Diagnostic accuracy of FDG-PET/MRI versus pelvic MRI and thoracic and abdominal CT for detecting synchronous distant metastases in rectal cancer patients

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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References

  1. 1.

    Glynne-Jones R, Wyrwicz L, Tiret E, Brown G, Rödel C, Cervantes A, et al. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up†. Ann Oncol. 2017;28:iv22–40.

    CAS  Article  Google Scholar 

  2. 2.

    Benson AB, Venook AP, Bekaii-Saab T, Chan E, Chen Y-J, Cooper HS, et al. Rectal cancer, version 2.2015. J Natl Compr Cancer Netw. 2015;13:719–28.

    Article  Google Scholar 

  3. 3.

    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;39:367–87.

    Article  Google Scholar 

  4. 4.

    Seo HJ, Kim M, Lee JD, Chung W, Kim Y-E. Gadoxetate disodium-enhanced magnetic resonance imaging versus contrast-enhanced 18F-fluorodeoxyglucose positron emission tomography/computed tomography for the detection of colorectal liver metastases. Investig Radiol. 2011;46:548–55.

    CAS  Article  Google Scholar 

  5. 5.

    Ozis SE, Soydal C, Akyol C, Can N, Kucuk ON, Yagcı C, et al. The role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in the primary staging of rectal cancer. World J Surg Oncol. 2014;12:26.

    Article  Google Scholar 

  6. 6.

    Howlader N, Noone AM, Krapcho M, Miller D, Brest A, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ CK (eds). SEER cancer statistics review, 1975–2016, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2016/, based on November 2018 SEER data submission, posted to the SEER web site, April 2019. [Internet]. 2019. Available from: https://seer.cancer.gov/statfacts/html/colorect.html

  7. 7.

    Kang B, Lee JM, Song YS, Woo S, Hur BY, Jeon JH, et al. Added value of integrated whole-body PET/MRI for evaluation of colorectal cancer: comparison with contrast-enhanced MDCT. Am J Roentgenol. 2016;206:W10–20.

    Article  Google Scholar 

  8. 8.

    Brendle C, Schwenzer NF, Rempp H, Schmidt H, Pfannenberg C, la Fougère C, et al. Assessment of metastatic colorectal cancer with hybrid imaging: comparison of reading performance using different combinations of anatomical and functional imaging techniques in PET/MRI and PET/CT in a short case series. Eur J Nucl Med Mol Imaging. 2016;43:123–32.

    CAS  Article  Google Scholar 

  9. 9.

    Paspulati RM, Partovi S, Herrmann KA, Krishnamurthi S, Delaney CP, Nguyen NC. Comparison of hybrid FDG PET/MRI compared with PET/CT in colorectal cancer staging and restaging: a pilot study. Abdom Imaging. 2015;40:1415–25.

    Article  Google Scholar 

  10. 10.

    Catalano OA, Coutinho AM, Sahani DV, Vangel MG, Gee MS, Hahn PF, et al. Colorectal cancer staging: comparison of whole-body PET/CT and PET/MR. Abdom Radiol. 2017;42:1141–51.

    Article  Google Scholar 

  11. 11.

    Rutegård MK, Båtsman M, Axelsson J, Brynolfsson P, Brännström F, Rutegård J, et al. 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;19:1–9.

    Article  Google Scholar 

  12. 12.

    Boellaard R, Delgado-Bolton R, Oyen WJG, Giammarile F, Tatsch K, Eschner W, et al. FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging. 2014.

  13. 13.

    Beets-Tan RGH, Lambregts DMJ, Maas M, Bipat S, Barbaro B, Curvo-Semedo L, et al. Magnetic resonance imaging for clinical management of rectal cancer: updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. Eur Radiol. 2018;28:1465–75.

    Article  Google Scholar 

  14. 14.

    Ye Y, Liu T, Lu L, Wang G, Wang M, Li J, et al. F-FDG PET-CT or PET: a meta-analysis including 2283 patients. Int J Clin Exp Med. 2015;8:21773–85.

    CAS  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Riihimäki M, Hemminki A, Sundquist J, Hemminki K. Patterns of metastasis in colon and rectal cancer. Sci Rep. 2016;6:29765 Nature Publishing Group.

    Article  Google Scholar 

  16. 16.

    Quadros CA, Falcão MF, Carvalho ME, Ladeia PA, Lopes A. Metastases to retroperitoneal or lateral pelvic lymph nodes indicated unfavorable survival and high pelvic recurrence rates in a cohort of 102 patients with low rectal adenocarcinoma. J Surg Oncol. 2012;106:653–8.

    Article  Google Scholar 

  17. 17.

    Niekel MC, Bipat S, Stoker J. Diagnostic imaging of colorectal liver metastases with CT, MR imaging, FDG PET, and/or FDG PET/CT: a meta-analysis of prospective studies including patients who have not previously undergone treatment. Radiology. 2010;257:674–84.

    Article  Google Scholar 

  18. 18.

    Maffione AM, Lopci E, Bluemel C, Giammarile F, Herrmann K, Rubello D. Diagnostic accuracy and impact on management of 18F-FDG PET and PET/CT in colorectal liver metastasis: a meta-analysis and systematic review. Eur J Nucl Med Mol Imaging. 2015;42:152–63.

    CAS  Article  Google Scholar 

  19. 19.

    Sivesgaard K, Larsen LP, Sørensen M, Kramer S, Schlander S, Amanavicius N, et al. Diagnostic accuracy of CE-CT, MRI and FDG PET/CT for detecting colorectal cancer liver metastases in patients considered eligible for hepatic resection and/or local ablation. Eur Radiol. 2018;28:4735–47.

    Article  Google Scholar 

  20. 20.

    Lee DH, Lee JM, Hur BY, Joo I, Yi N-J, Suh K-S, et al. Colorectal cancer liver metastases: diagnostic performance and prognostic value of PET/MR imaging. Radiology. 2016;280:782–92.

    Article  Google Scholar 

  21. 21.

    Reiner CS, Stolzmann P, Husmann L, Burger IA, Hüllner MW, Schaefer NG, et al. Protocol requirements and diagnostic value of PET/MR imaging for liver metastasis detection. Eur J Nucl Med Mol Imaging. 2014;41:649–58.

    Article  Google Scholar 

  22. 22.

    Heye T, Ley S, Heussel CP, Dienemann H, Kauczor HU, Hosch W, et al. Detection and size of pulmonary lesions: how accurate is MRI? A prospective comparison of CT and MRI. Acta Radiol. 2012;53:153–60.

    Article  Google Scholar 

  23. 23.

    Rauscher I, Eiber M, Furst S, Souvatzoglou M, Nekolla SG, Ziegler SI, et al. PET/MR imaging in the detection and characterization of pulmonary lesions: technical and diagnostic evaluation in comparison to PET/CT. J Nucl Med. 2014;55:724–9.

    CAS  Article  Google Scholar 

  24. 24.

    Siddiqui MRS, Simillis C, Hunter C, Chand M, Bhoday J, Garant A, et al. A meta-analysis comparing the risk of metastases in patients with rectal cancer and MRI-detected extramural vascular invasion (mrEMVI) vs mrEMVI-negative cases. Br J Cancer. 2017;116:1513–9.

    Article  Google Scholar 

  25. 25.

    Fraum TJ, Fowler KJ, McConathy J, Dehdashti F. Indeterminate findings on oncologic PET/CT: what difference does PET/MRI make? Nucl Med Mol Imaging. 2016;50:292–9.

    CAS  Article  Google Scholar 

  26. 26.

    Jess P, Seiersen M, Ovesen H, Sandstrøm H, Maltbæk N, Buhl AA, et al. Has PET/CT a role in the characterization of indeterminate lung lesions on staging CT in colorectal cancer? A prospective study. Eur J Surg Oncol. 2014;40:719–22.

    CAS  Article  Google Scholar 

  27. 27.

    Parsai A, Miquel ME, Jan H, Kastler A, Szyszko T, Zerizer I. Improving liver lesion characterisation using retrospective fusion of FDG PET/CT and MRI. Clin Imaging. 2019;55:23–8.

    Article  Google Scholar 

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Correspondence to Marcelo A. Queiroz.

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This article is part of the Topical Collection on Oncology - Digestive tract

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Queiroz, M.A., Ortega, C.D., Ferreira, F.R. et al. 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 48, 186–195 (2021). https://doi.org/10.1007/s00259-020-04911-x

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Keywords

  • Fluorodeoxyglucose F18
  • Neoplasm staging
  • Positron-emission tomography
  • Magnetic resonance imaging
  • Rectal neoplasms