Diagnostic value of PET/CT versus PET/MRI in gynecological malignancies of the pelvis: A meta-analysis

18F-FDG PET/MRI and 18F-FDG PET/CT for the Management of Gynecological Malignancies: A Comprehensive Review of the Literature

OBJECTIVE

Positron emission tomography with 2-deoxy-2-[fluorine-18] fluoro- D-glucose integrated with computed tomography (18F-FDG PET/CT) or magnetic resonance imaging (18F-FDG PET/MRI) has emerged as a promising tool for managing various types of cancer. This review study was conducted to investigate the role of 18F- FDG PET/CT and FDG PET/MRI in the management of gynecological malignancies.

SEARCH STRATEGY

We searched for relevant articles in the three databases PubMed/MEDLINE, Scopus, and Web of Science.

SELECTION CRITERIA

All studies reporting data on the FDG PET/CT and FDG PET MRI in the management of gynecological cancer, performed anywhere in the world and published exclusively in the English language, were included in the present study.

DATA COLLECTION AND ANALYSIS

We used the EndNote software (EndNote X8.1, Thomson Reuters) to list the studies and screen them on the basis of the inclusion criteria. Data, including first author, publication year, sample size, clinical application, imaging type, and main result, were extracted and tabulated in Excel. The sensitivity, specificity, and diagnostic accuracy of the modalities were extracted and summarized.

MAIN RESULTS

After screening 988 records, 166 studies published between 2004 and 2022 were included, covering various methodologies. Studies were divided into the following five categories: the role of FDG PET/CT and FDG-PET/MRI in the management of: (a) endometrial cancer (n = 30); (b) ovarian cancer (n = 60); (c) cervical cancer (n = 50); (d) vulvar and vagina cancers (n = 12); and (e) gynecological cancers (n = 14).

CONCLUSIONS

FDG PET/CT and FDG PET/MRI have demonstrated potential as non-invasive imaging tools for enhancing the management of gynecological malignancies. Nevertheless, certain associated challenges warrant attention.

Current Update on PET/MRI in Gynecological Malignancies-A Review of the Literature

Early detection of gynecological malignancies is vital for patient management and prolonging the patient's survival. Molecular imaging, such as positron emission tomography (PET)/computed tomography, has been increasingly utilized in gynecological malignancies. PET/magnetic resonance imaging (MRI) enables the assessment of gynecological malignancies by combining the metabolic information of PET with the anatomical and functional information from MRI. This article will review the updated applications of PET/MRI in gynecological malignancies.

Psychological Nursing Effect of Patients with Gynecological Malignant Tumor

Objective

To analyze the psychological nursing effect of patients with gynecological malignant tumor.

Method

A total of 104 patients with gynecological malignant tumor receiving chemotherapy in our hospital from December 2019 to November 2020 were selected and randomly divided into observation group and control group with 52 cases each. Patients in the control group were treated with routine nursing of gynecological malignant tumor chemotherapy. The observation group applied psychological nursing methods on the basis of the control group, and psychological status, quality of sleep, quality of life, treatment coordination, and adverse reactions were compared between the two groups.

Results

There was no difference in anxiety and depression scores (P > 0.05), the postintervention score was lower than the preintervention score, and the reduction was more significant in the observation group (P < 0.05). After intervention, PSQI scores of the two groups of subjects were significantly lower than before intervention (P < 0.05), subjects in the observation group were significantly lower than those in the control group, and the difference was statistically significant (P < 0.05). After intervention, the total score of FACT-B scale was significantly higher in the observation group than in the control group, and the difference was statistically significant (P < 0.05). After the implementation of psychological nursing, the degree of tumor treatment cooperation of observation group was higher than the control group (P < 0.05). After intervention, there was no statistically significant difference in hematology, allergic reaction, or hair loss between the two groups (P > 0.05). The incidence of gastrointestinal and neurological adverse events in the observation group was significantly lower than that in the control group, and the difference was statistically significant (P < 0.05).

Conclusion

The psychological state of patients with gynecological malignant tumor mainly included anxiety and terror and so on. Through psychological counseling, it could effectively alleviate the abovementioned bad psychology, improve the cooperation of patients with tumor treatment, and reduce the occurrence of patients' adverse reactions.

Neuroendocrine Neoplasms of the Gynecologic Tract

Simple Summary

Neuroendocrine refers to the cells that synthesize and secrete messenger chemicals such as neuropeptides and amines. Neuroendocrine neoplasms (NENs) are aggressive tumors arising from neuroendocrine cells, with an annual incidence of 6.98/100,000 and a prevalence of 170,000 in the United States. Primary gynecologic NENs constitute ≤2% of female reproductive tumors. NENs of the gynecologic tract are associated with high recurrence rates and dismal prognosis, making their treatment challenging. This article focuses on the updated staging classifications, clinicopathological characteristics, imaging, and management of NENs of the gynecological tract.

Abstract

Gynecological tract neuroendocrine neoplasms (NEN) are rare, aggressive tumors from endocrine cells derived from the neuroectoderm, neural crest, and endoderm. The primary gynecologic NENs constitute 2% of gynecologic malignancies, and the cervix is the most common site of NEN in the gynecologic tract. The updated WHO classification of gynecologic NEN is based on the Ki-67 index, mitotic index, and tumor characteristics such as necrosis, and brings more uniformity in the terminology of NENs like other disease sites. Imaging plays a crucial role in the staging, triaging, restaging, and surveillance of NENs. The expression of the somatostatin receptors on the surface of neuroendocrine cells forms the basis of increasing evaluation with functional imaging modalities using traditional and new tracers, including ⁶⁸Ga-DOTA-Somatostatin Analog-PET/CT. Management of NENs involves a multidisciplinary approach. New targeted therapies could improve the paradigm of care for these rare malignancies. This article focuses on the updated staging classifications, clinicopathological characteristics, imaging, and management of gynecologic NENs of the cervix, ovary, endometrium, vagina, and vulva, emphasizing the relatively common cervical neuroendocrine carcinomas among these entities.

Diagnosis and staging of cardiac masses: additional value of CMR with 18F-FDG-PET compared to CMR with CECT

PURPOSE

Characterization of malignant cardiac masses is usually performed with cardiac magnetic resonance (CMR) and staging with whole-body contrast-enhanced computed tomography (CECT). In this study, our objective was to evaluate the role of ¹⁸Fluor-fluorodeoxyglucose positron emission tomography (¹⁸F-FDG-PET) with CMR for both characterization and staging of cardiac masses.

METHODS

Patients with cardiac masses who underwent CMR, CECT, and ¹⁸F-FDG-PET were retrospectively identified. For the characterization of cardiac masses, we calculated the respective performances of CMR alone, ¹⁸F-FDG-PET alone, and the combination of ¹⁸F-FDG-PET and CMR. For staging, we compared head-to-head the respective performances of ¹⁸F-FDG-PET and CECT. Histology served as gold standard for malignancy, and response to anticoagulation for thrombus.

RESULTS

In a total of 28 patients (median age 60.5 years, 60.7% women), CMR accurately distinguished malignant from benign masses with sensitivity (Se) of 86.7%, specificity (Sp) of 100%, positive predictive value (PPV) of 100%, negative predictive value (NPV) of 86.7%, and accuracy of 92.9%. ¹⁸F-FDG-PET demonstrated 93.3% Se, 84.6% Sp, 87.5% PPV, 91.7% NPV, and 89.3% accuracy. Combining CMR with ¹⁸F-FDG-PET allowed to benefit from the high sensitivity of ¹⁸F-FDG-PET (92.9%) and the excellent specificity of CMR (100%) for malignant diseases. For staging, ¹⁸F-FDG-PET outperformed CECT on per-patient (66.7% vs 55.6% correct diagnosis, respectively), per-organ (10 vs 7 organs, respectively), and per-lesion basis (> 29 vs > 25 lesions, respectively).

CONCLUSION

Combining ¹⁸F-FDG-PET with CMR improved the characterization of cardiac masses compared to each modality alone. Additionally, the diagnostic performance of ¹⁸F-FDG-PET was better than CECT for staging. This study suggests that the combination of CMR and ¹⁸F-FDG-PET is the most effective for the characterization of cardiac masses and the staging of these lesions.

Clinical Applications of PET/MR Imaging

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.

Diagnostic performance of PET/CT and PET/MR in the management of ovarian carcinoma-a literature review

Ovarian cancer is a challenging disease. It often presents at an advanced stage with frequent recurrence despite optimal management. Accurate staging and restaging are critical for improving treatment outcomes and determining the prognosis. Imaging is an indispensable component of ovarian cancer management. Hybrid imaging modalities, including positron emission tomography/computed tomography (PET/CT) and PET/magnetic resonance imaging (MRI), are emerging as potential non-invasive imaging tools for improved management of ovarian cancer. This review article discusses the role of PET/CT and PET/MRI in ovarian cancer.