME may negatively affect rectal function, so rectum-sparing approaches such as transanal local excision have been proposed as an alternative to TME for patients showing a major or complete clinical response on restaging after pCRT. Magnetic resonance imaging (MRI) has a fundamental role in the local staging and restaging of RC, with or without positron emission tomography (PET). PET/MRI enables a multiplanar high-resolution morphological study of the pelvis, providing important information on cell density and metabolic activity with diffusion-weighted imaging (DWI) and 18 F fluorodeoxyglucose uptake respectively. This article offers a pictorial review of the MRI anatomy of the ano-rectal region and an update on local RC staging with a hybrid 18 F-FDG PET/MRI scan.
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Affiliation(s)
- Filippo Crimì
- Radiology Unit, Department of Medicine-DIMED, University Hospital of Padova, Padova, Italy
| | | | - Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine-DIMED, University Hospital of Padova, Padova, Italy
| | - Pietro Zucchetta
- Nuclear Medicine Unit, Department of Medicine-DIMED, University Hospital of Padova, Padova, Italy
| | - Fabio Pomerri
- Radiology Unit, Department of Medicine-DIMED, University Hospital of Padova, Padova, Italy
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Musafargani S, Ghosh KK, Mishra S, Mahalakshmi P, Padmanabhan P, Gulyás B. PET/MRI: a frontier in era of complementary hybrid imaging. Eur J Hybrid Imaging 2018; 2:12. [PMID: 29998214 PMCID: PMC6015803 DOI: 10.1186/s41824-018-0030-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 03/14/2018] [Indexed: 12/19/2022] Open
Abstract
With primitive approaches, the diagnosis and therapy were operated at the cellular, molecular, or even at the genetic level. As the diagnostic techniques are more concentrated towards molecular level, multi modal imaging becomes specifically essential. Multi-modal imaging has extensive applications in clinical as well as in pre-clinical studies. Positron Emission Tomography (PET) has flourished in the field of nuclear medicine, which has motivated it to fuse with Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) for PET/CT and PET/MRI respectively. However, the challenges in PET/CT are due to the inability of simultaneous acquisition and reduced soft tissue contrast, which has led to the development of PET/MRI. Also, MRI offers the better soft tissue contrast over CT. Hence, fusion of PET and MRI results in combining structural information with functional image from PET. Yet, it has many technical challenges due to the interference between the modalities. Also, it must be resolved with various approaches for addressing the shortcomings of each system and improvise on the image quantification system. This review elaborates on the various challenges in the present PET/MRI system and the future directions of the hybrid modality. Also, the different data acquisition and analysis techniques of PET/MRI system are discussed with enhanced details on the software tools.
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Affiliation(s)
- Sikkandhar Musafargani
- Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, Singapore, 636921 Singapore
| | - Krishna Kanta Ghosh
- Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, Singapore, 636921 Singapore
| | - Sachin Mishra
- Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, Singapore, 636921 Singapore
| | | | - Parasuraman Padmanabhan
- Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, Singapore, 636921 Singapore
| | - Balázs Gulyás
- Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, Singapore, 636921 Singapore
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Song Y. Value of high resolution magnetic resonance imaging in preoperative staging of rectal cancer. Shijie Huaren Xiaohua Zazhi 2018; 26:530-536. [DOI: 10.11569/wcjd.v26.i8.530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the value of conventional magnetic resonance imaging (MRI) combined with high resolution MRI (HR-MRI) in preoperative T and N staging of rectal cancer by comparing with pathological staging.
METHODS The clinical data of 84 patients with primary rectal cancer who were admitted to Tianjin Haibin People's Hospital from January 2017 to October 2017 and underwent conventional MRI and HR-MRI preoperatively and pathological examination postoperatively were collected. The consistency and correlation were analyzed between preoperative T and N staging by conventional MRI and HR-MRI and pathological T and N staging. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of conventional MRI combined with HR-MRI in diagnosing T and N stages were calculated.
RESULTS There was a strong consistency between preoperative T and N staging by conventional MRI and HR-MRI and pathological T and N staging (κ = 0.691, P = 0.000), and the correlation rate was 84.52% (71/84). The accuracy, sensitivity, and specificity of conventional MRI and HR-MRI were 93.15%, 87.44%, and 92.36% for preoperative T1 staging, 91.23%, 86.19%, and 95.42% for preoperative T2 staging, 93.15%, 87.44%, and 92.36% for preoperative T3 staging, and 95.24%, 100.00%, and 77.78% for preoperative T4 staging. The accuracy, sensitivity, and specificity of conventional MRI combined with HR-MRI for preoperative N staging were 93.15%, 87.44%, and 92.36%, respectively. Using postoperative pathological results as the "gold standard", the accuracy, specificity, and sensitivity of conventional MRI combined with HR-MRI in predicting mesorectal invasion before surgery were 93.15%, 87.44%, and 92.36%, respectively.
CONCLUSION Conventional MRI combined with HR-MRI has high diagnostic value in preoperative evaluation of T and N stages and mesangial invasion in patients with rectal cancer, which can provide a reliable reference for the clinical planning of surgical procedures.
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Evertsson M, Kjellman P, Cinthio M, Andersson R, Tran TA, In't Zandt R, Grafström G, Toftevall H, Fredriksson S, Ingvar C, Strand SE, Jansson T. Combined Magnetomotive ultrasound, PET/CT, and MR imaging of 68Ga-labelled superparamagnetic iron oxide nanoparticles in rat sentinel lymph nodes in vivo. Sci Rep 2017; 7:4824. [PMID: 28684867 PMCID: PMC5500498 DOI: 10.1038/s41598-017-04396-z] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 05/12/2017] [Indexed: 12/31/2022] Open
Abstract
Current methods for intra-surgical guidance to localize metastases at cancer surgery are based on radioactive tracers that cause logistical challenges. We propose the use of a novel ultrasound-based method, magnetomotive ultrasound (MMUS) imaging that employ a nanoparticle-based contrast agent that also may be used for pre-operative PET/MRI imaging. Since MMUS is radiation free, this eliminates the dependence between pre- and intra-operative imaging and the radiation exposure for the surgical staff. This study investigates a hypothetical clinical scenario of pre-operative PET imaging, combined with intra-operative MMUS imaging, implemented in a sentinel lymph node (SLN) rat model. At one-hour post injection of 68Ga-labelled magnetic nanoparticles, six animals were imaged with combined PET/CT. After two or four days, the same animals were imaged with MMUS. In addition, ex-vivo MRI was used to evaluate the amount of nanoparticles in each single SLN. All SLNs were detectable by PET. Four out of six SLNs could be detected with MMUS, and for these MMUS and MRI measurements were in close agreement. The MRI measurements revealed that the two SLNs undetectable with MMUS contained the lowest nanoparticle concentrations. This study shows that MMUS can complement standard pre-operative imaging by providing bedside real-time images with high spatial resolution.
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Affiliation(s)
- Maria Evertsson
- Department of Biomedical Engineering, Faculty of Engineering LTH at Lund University, Lund, Sweden.
| | - Pontus Kjellman
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Medical Radiation Physics, Lund, Sweden
| | - Magnus Cinthio
- Department of Biomedical Engineering, Faculty of Engineering LTH at Lund University, Lund, Sweden
| | | | - Thuy A Tran
- Lund University Bioimaging Center, Lund University, Lund, Sweden.,Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Division of Oncology-Pathology, Lund, Sweden
| | - Rene In't Zandt
- Lund University Bioimaging Center, Lund University, Lund, Sweden
| | - Gustav Grafström
- Lund University Bioimaging Center, Lund University, Lund, Sweden
| | | | | | | | - Sven-Erik Strand
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Medical Radiation Physics, Lund, Sweden
| | - Tomas Jansson
- Medical Services, Skåne University Hospital, Lund, Sweden.,Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Biomedical Engineering, Lund, Sweden
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Chew MH, Yeh YT, Toh EL, Sumarli SA, Chew GK, Lee LS, Tan MH, Hennedige TP, Ng SY, Lee SK, Chong TT, Abdullah HR, Goh TLH, Rasheed MZ, Tan KC, Tang CL. Critical evaluation of contemporary management in a new Pelvic Exenteration Unit: The first 25 consecutive cases. World J Gastrointest Oncol 2017; 9:218-227. [PMID: 28567186 PMCID: PMC5434389 DOI: 10.4251/wjgo.v9.i5.218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 02/02/2017] [Accepted: 03/13/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To critically appraise short-term outcomes in patients treated in a new Pelvic Exenteration (PE) Unit.
METHODS This retrospective observational study was conducted by analysing prospectively collected data for the first 25 patients (16 males, 9 females) who underwent PE for advanced pelvic tumours in our PE Unit between January 2012 and October 2016. Data evaluated included age, co-morbidities, American Society of Anesthesiologists (ASA) score, Eastern Cooperative Oncology Group (ECOG) status, preoperative adjuvant treatment, intra-operative blood loss, procedural duration, perioperative adverse event, lengths of intensive care unit (ICU) stay and hospital stay, and oncological outcome. Quantitative data were summarized as percentage or median and range, and statistically assessed by the χ2 test or Fisher’s exact test, as applicable.
RESULTS All 25 patients received comprehensive preoperative assessment via our dedicated multidisciplinary team approach. Long-course neoadjuvant chemoradiotherapy was provided, if indicated. The median age of the patients was 61.9-year-old. The median ASA and ECOG scores were 2 and 0, respectively. The indications for PE were locally invasive rectal adenocarcinoma (n = 13), advanced colonic adenocarcinoma (n = 5), recurrent cervical carcinoma (n = 3) and malignant sacral chordoma (n = 3). The procedures comprised 10 total PEs, 4 anterior PEs, 7 posterior PEs and 4 isolated lateral PEs. The median follow-up period was 17.6 mo. The median operative time was 11.5 h. The median volume of blood loss was 3306 mL, and the median volume of red cell transfusion was 1475 mL. The median lengths of ICU stay and of hospital stay were 1 d and 21 d, respectively. There was no case of mortality related to surgery. There were a total of 20 surgical morbidities, which occurred in 12 patients. The majority of the complications were grade 2 Clavien-Dindo. Only 2 patients experienced grade 3 Clavien-Dindo complications, and both required procedural interventions. One patient experienced grade 4a Clavien-Dindo complication, requiring temporary renal dialysis without long-term disability. The R0 resection rate was 64%. There were 7 post-exenteration recurrences during the follow-up period. No statistically significant relationship was found among histological origin of tumour, microscopic resection margin status and postoperative recurrence (P = 0.67). Four patients died from sequelae of recurrent disease during follow-up.
CONCLUSION By utilizing modern assessment and surgical techniques, our PE Unit can manage complex pelvic cancers with acceptable morbidities, zero-rate mortality and equivalent oncologic outcomes.
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Catalano OA, Coutinho AM, Sahani DV, Vangel MG, Gee MS, Hahn PF, Witzel T, Soricelli A, Salvatore M, Catana C, Mahmood U, Rosen BR, Gervais D. Colorectal cancer staging: comparison of whole-body PET/CT and PET/MR. Abdom Radiol (NY) 2017; 42:1141-1151. [PMID: 27891551 DOI: 10.1007/s00261-016-0985-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE Correct staging is imperative for colorectal cancer (CRC) since it influences both prognosis and management. Several imaging methods are used for this purpose, with variable performance. Positron emission tomography-magnetic resonance (PET/MR) is an innovative imaging technique recently employed for clinical application. The present study was undertaken to compare the staging accuracy of whole-body positron emission tomography-computed tomography (PET/CT) with whole-body PET/MR in patients with both newly diagnosed and treated colorectal cancer. METHODS Twenty-six patients, who underwent same day whole-body (WB) PET/CT and WB-PET/MR, were evaluated. PET/CT and PET/MR studies were interpreted by consensus by a radiologist and a nuclear medicine physician. Correlations with prior imaging and follow-up studies were used as the reference standard. Correct staging was compared between methods using McNemar's Chi square test. RESULTS The two methods were in agreement and correct for 18/26 (69%) patients, and in agreement and incorrect for one patient (3.8%). PET/MR and PET/CT stages for the remaining 7/26 patients (27%) were discordant, with PET/MR staging being correct in all seven cases. PET/MR significantly outperformed PET/CT overall for accurate staging (P = 0.02). CONCLUSION PET/MR outperformed PET/CT in CRC staging. PET/MR might allow accurate local and distant staging of CRC patients during both at the time of diagnosis and during follow-up.
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Affiliation(s)
- Onofrio A Catalano
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard University Medical School, 149 Thirteenth Street, Charlestown, MA, 02129, USA.
- Department of Radiology, Abdominal Imaging, Massachusetts General Hospital, Harvard Medical School, WHT 270, 55 Fruit St, Boston, MA, 02114, USA.
| | - Artur M Coutinho
- Department of Nuclear Medicine, University of São Paulo Medical School (FMUSP) and Hospital Sirio-Libanes, Sao Paulo, 01308-050, Brazil
| | - Dushyant V Sahani
- Department of Radiology, Abdominal Imaging, Massachusetts General Hospital, Harvard Medical School, WHT 270, 55 Fruit St, Boston, MA, 02114, USA
| | - Mark G Vangel
- Department of Radiology, MGH Biostatistics Center and MGH Martinos Center, Harvard University Medical School, 149 Thirteenth Street, Charlestown, MA, 02129, USA
| | - Michael S Gee
- Department of Radiology, Abdominal Imaging, Massachusetts General Hospital, Harvard Medical School, WHT 270, 55 Fruit St, Boston, MA, 02114, USA
- Department of Radiology, Pediatric Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Peter F Hahn
- Department of Radiology, Abdominal Imaging, Massachusetts General Hospital, Harvard Medical School, WHT 270, 55 Fruit St, Boston, MA, 02114, USA
| | - Thomas Witzel
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard University Medical School, 149 Thirteenth Street, Charlestown, MA, 02129, USA
| | - Andrea Soricelli
- Department of Radiology, University of Naples Parthenope, Via F. Acton 38, 80143, Naples, Italy
| | - Marco Salvatore
- Department of Nuclear Medicine, SDN IRCCS, Via Gianturco 113, 80143, Naples, Italy
| | - Ciprian Catana
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard University Medical School, 149 Thirteenth Street, Charlestown, MA, 02129, USA
| | - Umar Mahmood
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard University Medical School, 149 Thirteenth Street, Charlestown, MA, 02129, USA
- Department of Radiology, Nuclear Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Bruce R Rosen
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard University Medical School, 149 Thirteenth Street, Charlestown, MA, 02129, USA
| | - Debra Gervais
- Department of Radiology, Abdominal Imaging, Massachusetts General Hospital, Harvard Medical School, WHT 270, 55 Fruit St, Boston, MA, 02114, USA
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Singnurkar A, Poon R, Metser U. Comparison of 18F-FDG-PET/CT and 18F-FDG-PET/MR imaging in oncology: a systematic review. Ann Nucl Med 2017; 31:366-378. [PMID: 28353197 DOI: 10.1007/s12149-017-1164-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 03/06/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The aim of this study was to systematically review the literature to evaluate the clinical performance of integrated 18F-FDG PET/MR as compared with 18F-FDG PET/CT in oncologic imaging. METHODS The literature was searched using MEDLINE and EMBASE via OVID. Studies comparing the diagnostic accuracy of integrated 18F-FDG PET/MR and 18F-FDG PET/CT in the diagnosis, staging/restaging, assessment of treatment response, or evaluation of metastasis in patients with suspected or diagnosed cancers were deemed eligible for inclusion. Risk of bias and applicability concerns were assessed using the QUADAS-2 tool. RESULTS Twenty studies met the inclusion criteria. The overall quality of the studies was rated favorably with bias or applicability concerns in a few studies. Our review suggests that 18F-FDG PET/MR performs comparably to 18F-FDG PET/CT in the detection of local lymph node and distant metastases and superiorly in determining the local extent of tumor. SUV obtained from 18F-FDG PET/MR correlated highly with those obtained from 18F-FDG PET/CT. CONCLUSIONS Based on early evidence, 18F-FDG PET/MR is comparable to 18F-FDG PET/CT in the clinical scenarios examined in this review. The potential for interchangeability of 18F-FDG PET/MR with 18F-FDG PET/CT will vary by indication and the body site that is being imaged, with PET scanners integrated with MRI predicted to provide greater detail in the evaluation of local tumor extent, where 18F-FDG PET/CT can be limited.
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Affiliation(s)
- Amit Singnurkar
- Department of Nuclear Medicine and Molecular Imaging, Hamilton Health Sciences and St. Joseph's Healthcare Hamilton, 711 Concession Street, Hamilton, ON, L8V 1C3, Canada
| | - Raymond Poon
- Program in Evidence-Based Care, Cancer Care Ontario, Juravinski Hospital and Cancer Centre, G Wing, 2nd Floor, 711 Concession Street, Hamilton, ON, L8V 1C3, Canada.
| | - Ur Metser
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, 610 University Ave., Suite 3-960, Toronto, ON, M5G 2M9, Canada
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Initial Staging of Locally Advanced Rectal Cancer and Regional Lymph Nodes: Comparison of Diffusion-Weighted MRI With 18F-FDG-PET/CT. Clin Nucl Med 2016; 41:289-95. [PMID: 26828149 PMCID: PMC4851242 DOI: 10.1097/rlu.0000000000001172] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Purpose The aim of the study was to compare diffusion-weighted MRI (DW-MRI) parameters with 18F-FDG PET/CT in primary locally advanced rectal cancer (LARC). Methods From October 2012 to September 2014, 24 patients with histologically confirmed and untreated LARC (T3–T4) prospectively underwent a pelvic 1.5-T DW-MRI (b = 0 s/mm2, b = 600 s/mm2) and a whole-body 18F-FDG PET/CT, before neoadjuvant therapy. The 2 examinations were performed on the same day. Two readers measured 18F-FDG SUVmax and SUVmean of the rectal tumor and of the pathological regional lymph nodes on PET/CT and compared these with minimum and mean values of the ADC (ADCmin and ADCmean) on maps generated from DW-MRI. The diagnostic performance of ADC values in identifying pathological lymph nodes was also assessed. Results Regarding tumors (n = 24), we found a significant negative correlation between SUVmean and corresponding ADCmean values (ρ = −0.61, P = 0.0017) and between ADCmin and SUVmax (ρ = −0.66, P = 0.0005). Regarding the lymph nodes (n = 63), there was a significant negative correlation between ADCmean and SUVmean values (ρ = −0.38, P = 0.0021), but not between ADCmin and SUVmax values (ρ = −0.11, P = 0.41). Neither ADCmean nor ADCmin values helped distinguish pathological from benign lymph nodes (AUC of 0.24 [confidence interval, 0.10–0.38] and 0.41 [confidence interval, 0.22–0.60], respectively). Conclusions The correlations between ADCmean and SUVmean suggest an association between tumor cellularity and metabolic activity in untreated LARC and in regional lymph nodes. However, compared with 18F-FDG PET/CT, ADC values are not reliable for identifying pathological lymph nodes.
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Matthews R, Choi M. Clinical Utility of Positron Emission Tomography Magnetic Resonance Imaging (PET-MRI) in Gastrointestinal Cancers. Diagnostics (Basel) 2016; 6:diagnostics6030035. [PMID: 27618106 PMCID: PMC5039569 DOI: 10.3390/diagnostics6030035] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 08/26/2016] [Accepted: 08/26/2016] [Indexed: 12/17/2022] Open
Abstract
Anatomic imaging utilizing both CT (computed tomography) and MRI (magnetic resonance imaging) limits the assessment of cancer metastases in lymph nodes and distant organs while functional imaging like PET (positron emission tomography) scan has its limitation in spatial resolution capacity. Hybrid imaging utilizing PET-CT and PET-MRI are novel imaging modalities that are changing the current landscape in cancer diagnosis, staging, and treatment response. MRI has shown to have higher sensitivity in soft tissue, head and neck pathology, and pelvic disease, as well as, detecting small metastases in the liver and bone compared to CT. Combining MRI with PET allows for detection of metastases that may have been missed with current imaging modalities. In this review, we will examine the clinical utility of FDG PET-MRI in the diagnosis and staging of gastrointestinal cancers with focus on esophageal, stomach, colorectal, and pancreatic cancers. We will also explore its role in treatment response and future directions associated with it.
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Affiliation(s)
- Robert Matthews
- Department of Radiology, Stony Brook University Medical Center, Stony Brook, NY 11794, USA.
| | - Minsig Choi
- Department of Medicine, Stony Brook University Medical Center, Stony Brook, NY 11794, USA.
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Fraum TJ, Owen JW, Fowler KJ. Beyond Histologic Staging: Emerging Imaging Strategies in Colorectal Cancer with Special Focus on Magnetic Resonance Imaging. Clin Colon Rectal Surg 2016; 29:205-15. [PMID: 27582645 DOI: 10.1055/s-0036-1584288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Imaging plays an increasingly important role in the staging and management of colorectal cancer. In recent years, magnetic resonance imaging (MRI) has supplanted transrectal ultrasound as the preferred modality for the locoregional staging of rectal cancer. Furthermore, the advent of both diffusion-weighted imaging and hepatobiliary contrast agents has significantly enhanced the ability of MRI to detect colorectal liver metastases. In clinical practice, MRI routinely provides prognostic information, helps to guide surgical strategy, and determines the need for neoadjuvant therapies related to both the primary tumor and metastatic disease. Expanding on these roles for MRI, positron emission tomography (PET)/MRI is the newest clinical hybrid imaging modality and combines the metabolic information of PET with the high soft tissue contrast of MRI. The addition of PET/MRI to the clinical staging armamentarium has the potential to provide comprehensive state-of-the-art colorectal cancer staging in a single examination.
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Affiliation(s)
- Tyler J Fraum
- Mallinckrodt Institute of Radiology, Washington University, Saint Louis, Missouri
| | - Joseph W Owen
- Mallinckrodt Institute of Radiology, Washington University, Saint Louis, Missouri
| | - Kathryn J Fowler
- Mallinckrodt Institute of Radiology, Washington University, Saint Louis, Missouri
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Goh V, Prezzi D, Mallia A, Bashir U, Stirling JJ, John J, Charles-Edwards G, MacKewn J, Cook G. Positron Emission Tomography/Magnetic Resonance Imaging of Gastrointestinal Cancers. Semin Ultrasound CT MR 2016; 37:352-7. [PMID: 27342899 DOI: 10.1053/j.sult.2016.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
As an integrated system, hybrid positron emission tomography/magnetic resonance imaging (PET/MRI) is able to provide simultaneously complementary high-resolution anatomic, molecular, and functional information, allowing comprehensive cancer phenotyping in a single imaging examination. In addition to an improved patient experience by combining 2 separate imaging examinations and streamlining the patient pathway, the superior soft tissue contrast resolution of MRI and the ability to acquire multiparametric MRI data is advantageous over computed tomography. For gastrointestinal cancers, this would improve tumor staging, assessment of neoadjuvant response, and of the likelihood of a complete (R0) resection in comparison with positron emission tomography or computed tomography.
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Affiliation(s)
- Vicky Goh
- Cancer Imaging Department, Division of Imaging Sciences & Biomedical Engineering, King׳s College London, London, UK; Department of Radiology, Guy׳s & St Thomas׳ Hospitals, London, UK.
| | - Davide Prezzi
- Cancer Imaging Department, Division of Imaging Sciences & Biomedical Engineering, King׳s College London, London, UK; Department of Radiology, Guy׳s & St Thomas׳ Hospitals, London, UK
| | - Andrew Mallia
- Cancer Imaging Department, Division of Imaging Sciences & Biomedical Engineering, King׳s College London, London, UK; Guys and St Thomas׳ PET Centre, St Thomas׳ Hospital, King׳s College London, London, UK
| | - Usman Bashir
- Cancer Imaging Department, Division of Imaging Sciences & Biomedical Engineering, King׳s College London, London, UK; Department of Radiology, Guy׳s & St Thomas׳ Hospitals, London, UK
| | - J James Stirling
- Guys and St Thomas׳ PET Centre, St Thomas׳ Hospital, King׳s College London, London, UK
| | - Joemon John
- Guys and St Thomas׳ PET Centre, St Thomas׳ Hospital, King׳s College London, London, UK
| | - Geoff Charles-Edwards
- Cancer Imaging Department, Division of Imaging Sciences & Biomedical Engineering, King׳s College London, London, UK; Medical Physics, Guy׳s and St Thomas׳ Hospitals, London, UK
| | - Jane MacKewn
- Guys and St Thomas׳ PET Centre, St Thomas׳ Hospital, King׳s College London, London, UK
| | - Gary Cook
- Cancer Imaging Department, Division of Imaging Sciences & Biomedical Engineering, King׳s College London, London, UK; Guys and St Thomas׳ PET Centre, St Thomas׳ Hospital, King׳s College London, London, UK
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Abstract
PET/computed tomography (PET/CT) is an established hybrid imaging technique for staging and follow-up of gastrointestinal (GI) tract malignancies, especially for colorectal carcinoma. Dedicated hybrid PET/MR imaging scanners are currently available for clinical use. Although they will not replace regular use of PET/CT, they may have utility in selected cases of GI tract malignancies. The superior soft tissue contrast resolution and depiction of anatomy and the functional information obtained from diffusion-weighted imaging (DWI) provided by MR imaging in PET/MR imaging are advantages over CT of PET/CT for T staging and follow-up of rectal carcinoma and for better characterization of liver lesions. Functional information from DWI and use of liver-specific MR imaging contrast agents are an added advantage in follow-up of liver metastases after systemic and locoregional treatment. New radiotracers will improve the utility of PET/MR imaging in staging and follow-up of tumors, which may not be [18F]-2-fluoro-2-deoxy-d-glucose avid, such as hepatocellular carcinoma and neuroendocrine tumors. PET/MR imaging also has application in selected cases of cholangiocarcinoma, gallbladder cancer, and pancreatic carcinoma for initial staging and follow-up assessment.
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Affiliation(s)
- Raj Mohan Paspulati
- Division of Abdominal Imaging, Department of Radiology, University Hospitals Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
| | - Amit Gupta
- Department of Radiology, University Hospitals Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA
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Lee DH, Lee JM. Whole-body PET/MRI for colorectal cancer staging: Is it the way forward? J Magn Reson Imaging 2016; 45:21-35. [DOI: 10.1002/jmri.25337] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 05/24/2016] [Indexed: 12/22/2022] Open
Affiliation(s)
- Dong Ho Lee
- Department of Radiology; Seoul National University Hospital; Seoul Korea
- Seoul National University College of Medicine; Seoul Korea
| | - Jeong Min Lee
- Department of Radiology; Seoul National University Hospital; Seoul Korea
- Seoul National University College of Medicine; Seoul Korea
- Institute of Radiation Medicine; Seoul National University Medical Research Center; Seoul Korea
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Shen G, Hu S, Liu B, Kuang A. Diagnostic Performance of Whole-Body PET/MRI for Detecting Malignancies in Cancer Patients: A Meta-Analysis. PLoS One 2016; 11:e0154497. [PMID: 27124545 PMCID: PMC4849712 DOI: 10.1371/journal.pone.0154497] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/14/2016] [Indexed: 02/05/2023] Open
Abstract
Background As an evolving imaging modality, PET/MRI is preliminarily applied in clinical practice. The aim of this study was to assess the diagnostic performance of PET/MRI for tumor staging in patients with various types of cancer. Methods Relevant articles about PET/MRI for cancer staging were systematically searched in PubMed, EMBASE, EBSCO and the Cochrane Library. Two researchers independently selected studies, extracted data and assessed the methodological quality using the QUADAS tool. The pooled sensitivity, specificity, diagnostic odds ratio (DOR), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) were calculated per patient and per lesion. The summary receiver-operating characteristic (SROC) curves were also constructed, and the area under the curve (AUC) and Q* estimates were obtained. Results A total of 38 studies that involved 753 patients and 4234 lesions met the inclusion criteria. On a per-patient level, the pooled sensitivity and specificity with 95% confidence intervals (CIs) were 0.93 (0.90–0.95) and 0.92 (0.89–0.95), respectively. On a per-lesion level, the corresponding estimates were 0.90 (0.88–0.92) and 0.95 (0.94–0.96), respectively. The pooled PLR, NLR and DOR estimates were 6.67 (4.83–9.19), 0.12 (0.07–0.21) and 75.08 (42.10–133.91) per patient and 10.91 (6.79–17.54), 0.13 (0.08–0.19) and 102.53 (59.74–175.97) per lesion, respectively. Conclusion According to our results, PET/MRI has excellent diagnostic potential for the overall detection of malignancies in cancer patients. Large, multicenter and prospective studies with standard scanning protocols are required to evaluate the diagnostic value of PET/MRI for individual cancer types.
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Affiliation(s)
- Guohua Shen
- Department of Nuclear Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Shuang Hu
- Department of Nuclear Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Bin Liu
- Department of Nuclear Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Anren Kuang
- Department of Nuclear Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan, 610041, People’s Republic of China
- * E-mail:
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Kwon HW, Becker AK, Goo JM, Cheon GJ. FDG Whole-Body PET/MRI in Oncology: a Systematic Review. Nucl Med Mol Imaging 2016; 51:22-31. [PMID: 28250855 DOI: 10.1007/s13139-016-0411-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 03/01/2016] [Accepted: 03/16/2016] [Indexed: 01/14/2023] Open
Abstract
The recent advance in hybrid imaging techniques enables offering simultaneous positron emission tomography (PET)/magnetic resonance imaging (MRI) in various clinical fields. 18F-fluorodeoxyglucose (FDG) PET has been widely used for diagnosis and evaluation of oncologic patients. The growing evidence from research and clinical experiences demonstrated that PET/MRI with FDG can provide comparable or superior diagnostic performance more than conventional radiological imaging such as computed tomography (CT), MRI or PET/CT in various cancers. Combined analysis using structural information and functional/molecular information of tumors can draw additional diagnostic information based on PET/MRI. Further studies including determination of the diagnostic efficacy, optimizing the examination protocol, and analysis of the hybrid imaging results is necessary for extending the FDG PET/MRI application in clinical oncology.
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Affiliation(s)
- Hyun Woo Kwon
- Department of Nuclear Medicine, Soonchunhyang University Hospital, Cheonan, South Korea
| | | | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehang-ro, Jongno-gu, Seoul, 03080 Republic of Korea
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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; 57:420-30. [PMID: 26742709 PMCID: PMC5003572 DOI: 10.2967/jnumed.115.158808] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 01/05/2016] [Indexed: 12/31/2022] Open
Abstract
(18)F-FDG PET/CT has become the reference standard in oncologic imaging against which the performance of other imaging modalities is measured. The promise of PET/MRI includes multiparametric imaging to further improve diagnosis and phenotyping of cancer. Rather than focusing on these capabilities, many investigators have examined whether (18)F-FDG PET combined with mostly anatomic MRI improves cancer staging and restaging. After a description of PET/MRI scanner designs and a discussion of technical and operational issues, we review the available literature to determine whether cancer assessments are improved with PET/MRI. The available data show that PET/MRI is feasible and performs as well as PET/CT in most types of cancer. Diagnostic advantages may be achievable in prostate cancer and in bone metastases, whereas disadvantages exist in lung nodule assessments. We conclude that (18)F-FDG PET/MRI and PET/CT provide comparable diagnostic information when MRI is used simply to provide the anatomic framework. Thus, PET/MRI could be used in lieu of PET/CT if this approach becomes economically viable and if reasonable workflows can be established. Future studies should explore the multiparametric potential of MRI.
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Affiliation(s)
- Claudio Spick
- Ahmanson Translational Imaging Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, California; and
| | - Ken Herrmann
- Ahmanson Translational Imaging Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, California; and Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Johannes Czernin
- Ahmanson Translational Imaging Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, California; and
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Sawicki LM, Grueneisen J, Schaarschmidt BM, Buchbender C, Nagarajah J, Umutlu L, Antoch G, Kinner S. Evaluation of 18 F-FDG PET/MRI, 18 F-FDG PET/CT, MRI, and CT in whole-body staging of recurrent breast cancer. Eur J Radiol 2016; 85:459-65. [DOI: 10.1016/j.ejrad.2015.12.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 12/09/2015] [Accepted: 12/14/2015] [Indexed: 10/22/2022]
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Fraum TJ, Fowler KJ, McConathy J. PET/MRI: Emerging Clinical Applications in Oncology. Acad Radiol 2016; 23:220-36. [PMID: 26521689 DOI: 10.1016/j.acra.2015.09.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 08/08/2015] [Accepted: 09/27/2015] [Indexed: 01/09/2023]
Abstract
Positron emission tomography (PET), commonly performed in conjunction with computed tomography (CT), has revolutionized oncologic imaging. PET/CT has become the standard of care for the initial staging and assessment of treatment response for many different malignancies. Despite this success, PET/CT is often supplemented by magnetic resonance imaging (MRI), which offers superior soft-tissue contrast and a means of assessing cellular density with diffusion-weighted imaging. Consequently, PET/MRI, the newest clinical hybrid imaging modality, has the potential to provide added value over PET/CT or MRI alone. The purpose of this article is to provide a comprehensive review of the current body of literature pertaining to the clinical performance of PET/MRI, with the aim of summarizing current evidence and identifying gaps in knowledge to direct clinical expansion and future research. Multiple example cases are also provided to illustrate the central findings of these publications.
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