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FDG-PET/MRI in patients with pelvic recurrence of rectal cancer: first clinical experiences

  • Gastrointestinal
  • Published:
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A Correction to this article was published on 06 August 2018

This article has been updated

Abstract

Objectives

To determine the value of 18F-FDG-PET/MRI in the diagnosis and management of patients with pelvic recurrence of rectal cancer.

Methods

Forty-four patients (16 women, 28 men) with a history of rectal cancer who received FDG-PET/MRI between June 2011 and February 2017 at our institution were retrospectively enrolled. Three patients received two FDG-PET/MRIs; thus a total of 47 examinations were included. Pelvic recurrence was confirmed either with histology (n = 27) or imaging follow-up (n = 17) (> 4 months). Two readers (one radiologist, one nuclear medicine physician) interpreted the images in consensus. Pelvic lesions were assessed regarding FDG uptake and morphology. Sensitivity, specificity, positive and negative predictive values as well as accuracy of PET/MRI in detecting recurrence were determined.

Results

In 47 FDG-PET/MRIs 30 suspicious pelvic lesions were identified, 29 of which were malignant. Two patients underwent resection and had histologically proven pelvic recurrence without showing suspicious findings on FDG-PET/MRI. Changes in management due to FDG-PET/MRI findings had been implemented in eight patients. Eighty per cent (16/20) of resected patients had histologically negative resection margins (R0), one patient had uncertain resection margins. Sensitivity of FDG-PET/MRI in detecting recurrence was 94%, specificity 94%, positive/negative predictive value and accuracy were 97%, 90% and 94%, respectively.

Conclusions

FDG-PET/MRI is a valuable tool in the diagnosis and staging of pelvic recurrence in patients with rectal cancer.

Key Points

• Metabolic information obtained from PET coupled with excellent soft tissue contrast from MRI could facilitate detection of rectal cancer recurrence and assist in treatment planning.

• PET/MRI demonstrates high sensitivity and specificity for the diagnosis of local recurrence of rectal cancer

• PET/MRI led to alterations in management in 18.2% of patients.

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Change history

  • 06 August 2018

    The original version of this article, published on 6 July 2018, unfortunately contained a mistake.

References

  1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM (2010) Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 127:2893–2917

    Article  CAS  Google Scholar 

  2. Even-Sapir E, Parag Y, Lerman H et al (2004) Detection of recurrence in patients with rectal cancer: PET/CT after abdominoperineal or anterior resection. Radiology 232:815–822

    Article  Google Scholar 

  3. Schaefer O, Langer M (2007) Detection of recurrent rectal cancer with CT, MRI and PET/CT. Eur Radiol 17:2044–2054

    Article  CAS  Google Scholar 

  4. Sebag-Montefiore D, Stephens RJ, Steele R et al (2009) Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre randomized trial. Lancet 373:811–820

    Article  Google Scholar 

  5. Arriola E, Navarro M, Pares D et al (2006) Imaging techniques contribute to increased surgical rescue of relapse in the follow-up of colorectal cancer. Dis Colon Rectum 49:478–484

    Article  Google Scholar 

  6. Abir F, Alva S, Longo WE, Audiso R, Virgo KS, Johnson FE (2006) The postoperative surveillance of patients with colon cancer and rectal cancer. Am J Surg 192:100–108

    Article  Google Scholar 

  7. Rahbari NN, Ulrich AB, Bruckner T et al (2011) Surgery for locally recurrent rectal cancer in the era of total mesorectal excision: is there still a chance for cure? Ann Surg 253:522–533

    Article  Google Scholar 

  8. Huguier M, Houry S, Barrier A (2001) Local recurrence of cancer of the rectum. Am J Surg 182:437–439

    Article  CAS  Google Scholar 

  9. Goldberg RM, Fleming TR, Tangen CL et al (1998) Surgery for recurrent colon cancer: strategies for identifying resectable recurrence and success rates after resection. Eastern Cooperative Oncology Group, the North Central Cancer Treatment Group, and the Southwest Oncology Group. Ann Intern Med 129:27–35

    Article  CAS  Google Scholar 

  10. Yamada K, Ishizawa T, Niwa K, Chuman Y, Aikou T (2002) Pelvic exenteration and sacral resection for locally advanced primary and recurrent rectal cancer. Dis Colon Rectum 45:1078–1084

    Article  Google Scholar 

  11. Law WL, Chu KW, Choi HK (2000) Total pelvic exenteration for locally advanced rectal cancer. J Am Coll Surg 190:78–83

    Article  CAS  Google Scholar 

  12. Domes T, Colquhoun P, Taylor B, Izawa J, House A, Luke P (2011) Total pelvic exenteration for rectal cancer: outcomes and prognostic factors. Can J Surg 54:387–393

    Article  Google Scholar 

  13. De Lange EE, Fechner RE, Wanebo HJ (1989) Suspected recurrent rectosigmoid carcinoma after abdominoperinea resection: MR imaging and histopathologic findings. Radiology 170:323–328

    Article  Google Scholar 

  14. Blomqvist L, Fransson P, Hindmarsh T (1998) The pelvis after surgery and radio-chemotherapy for rectal cancer studies with Gd-DTPA-enhanced fast dynamic MR imaging. Eur Radiol 8:781–787

    Article  CAS  Google Scholar 

  15. Kelvin FM, Koronkin M, Heaston DK, Grant JP, Akwari O (1983) The pelvis after surgery for rectal carcinoma: serial CT observations with emphasis on nonneoplastic features. AJR Am J Roentgenol 141:959–964

    Article  CAS  Google Scholar 

  16. Muller-Schimpfle M, Brix G, Layer G et al (1993) Recurrent rectal cancer: diagnosis with dynamic MR imaging. Radiology 189:881–889

    Article  CAS  Google Scholar 

  17. Beets-Tan RGH, Lambregts DMJ, Maas M et al (2018) 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 28:1465–1475

    Article  Google Scholar 

  18. Titu LV, Nicholson AA, Hartley JE et al (2006) Routine follow-up by magnetic resonance imaging does not improve detection of resectable local recurrences from colorectal cancer. Ann Surg 243:348–352

    Article  Google Scholar 

  19. Moore HG, Akhurst T, Larson SM, Minsky BD, Mazumdar M, Guillem JG (2003) A case-controlled study of 18-fluordeoxyglucose positron emission tomography in the detection of pelvic recurrence in previously irradiated rectal cancer patients. J Am Coll Surg 197:22–28

    Article  Google Scholar 

  20. Platzek I, Beuthien-Baumann B, Schneider M et al (2013) PET/MRI in head and neck cancer: initial experience. Eur J Nucl Med Mol Imaging 40:6–11

    Article  Google Scholar 

  21. Boellaard R, O’Doherty M, Weber W et al (2009) FDG PET and PET/CT: EANM procedure guidelines for tumour PET imaging: version 1.0. Eur J Nucl Med Mol Imaging 37:181–200

    Article  Google Scholar 

  22. Lerman H, Metser U, Grisaru D, Fishman A, Lievshitz G, Even-Sapir E (2004) Normal and abnormal 18F-FDG endometrial and ovarian uptake in pre- and postmenopausal patients: assessment by PET/CT. J Nucl Med 45:266–271

    PubMed  Google Scholar 

  23. Berger K, Nicholson S, Dehdashti F, Siegel B (2000) FDG PET evaluation of mucinous neoplasms: correlation of FDG uptake with histopathologic features. AJR Am J Roentgenol 174:1005–1008

  24. Imbriaco M, Akhurst T, Hilton S et al (2000) Whole-body FDG-PET in patients with recurrent colorectal carcinoma: a comparative study with CT. Clin Positron Imaging 3:107–114

    Article  CAS  Google Scholar 

  25. Huebner RH, Park KC, Shepherd JE et al (2000) A meta-analysis of the literature for whole-body FDG PET detection of recurrent colorectal cancer. J Nucl Med 41:1177–1189

    CAS  PubMed  Google Scholar 

  26. Ogunbiyi OA, Flanagan FL, Dehdashti F et al (1997) Detection of recurrent and metastastatic colorectal cancer: comparison of positron emission tomography and computed tomography. Ann Surg Oncol 4:613–620

    Article  CAS  Google Scholar 

  27. Imdahl A, Reinhardt MJ, Nitzsche EU et al (2000) Impact of 18F-FDG-positron emission tomography for decision making in colorectal cancer recurrences. Langenbecks Arch Surg 385:129–134

  28. Flamen P, Stroobants S, Van Cutsem E et al (1999) Additional value of whole body positron emission tomography with fluorine-18-2-fluoro-2-deoxy-d-glucose in recurrent colorectal cancer. J Clin Oncol 17:894–901

    Article  CAS  Google Scholar 

  29. Hupkens BJP, Maas M, Martens MH et al (2017) MRI surveillance for the detection of local recurrence after transanal endoscopic microsurgery. Eur Radiol 27:4960–4969

    Article  Google Scholar 

  30. Lambregts DMJ, Lahaye MJ, Heijnen LA et al (2016) MRI and diffusion-weighted MRI to diagnose a local tumour regrowth during long-term follow-up of rectal cancer patients treated with organ preservation after chemoradiotherapy. Eur Radiol 26:2118–2125

    Article  Google Scholar 

  31. Ito K, Kato T, Tadokoro M et al (1992) Recurrent rectal cancer and scar: differentiation with PET and MR imaging. Radiology 182:549–552

    Article  CAS  Google Scholar 

Download references

Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Institut und Poliklinik fuer Radiologische Diagnostik, Universitaetsklinikum Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany

    Verena Plodeck, Christoph G. Radosa, Michael Laniado, Ralf-Thorsten Hoffmann & Ivan Platzek

  2. Klinik und Poliklinik fuer Viszeral-, Thorax- und Gefäßchirurgie, Universitaetsklinikum Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany

    Nuh N. Rahbari & Juergen Weitz

  3. Klinik und Poliklinik für Nuklearmedizin, Universitaetsklinikum Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany

    Klaus Zöphel & Joerg Kotzerke

  4. Deutsches Krebsforschungszentrum, Abteilung Radiologie, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany

    Bettina Beuthien-Baumann

  5. Institut für Radiopharmazeutische Krebsforschung, Helmholtz-Zentrum Dresden Rossendorf, Bautzner Landstraße 400, 01328, Dresden, Germany

    Joerg van den Hoff

Authors
  1. Verena Plodeck
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  2. Nuh N. Rahbari
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  7. Klaus Zöphel
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Corresponding author

Correspondence to Verena Plodeck.

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Guarantor

The scientific guarantor of this publication is Verena Plodeck.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional review board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported at the RSNA 2017.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

Additional information

The original version of this article was revised: The name of Klaus Zöphel was presented incorrectly.

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Plodeck, V., Rahbari, N.N., Weitz, J. et al. FDG-PET/MRI in patients with pelvic recurrence of rectal cancer: first clinical experiences. Eur Radiol 29, 422–428 (2019). https://doi.org/10.1007/s00330-018-5589-6

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  • DOI: https://doi.org/10.1007/s00330-018-5589-6

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