The use of PET/MRI for imaging rectal cancer

  • Thomas A. HopeEmail author
  • Zahra Kassam
  • Andreas Loening
  • Michelle M. McNamara
  • Raj Paspulati
Special Section: Rectal Cancer
Part of the following topical collections:
  1. CME articles


Combined PET/MRI is a proposed imaging modality for rectal cancer, leveraging the advantages of MRI and 18F-fluorodeoxyglucose PET. Rectal cancer PET/MRI protocols typically include dedicated pelvis bed positions utilizing small field-of-view T2-weighted imaging. For staging of the primary tumor, PET/MRI can help delineate the extent of tumor better as well as the extent of tumor beyond the muscularis propria. PET uptake may help characterize small lymph nodes, and the use of hepatobiliary phase imaging can improve the detection of small hepatic metastases. The most beneficial aspect of PET/MRI may be in treatment response, although current data are limited on how to combine PET and MRI data in this setting. Limitations of PET/MRI include the inability to detect small pulmonary nodules and issues related to attenuation correction, although the development of new attenuation correction techniques may address this issue. Overall PET/MRI can improve the staging of rectal cancer, although this potential has yet to be fulfilled.


Rectal cancer PET/MRI Staging Treatment response 



T.A.H. was supported by the National Institutes of Health (Grant R01CA212148).


  1. 1.
    Horvat N, Carlos Tavares Rocha C, Clemente de Oliveira B, Petkovska I, Gollub MJ. MRI of Rectal Cancer: Tumor Staging, Imaging Techniques, and Management. Radiographics. 2019;:180114.Google Scholar
  2. 2.
    Jeong JH, Cho IH, Chun KA, Kong EJ, Kwon SD, Kim JH. Correlation Between Apparent Diffusion Coefficients and Standardized Uptake Values in Hybrid (18)F-FDG PET/MR: Preliminary Results in Rectal Cancer. Nucl Med Mol Imaging. Springer Berlin Heidelberg. 2016;50:150–156.Google Scholar
  3. 3.
    Buchbender C, Heusner TA, Lauenstein TC, Bockisch A, Antoch G (2012) Oncologic PET/MRI, part 1: tumors of the brain, head and neck, chest, abdomen, and pelvis. J Nucl Med. 53:928–938CrossRefGoogle Scholar
  4. 4.
    Park MJ, Kim SH, Lee SJ, Jang KM, Rhim H (2011) Locally advanced rectal cancer: added value of diffusion-weighted MR imaging for predicting tumor clearance of the mesorectal fascia after neoadjuvant chemotherapy and radiation therapy. Radiology. 260:771–780CrossRefGoogle Scholar
  5. 5.
    Rosenkrantz AB, Friedman K, Chandarana H, et al. (2016) Current Status of Hybrid PET/MRI in Oncologic Imaging. American Journal of Roentgenology. 206:162–172CrossRefGoogle Scholar
  6. 6.
    Langman G, Patel A, Bowley DM (2015) Size and distribution of lymph nodes in rectal cancer resection specimens. Dis Colon Rectum. 58:406–414CrossRefGoogle Scholar
  7. 7.
    Lahaye MJ, Beets GL, Engelen SME, et al. Locally advanced rectal cancer: MR imaging for restaging after neoadjuvant radiation therapy with concomitant chemotherapy. Part II. What are the criteria to predict involved lymph nodes? Radiology. 2009;252:81–91.Google Scholar
  8. 8.
    Kim DJ, Kim JH, Ryu YH, et al. (2011) Nodal staging of rectal cancer: high-resolution pelvic MRI versus 18F-FDGPET/CT. J Comput Assist Tomogr. 35:531–534CrossRefGoogle Scholar
  9. 9.
    Cerny M, Dunet V, Prior JO, et al. (2016) Initial Staging of Locally Advanced Rectal Cancer and Regional Lymph Nodes: Comparison of Diffusion-Weighted MRI With 18F-FDG-PET/CT. Clin Nucl Med. Clinical Nuclear Medicine. 41:289–295CrossRefGoogle Scholar
  10. 10.
    Heijnen LA, Lambregts DMJ, Mondal D, et al. (2013) Diffusion-weighted MR imaging in primary rectal cancer staging demonstrates but does not characterise lymph nodes. European radiology. 23:3354–3360CrossRefGoogle Scholar
  11. 11.
    Cho EY, Kim SH, Yoon J-H, et al. (2013) Apparent diffusion coefficient for discriminating metastatic from non-metastatic lymph nodes in primary rectal cancer. Eur J Radiol. 82:e662–e668CrossRefGoogle Scholar
  12. 12.
    Bailey JJ, Jordan EJ, Burke C, et al. Does Extended PET Acquisition in PET/MRI Rectal Cancer Staging Improve Results? American Journal of Roentgenology. 2018;:1–5.Google Scholar
  13. 13.
    Koh D-M, Brown G, Temple L, et al. (2004) Rectal cancer: mesorectal lymph nodes at MR imaging with USPIO versus histopathologic findings–initial observations. Radiology. 231:91–99CrossRefGoogle Scholar
  14. 14.
    Ferumoxytol-Enhanced MRI in Imaging Lymph Nodes in Patients With Locally Advanced Rectal Cancer. Accessed May 22, 2019
  15. 15.
    Turkbey B, Agarwal HK, Shih J, et al. (2015) A Phase I Dosing Study of Ferumoxytol for MR Lymphography at 3 T in Patients With Prostate Cancer. American Journal of Roentgenology. 205:64–69CrossRefGoogle Scholar
  16. 16.
    Hope TA, Pampaloni MH, Nakakura E, et al. Simultaneous (68)Ga-DOTA-TOC PET/MRI with gadoxetate disodium in patients with neuroendocrine tumor. Abdom Imaging. Springer US. 2015;40:1432–1440.Google Scholar
  17. 17.
    Sawicki LM, Deuschl C, Beiderwellen K, et al. Evaluation of (68)Ga-DOTATOC PET/MRI for whole-body staging of neuroendocrine tumours in comparison with (68)Ga-DOTATOC PET/CT. European radiology. Springer Berlin Heidelberg. 2017;26:3063–3069.Google Scholar
  18. 18.
    Kang B, Lee JM, Song YS, et al. (2016) Added Value of Integrated Whole-Body PET/MRI for Evaluation of Colorectal Cancer: Comparison With Contrast-Enhanced MDCT. American Journal of Roentgenology. 206:W10–W20CrossRefGoogle Scholar
  19. 19.
    Avallone A, Aloj L, Pecori B, et al. 18F-FDG PET/CT Is an Early Predictor of Pathologic Tumor Response and Survival to Preoperative Radiochemotherapy with Bevacizumab in High Risk Locally Advanced Rectal Cancer. Journal of Nuclear Medicine. 2019;:jnumed.118.222604–jnumed.118.222629.Google Scholar
  20. 20.
    Rakheja R, Chandarana H, DeMello L, et al. (2013) Correlation between standardized uptake value and apparent diffusion coefficient of neoplastic lesions evaluated with whole-body simultaneous hybrid PET/MRI. American Journal of Roentgenology. 201:1115–1119CrossRefGoogle Scholar
  21. 21.
    Cerny M, Dunet V, Rebecchini C, et al. (2019) Response of locally advanced rectal cancer (LARC) to radiochemotherapy: DW-MRI and multiparametric PET/CT in correlation with histopathology. Nuklearmedizin. 58:28–38CrossRefGoogle Scholar
  22. 22.
    Plodeck V, Rahbari NN, Weitz J, et al. FDG-PET/MRI in patients with pelvic recurrence of rectal cancer: first clinical experiences. European radiology. Springer Berlin Heidelberg. 2019;29:422–428.Google Scholar
  23. 23.
    Altini C, Niccoli Asabella A, De Luca R, et al. Comparison of (18)F-FDG PET/CT methods of analysis for predicting response to neoadjuvant chemoradiation therapy in patients with locally advanced low rectal cancer. Abdom Imaging. Springer US. 2015;40:1190–1202.Google Scholar
  24. 24.
    Ippolito D, Monguzzi L, Guerra L, et al. (2012) Response to neoadjuvant therapy in locally advanced rectal cancer: assessment with diffusion-weighted MR imaging and 18FDG PET/CT. Abdom Imaging. 37:1032–1040CrossRefGoogle Scholar
  25. 25.
    Tie J, Wang Y, Tomasetti C, et al. Circulating tumor DNA analysis detects minimal residual disease and predicts recurrence in patients with stage II colon cancer. Sci Transl Med. 2016;8:346ra92.Google Scholar
  26. 26.
    Chandarana H, Heacock L, Rakheja R, et al. (2013) Pulmonary nodules in patients with primary malignancy: comparison of hybrid PET/MR and PET/CT imaging. Radiology. 268:874–881CrossRefGoogle Scholar
  27. 27.
    Burris NS, Johnson KM, Larson PEZ, et al. (2016) Detection of Small Pulmonary Nodules with Ultrashort Echo Time Sequences in Oncology Patients by Using a PET/MR System. Radiology. 278:239–246CrossRefGoogle Scholar
  28. 28.
    Samarin A, Burger C, Wollenweber SD, et al. (2012) PET/MR imaging of bone lesions - implications for PET quantification from imperfect attenuation correction. Eur J Nucl Med Mol Imaging. 39:1154–1160CrossRefGoogle Scholar
  29. 29.
    Leynes AP, Yang J, Shanbhag DD, et al. (2017) Hybrid ZTE/Dixon MR-based attenuation correction for quantitative uptake estimation of pelvic lesions in PET/MRI. Med Phys. 44:902–913CrossRefGoogle Scholar
  30. 30.
    Leynes AP, Yang J, Wiesinger F, et al. (2018) Zero-Echo-Time and Dixon Deep Pseudo-CT (ZeDD CT): Direct Generation of Pseudo-CT Images for Pelvic PET/MRI Attenuation Correction Using Deep Convolutional Neural Networks with Multiparametric MRI. J Nucl Med. 59:852–858CrossRefGoogle Scholar
  31. 31.
    Zukotynski K, Jadvar H, Hope TA, et al. (2017) SNMMI Comment on the 2016 Society of Surgical Oncology “Choosing Wisely” Recommendation on the Use of PET/CT in Colorectal Cancer. J Nucl Med. 58:11–12CrossRefGoogle Scholar
  32. 32.
    Ozis SE, SOYDAL Ç, Akyol C, et al. The role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in the primary staging of rectal cancer. World J Surg Oncol. BioMed Central. 2014;12:26.Google Scholar
  33. 33.
    Rosenberg R, Herrmann K, Gertler R, et al. (2009) The predictive value of metabolic response to preoperative radiochemotherapy in locally advanced rectal cancer measured by PET/CT. Int J Colorectal Dis. Springer-Verlag. 24:191–200CrossRefGoogle Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Thomas A. Hope
    • 1
    • 2
    • 3
    Email author
  • Zahra Kassam
    • 4
  • Andreas Loening
    • 5
  • Michelle M. McNamara
    • 6
  • Raj Paspulati
    • 7
  1. 1.Department of Radiology and Biomedical ImagingUniversity of California San FranciscoSan FranciscoUSA
  2. 2.Department of RadiologySan Francisco VA Medical CenterSan FranciscoUSA
  3. 3.UCSF Helen Diller Family Comprehensive Cancer CenterUniversity of California San FranciscoSan FranciscoUSA
  4. 4.Schulich School of MedicineWestern UniversityLondonCanada
  5. 5.Department of RadiologyStanford University School of MedicineStanfordUSA
  6. 6.Department of RadiologyUniversity of Alabama at BirminghamBirminghamUSA
  7. 7.Department of RadiologyUH Case Medical CenterClevelandUSA

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