Comparison of 18F-FDG PET/MRI and MRI for pre-therapeutic tumor staging of patients with primary cancer of the uterine cervix

  • Theresia Sarabhai
  • Benedikt M. Schaarschmidt
  • Axel Wetter
  • Julian Kirchner
  • Bahriye Aktas
  • Michael Forsting
  • Verena Ruhlmann
  • Ken Herrmann
  • Lale Umutlu
  • Johannes Grueneisen
Original Article
  • 273 Downloads

Abstract

Purpose

The aim of the present study was to assess and compare the diagnostic performance of integrated PET/MRI and MRI alone for local tumor evaluation and whole-body tumor staging of primary cervical cancers. In addition, the corresponding impact on further patient management of the two imaging modalities was assessed.

Methods

A total of 53 consecutive patients with histopathological verification of a primary cervical cancer were prospectively enrolled for a whole-body 18F-FDG PET/MRI examination. Two experienced physicians analyzed the MRI data, in consensus, followed by a second reading session of the PET/MRI datasets. The readers were asked to perform a dedicated TNM staging in accordance with the 7th edition of the AJCC staging manual. Subsequently, the results of MRI and PET/MRI were discussed in a simulated interdisciplinary tumor board and therapeutic decisions based on both imaging modalities were recorded. Results from histopathology and cross-sectional imaging follow-up served as the reference standard.

Results

PET/MRI allowed for a correct determination of the T stage in 45/53 (85%) cases, while MRI alone enabled a correct identification of the tumor stage in 46/53 (87%) cases. In 24 of the 53 patients, lymph node metastases were present. For the detection of nodal-positive patients, sensitivity, specificity and accuracy of PET/MRI were 83%, 90% and 87%, respectively. The respective values for MRI alone were 71%, 83% and 77%. In addition, PET/MRI showed higher values for the detection of distant metastases than MRI alone (sensitivity: 87% vs. 67%, specificity: 92% vs. 90%, diagnostic accuracy: 91% vs. 83%). Among the patients with discrepant staging results in the two imaging modalities, PET/MRI enabled correct treatment recommendations for a higher number (n = 9) of patients than MRI alone (n = 3).

Conclusion

The present results demonstrate the successful application of integrated PET/MRI imaging for whole-body tumor staging of cervical cancer patients, enabling improved treatment planning when compared to MRI alone.

Keywords

PET/MRI MRI Whole-body staging Cervical cancer 

Notes

Compliance with ethical standards

Conflict of interest

None.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Research Committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87–108. https://doi.org/10.3322/caac.21262.
  2. 2.
    Pecorelli S, Zigliani L, Odicino F. Revised FIGO staging for carcinoma of the cervix. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 2009;105(2):107–8. https://doi.org/10.1016/j.ijgo.2009.02.009.
  3. 3.
    Lagasse LD, Creasman WT, Shingleton HM, Ford JH, Blessing JA. Results and complications of operative staging in cervical cancer: Experience of the gynecologic oncology group. Gynecol Oncol. 1980;9(1):90–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Sala E, Wakely S, Senior E, Lomas D. MRI of malignant neoplasms of the uterine corpus and cervix. AJR Am J Roentgenol. 2007;188(6):1577–87. https://doi.org/10.2214/ajr.06.1196.
  5. 5.
    Bipat S, Glas AS, van der Velden J, Zwinderman AH, Bossuyt PM, Stoker J. Computed tomography and magnetic resonance imaging in staging of uterine cervical carcinoma: A systematic review. Gynecol Oncol. 2003;91(1):59–66.CrossRefPubMedGoogle Scholar
  6. 6.
    Grant P, Sakellis C, Jacene HA. Gynecologic oncologic imaging with PET/CT. Semin Nucl Med. 2014;44(6):461–78. https://doi.org/10.1053/j.semnuclmed.2014.06.005.
  7. 7.
    Choi HJ, Roh JW, Seo SS, Lee S, Kim JY, Kim SK, et al. Comparison of the accuracy of magnetic resonance imaging and positron emission tomography/computed tomography in the presurgical detection of lymph node metastases in patients with uterine cervical carcinoma: A prospective study. Cancer. 2006;106(4):914–22. https://doi.org/10.1002/cncr.21641.
  8. 8.
    Selman TJ, Mann C, Zamora J, Appleyard TL, Khan K. Diagnostic accuracy of tests for lymph node status in primary cervical cancer: a systematic review and meta-analysis. CMAJ: Can Med Assoc J = J l'Assoc Med Can. 2008;178(7):855–62. https://doi.org/10.1503/cmaj.071124.
  9. 9.
    Heusch P, Nensa F, Schaarschmidt B, Sivanesapillai R, Beiderwellen K, Gomez B, et al. Diagnostic accuracy of whole-body PET/MRI and whole-body PET/CT for TNM staging in oncology. Eur J Nucl Med Mol Imaging. 2015;42(1):42–8. https://doi.org/10.1007/s00259-014-2885-5.
  10. 10.
    Schafer JF, Gatidis S, Schmidt H, Guckel B, Bezrukov I, Pfannenberg CA, et al. Simultaneous whole-body PET/MR imaging in comparison to PET/CT in pediatric oncology: Initial results. Radiology. 2014;273(1):220–31. https://doi.org/10.1148/radiol.14131732.
  11. 11.
    Melsaether AN, Raad RA, Pujara AC, Ponzo FD, Pysarenko KM, Jhaveri K, et al. Comparison of whole-body (18)F FDG PET/MR imaging and whole-body (18)F FDG PET/CT in terms of lesion detection and radiation dose in patients with breast cancer. Radiology. 2016;281(1):193–202. https://doi.org/10.1148/radiol.2016151155.
  12. 12.
    Grueneisen J, Schaarschmidt BM, Heubner M, Aktas B, Kinner S, Forsting M, et al. Integrated PET/MRI for whole-body staging of patients with primary cervical cancer: Preliminary results. Eur J Nucl Med Mol Imaging. 2015;42(12):1814–24. https://doi.org/10.1007/s00259-015-3131-5.
  13. 13.
    Edge SB, Compton CC. The American joint committee on cancer: The 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17(6):1471–4. https://doi.org/10.1245/s10434-010-0985-4.
  14. 14.
    Beiderwellen K, Gomez B, Buchbender C, Hartung V, Poeppel TD, Nensa F, et al. Depiction and characterization of liver lesions in whole body [(1)(8)F]-FDG PET/MRI. Eur J Radiol. 2013;82(11):e669–75. https://doi.org/10.1016/j.ejrad.2013.07.027.
  15. 15.
    Buchbender C, Hartung-Knemeyer V, Beiderwellen K, Heusch P, Kuhl H, Lauenstein TC, et al. Diffusion-weighted imaging as part of hybrid PET/MRI protocols for whole-body cancer staging: Does it benefit lesion detection? Eur J Radiol. 2013;82(5):877–82. https://doi.org/10.1016/j.ejrad.2013.01.019.
  16. 16.
    Platzek I, Beuthien-Baumann B, Schramm G, Maus J, Laniado M, Kotzerke J, et al. FDG PET/MR in initial staging of sarcoma: Initial experience and comparison with conventional imaging. Clin Imaging. 2017;42:126–32. https://doi.org/10.1016/j.clinimag.2016.11.016.
  17. 17.
    Micco M, Sala E, Lakhman Y, Hricak H, Vargas HA. Role of imaging in the pretreatment evaluation of common gynecological cancers. Women’s health (Lond Engl). 2014;10(3):299–321. https://doi.org/10.2217/whe.14.19.
  18. 18.
    Addley HC, Vargas HA, Moyle PL, Crawford R, Sala E. Pelvic imaging following chemotherapy and radiation therapy for gynecologic malignancies. Radiogr Rev Publ Radiol Soc N Am Inc. 2010;30(7):1843–56. https://doi.org/10.1148/rg.307105063.
  19. 19.
    Sala E, Rockall AG, Freeman SJ, Mitchell DG, Reinhold C. The added role of MR imaging in treatment stratification of patients with gynecologic malignancies: What the radiologist needs to know. Radiology. 2013;266(3):717–40. https://doi.org/10.1148/radiol.12120315.
  20. 20.
    Hoh CK, Hawkins RA, Glaspy JA, Dahlbom M, Tse NY, Hoffman EJ, et al. Cancer detection with whole-body PET using 2-[18F]fluoro-2-deoxy-D-glucose. J Comput Assist Tomogr. 1993;17(4):582–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Schwarz JK, Grigsby PW, Dehdashti F, Delbeke D. The role of 18F-FDG PET in assessing therapy response in cancer of the cervix and ovaries. J Nucl Med Off Publ Soc Nucl Med. 2009;50(Suppl 1):64s–73s. https://doi.org/10.2967/jnumed.108.057257.
  22. 22.
    Yoshida Y, Kurokawa T, Kawahara K, Yagihara A, Tsuchida T, Okazawa H, et al. Metabolic monitoring of advanced uterine cervical cancer neoadjuvant chemotherapy by using [F-18]-Fluorodeoxyglucose positron emission tomography: Preliminary results in three patients. Gynecol Oncol. 2004;95(3):597–602. https://doi.org/10.1016/j.ygyno.2004.08.037.
  23. 23.
    Nishiyama Y, Yamamoto Y, Kanenishi K, Ohno M, Hata T, Kushida Y, et al. Monitoring the neoadjuvant therapy response in gynecological cancer patients using FDG PET. Eur J Nucl Med Mol Imaging. 2008;35(2):287–95. https://doi.org/10.1007/s00259-007-0627-7.
  24. 24.
    Schwarz JK, Siegel BA, Dehdashti F, Grigsby PW. Association of posttherapy positron emission tomography with tumor response and survival in cervical carcinoma. JAMA. 2007;298(19):2289–95. https://doi.org/10.1001/jama.298.19.2289.
  25. 25.
    Miller TR, Grigsby PW. Measurement of tumor volume by PET to evaluate prognosis in patients with advanced cervical cancer treated by radiation therapy. Int J Radiat Oncol Biol Phys. 2002;53(2):353–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Tanaka Y, Sawada S, Murata T. Relationship between lymph node metastases and prognosis in patients irradiated postoperatively for carcinoma of the uterine cervix. Acta Radiol Oncol. 1984;23(6):455–9.CrossRefPubMedGoogle Scholar
  27. 27.
    Piver MS, Chung WS. Prognostic significance of cervical lesion size and pelvic node metastases in cervical carcinoma. Obstet Gynecol. 1975;46(5):507–10.PubMedGoogle Scholar
  28. 28.
    Fuller AF Jr, Elliott N, Kosloff C, Hoskins WJ, Lewis JL Jr. Determinants of increased risk for recurrence in patients undergoing radical hysterectomy for stage IB and IIA carcinoma of the cervix. Gynecol Oncol. 1989;33(1):34–9.CrossRefPubMedGoogle Scholar
  29. 29.
    Havrilesky LJ, Kulasingam SL, Matchar DB, Myers ER. FDG-PET for management of cervical and ovarian cancer. Gynecol Oncol. 2005;97(1):183–91. https://doi.org/10.1016/j.ygyno.2004.12.007.
  30. 30.
    Kitajima K, Suenaga Y, Ueno Y, Kanda T, Maeda T, Deguchi M, et al. Fusion of PET and MRI for staging of uterine cervical cancer: Comparison with contrast-enhanced (18)F-FDG PET/CT and pelvic MRI. Clin Imaging. 2014;38(4):464–9. https://doi.org/10.1016/j.clinimag.2014.02.006.
  31. 31.
    Queiroz MA, Kubik-Huch RA, Hauser N, Freiwald-Chilla B, von Schulthess G, Froehlich JM, et al. PET/MRI and PET/CT in advanced gynaecological tumours: Initial experience and comparison. Eur Radiol. 2015;25(8):2222–30. https://doi.org/10.1007/s00330-015-3657-8.
  32. 32.
    Pandharipande PV, Choy G, del Carmen MG, Gazelle GS, Russell AH, Lee SI. MRI and PET/CT for triaging stage IB clinically operable cervical cancer to appropriate therapy: Decision analysis to assess patient outcomes. AJR Am J Roentgenol. 2009;192(3):802–14. https://doi.org/10.2214/ajr.08.1224.
  33. 33.
    Beckmann MW, Mallmann P. Interdisciplinary S2k guideline on the diagnosis and treatment of cervical carcinoma. J Cancer Res Clin Oncol. 2009;135(9):1197–206. https://doi.org/10.1007/s00432-009-0560-1.

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Theresia Sarabhai
    • 1
  • Benedikt M. Schaarschmidt
    • 2
  • Axel Wetter
    • 1
  • Julian Kirchner
    • 2
  • Bahriye Aktas
    • 3
  • Michael Forsting
    • 1
  • Verena Ruhlmann
    • 4
  • Ken Herrmann
    • 4
  • Lale Umutlu
    • 1
  • Johannes Grueneisen
    • 1
  1. 1.Department of Diagnostic and Interventional Radiology and NeuroradiologyUniversity Hospital Essen, University of Duisburg-EssenEssenGermany
  2. 2.Department of Diagnostic and Interventional Radiology, Medical FacultyUniversity DusseldorfDusseldorfGermany
  3. 3.Department of Obstetrics and GynecologyUniversity Hospital Essen, University of Duisburg-EssenEssenGermany
  4. 4.Department of Nuclear MedicineUniversity Hospital Essen, University of Duisburg-EssenEssenGermany

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