• Benedikt M. Schaarschmidt
  • Lino M. Sawicki
  • Gerald Antoch
  • Philipp Heusch


18F-FDG PET/CT imaging has become an integral part in oncological imaging. Albeit an unspecific tracer for glucose metabolism, the increased uptake of 18F-FDG in tumor cells due to their increased glucose metabolism, known as the “warburg effect”, makes 18F-FDG a highly useful tracer for the detection of metastatic disease in many cancer types. However, the true potential of this imaging method can only be unleashed if a precise anatomic allocation of a focus exhibiting an increased glucose metabolism can be achieved. Hence, only the combination of PET and CT imaging in one single modality, PET/CT, has led to the widespread use of 18F-FDG PET imaging in clinical practice and the introduction into several guidelines, most notably in lung and head and neck cancer.

Despite its advantages, the low soft tissue contrast of CT makes the evaluation of several body regions difficult. In local tumor assessment, especially the precise prediction of local tumor infiltration can be problematic, most notably in head and neck cancer or soft tissue sarcoma. In the evaluation of distant metastases, especially small metastases can be difficult to detect on PET images in tissues with a high background uptake such as the liver or the brain. Unfortunately, even contrast enhanced CT imaging does not increase the diagnostic accuracy in this regard.

Therefore, the idea of combining PET and MRI in one single scanner was applauded by radiologists and nuclear medicine physicians alike and the introduction of integrated PET/MRI scanners into clinical practice was accompanied by a tremendous hype. The most recent publications show, however, that the differences between the two hybrid modalities are smaller than initially expected. This is most likely caused by the high sensitivity and specificity of PET for detection of distant metastases. To unleash the full potential of PET/MRI, it is therefore necessary to combine a fast whole-body protocol comprising only few selected sequences with high resolution MR imaging of selected regions to assess local tumor extent and to detect metastases in frequently affected regions such as the brain in lung cancer or the liver in colorectal cancer, to perform true “one stop shop” examinations. Another advantage of PET/MRI is the simultaneous acquisition of functional MRI and PET data, allowing true multiparametric tumor evaluation. Especially diffusion weighted imaging (DWI) as a marker of cellular density and perfusion imaging are promising techniques.

Therefore, the advantages, disadvantages and potential pitfalls in oncological 18F-FDG PET/MRI imaging concerning local tumor evaluation, lymph node and distant metastasis staging as well as restaging and therapy response assessment will be discussed and differences in comparison to 18F-FDG PET/CT will be highlighted.


  1. Abgral R, Querellou S, Potard G, et al. Does 18F-FDG PET/CT improve the detection of posttreatment recurrence of head and neck squamous cell carcinoma in patients negative for disease on clinical follow-up? J Nucl Med. 2009;50:24–9. Scholar
  2. Afaq A, Fraioli F, Sidhu H, et al. Comparison of PET/MRI With PET/CT in the evaluation of disease status in lymphoma. Clin Nucl Med. 2017;42:1–7. Scholar
  3. Andersen KF, Jensen KE, Loft A. PET/MRI imaging in musculoskeletal disorders. PET Clin. 2016;11:453–63. Scholar
  4. Antoch G, Bockisch A. Combined PET/MRI: a new dimension in whole-body oncology imaging? Eur J Nucl Med Mol Imaging. 2009;36:113–20. Scholar
  5. Antoch G, Stattaus J, Nemat AT, et al. Non–small cell lung cancer: dual-modality PET/CT in preoperative staging. Radiology. 2003;229:526–33. Scholar
  6. Armato SG III, Labby ZE, Coolen J, et al. Imaging in pleural mesothelioma: a review of the 11th International Conference of the International Mesothelioma Interest Group. Lung Cancer. 2013;82:190–6. Scholar
  7. Atkinson W, Catana C, Abramson JS, et al. Hybrid FDG-PET/MRI compared to FDG-PET/CT in adult lymphoma patients. Abdom Radiol NY. 2016;41:1338–48. Scholar
  8. Basu S, Nair N. 18F-FDG uptake in bilateral adrenal hyperplasia causing Cushing’s syndrome. Eur J Nucl Med Mol Imaging. 2005;32:384. Scholar
  9. Beiderwellen K, Geraldo L, Ruhlmann V, et al. Accuracy of [18F]FDG PET/MRI for the detection of liver metastases. PLoS One. 2015;10:e0137285. Scholar
  10. Beiderwellen K, Gomez B, Buchbender C, et al. Depiction and characterization of liver lesions in whole body [18F]-FDG PET/MRI. Eur J Radiol. 2013a;82:e669–75. Scholar
  11. Beiderwellen K, Huebner M, Heusch P, et al. Whole-body [18F]FDG PET/MRI vs. PET/CT in the assessment of bone lesions in oncological patients: initial results. Eur Radiol. 2014;24:2023–30. Scholar
  12. Beiderwellen KJ, Poeppel TD, Hartung-Knemeyer V, et al. Simultaneous 68Ga-DOTATOC PET/MRI in patients with gastroenteropancreatic neuroendocrine tumors: initial results. Investig Radiol. 2013b;48:273–9. Scholar
  13. Biederer J, Beer M, Hirsch W, et al. MRI of the lung (2/3). Why … when … how? Insights Imaging. 2012;3:355–71. Scholar
  14. Boysen M, Lövdal O, Tausjö J. Winther F (1992) The value of follow-up in patients treated for squamous cell carcinoma of the head and neck. Eur J Cancer Oxf Engl. 1990;28:426–30.CrossRefGoogle Scholar
  15. Breathnach OS, Freidlin B, Conley B, et al. Twenty-two years of phase III trials for patients with advanced non–small-cell lung cancer: sobering results. J Clin Oncol. 2001;19:1734–42.PubMedCrossRefGoogle Scholar
  16. Buchbender C, Heusner TA, Lauenstein TC, et al. Oncologic PET/MRI, part 1: tumors of the brain, head and neck, chest, abdomen, and pelvis. J Nucl Med. 2012a;53:928–38. Scholar
  17. Buchbender C, Heusner TA, Lauenstein TC, et al. Oncologic PET/MRI, part 2: bone tumors, soft-tissue tumors, melanoma, and lymphoma. J Nucl Med. 2012b;53:1244–52. Scholar
  18. Burris NS, Johnson KM, Larson PEZ, et al. Detection of small pulmonary nodules with ultrashort echo time sequences in oncology patients by using a PET/MRI system. Radiology. 2016;278:239–46. Scholar
  19. Catalano OA, Nicolai E, Rosen BR, et al. Comparison of CE-FDG-PET/CT with CE-FDG-PET/MRI in the evaluation of osseous metastases in breast cancer patients. Br J Cancer. 2015;112:1452–60. Scholar
  20. Catalano OA, Rosen BR, Sahani DV, et al. Clinical impact of PET/MRI imaging in patients with cancer undergoing same-day PET/CT: initial experience in 134 patients—a hypothesis-generating exploratory study. Radiology. 2013;269:857–69. Scholar
  21. Chandarana H, Heacock L, Rakheja R, et al. Pulmonary nodules in patients with primary malignancy: comparison of hybrid PET/MRI and PET/CT imaging. Radiology. 2013;268:874–81. Scholar
  22. Cheson BD, Fisher RI, Barrington SF, et al. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: The Lugano classification. J Clin Oncol. 2014;32:3059–67. Scholar
  23. Colli A, Fraquelli M, Casazza G, et al. Accuracy of ultrasonography, spiral CT, magnetic resonance, and alpha-fetoprotein in diagnosing hepatocellular carcinoma: a systematic review. Am J Gastroenterol. 2006;101:513–23. Scholar
  24. Comoretto M, Balestreri L, Borsatti E, et al. Detection and restaging of residual and/or recurrent nasopharyngeal carcinoma after chemotherapy and radiation therapy: comparison of MR imaging and FDG PET/CT. Radiology. 2008;249:203–11. Scholar
  25. Coolen J, De Keyzer F, Nafteux P, et al. Malignant pleural mesothelioma: visual assessment by using pleural pointillism at diffusion-weighted MR imaging. Radiology. 2014;274:576–84. Scholar
  26. de Bree R, Deurloo EE, Snow GB, Leemans CR. Screening for distant metastases in patients with head and neck cancer. Laryngoscope. 2000;110:397–401. Scholar
  27. Donati OF, Hany TF, Reiner CS, et al. Value of retrospective fusion of PET and MR images in detection of hepatic metastases: comparison with 18F-FDG PET/CT and Gd-EOB-DTPA-enhanced MRI. J Nucl Med Off Publ Soc Nucl Med. 2010;51:692–9. Scholar
  28. D’souza MM, Sharma R, Mondal A, et al. Prospective evaluation of CECT and 18F-FDG-PET/CT in detection of hepatic metastases. Nucl Med Commun. 2009;30:117–25. Scholar
  29. Eiber M, Martinez-Möller A, Souvatzoglou M, et al. Value of a Dixon-based MR/PET attenuation correction sequence for the localization and evaluation of PET-positive lesions. Eur J Nucl Med Mol Imaging. 2011;38:1691–701. Scholar
  30. Engelbrecht V, Pisar E, Fürst G, Mödder U. Verlaufskontrolle und Rezidivdiagnostik maligner Kopf- und Halstumoren nach Radiochemotherapie. RöFo - Fortschritte Auf Dem Geb Röntgenstrahlen Bildgeb Verfahr. 1995;162:304–10. Scholar
  31. Engert A, Haverkamp H, Kobe C, et al. Reduced-intensity chemotherapy and PET-guided radiotherapy in patients with advanced stage Hodgkin’s lymphoma (HD15 trial): a randomised, open-label, phase 3 non-inferiority trial. Lancet. 2012;379:1791–9. Scholar
  32. Even-Sapir E. Imaging of malignant bone involvement by morphologic, scintigraphic, and hybrid modalities. J Nucl Med. 2005;46:1356–67.PubMedGoogle Scholar
  33. Flamen P, Lerut A, Van Cutsem E, et al. Utility of positron emission tomography for the staging of patients with potentially operable esophageal carcinoma. J Clin Oncol Off J Am Soc Clin Oncol. 2000;18:3202–10. Scholar
  34. Fowler KJ, Maughan NM, Laforest R, et al. PET/MRI of hepatic 90Y microsphere deposition determines individual tumor response. Cardiovasc Intervent Radiol. 2016;39:855–64. Scholar
  35. Fraioli F, Screaton NJ, Janes SM, et al. Non-small-cell lung cancer resectability: diagnostic value of PET/MRI. Eur J Nucl Med Mol Imaging. 2014;42:49–55. Scholar
  36. Freudenberg LS, Antoch G, Schütt P, et al. FDG-PET/CT in re-staging of patients with lymphoma. Eur J Nucl Med Mol Imaging. 2004;31:325–9. Scholar
  37. Gatidis S, Schmidt H, Claussen CD, Schwenzer NF. Multiparametrische Bildgebung mittels simultaner MR/PET. Radiology. 2013;53:669–75. Scholar
  38. Goeckenjan G, Sitter H, Thomas M, et al. Prevention, diagnosis, therapy, and follow-up of lung cancer. Pneumologie. 2010;65:39–59. Scholar
  39. Goodwin MD, Dobson JE, Sirlin CB, et al. Diagnostic challenges and pitfalls in MR imaging with hepatocyte-specific contrast agents. Radiographics. 2011;31:1547–68. Scholar
  40. Grégoire V, Lefebvre J-L, Licitra L, Felip E. Squamous cell carcinoma of the head and neck: EHNS–ESMO–ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010;21:v184–6. Scholar
  41. Grueneisen J, Sawicki LM, Schaarschmidt BM, et al. Evaluation of a fast protocol for staging lymphoma patients with integrated PET/MRI. PLoS One. 2016;11:e0157880. Scholar
  42. Haerle SK, Schmid DT, Ahmad N, et al. The value of (18)F-FDG PET/CT for the detection of distant metastases in high-risk patients with head and neck squamous cell carcinoma. Oral Oncol. 2011;47:653–9. Scholar
  43. Hafidh MA, Lacy PD, Hughes JP, et al. Evaluation of the impact of addition of PET to CT and MR scanning in the staging of patients with head and neck carcinomas. Eur Arch Oto-Rhino-Laryngol Head Neck. 2006;263:853–9. Scholar
  44. Haggar FA, Boushey RP. Colorectal cancer epidemiology: incidence, mortality, survival, and risk factors. Clin Colon Rectal Surg. 2009;22:191–7. Scholar
  45. Hahn S, Hecktor J, Grabellus F, et al. Diagnostic accuracy of dual-time-point 18F-FDG PET/CT for the detection of axillary lymph node metastases in breast cancer patients. Acta Radiol. 2012;53:518–23. Scholar
  46. Haider MA, Ghai S, Jhaveri K, Lockwood G. Chemical Shift MR imaging of hyperattenuating (>10 HU) adrenal masses: does it still have a role? Radiology. 2004;231:711–6. Scholar
  47. Hartung-Knemeyer V, Beiderwellen KJ, Buchbender C, et al. Optimizing positron emission tomography image acquisition protocols in integrated positron emission tomography/magnetic resonance imaging. Investig Radiol. 2013;48:290–4. Scholar
  48. Heacock L, Weissbrot J, Raad R, et al. PET/MRI for the evaluation of patients with lymphoma: initial observations. AJR Am J Roentgenol. 2015;204:842–8. Scholar
  49. Heelan RT, Rusch VW, Begg CB, et al. Staging of malignant pleural mesothelioma: comparison of CT and MR imaging. Am J Roentgenol. 1999;172:1039–47. Scholar
  50. Herrmann K, Queiroz M, Huellner MW, et al. Diagnostic performance of FDG-PET/MRI and WB-DW-MRI in the evaluation of lymphoma: a prospective comparison to standard FDG-PET/CT. BMC Cancer. 2015;15:1002. Scholar
  51. Heusch P, Buchbender C, Köhler J, et al. Correlation of the Apparent Diffusion Coefficient (ADC) with the Standardized Uptake Value (SUV) in hybrid 18F-FDG PET/MRI in Non-Small Cell Lung Cancer (NSCLC) lesions: initial results. RöFo - Fortschritte Auf Dem Geb Röntgenstrahlen Bildgeb Verfahr. 2013;185:1056–62. Scholar
  52. Heusch P, Buchbender C, Köhler J, et al. Thoracic staging in lung cancer: prospective comparison of 18F-FDG PET/MRI imaging and 18F-FDG PET/CT. J Nucl Med. 2014a;55:373–8. Scholar
  53. Heusch P, Nensa F, Schaarschmidt 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. 2014b;42:42–8. Scholar
  54. Heusch P, Sproll C, Buchbender C, et al. Diagnostic accuracy of ultrasound, 18F-FDG-PET/CT, and fused 18F-FDG-PET-MR images with DWI for the detection of cervical lymph node metastases of HNSCC. Clin Oral Investig. 2014c;18:969–78. Scholar
  55. Hintze C, Biederer J, Wenz HW, et al. MRI in staging of lung cancer. Radiology. 2006;46:251–254., 256–259. Scholar
  56. Hofman MS, Lau WFE, Hicks RJ. Somatostatin receptor imaging with 68Ga DOTATATE PET/CT: clinical utility, normal patterns, pearls, and pitfalls in interpretation. Radiographics. 2015;35:500–16. Scholar
  57. 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. 2015;40:1432–40. Scholar
  58. Howaldt HP, Vorast H, Blecher JC, et al. Results of the DOSAK tumor register. Mund- Kiefer- Gesichtschirurgie MKG. 2000;4(Suppl 1):S216–25.PubMedCrossRefGoogle Scholar
  59. Huellner MW, Appenzeller P, Kuhn FP, et al. Whole-body nonenhanced PET/MRI versus PET/CT in the staging and restaging of cancers: preliminary observations. Radiology. 2014;273:859–69. Scholar
  60. Huellner MW, Barbosa F de G, Husmann L, et al (2016) TNM staging of non–small cell lung cancer: comparison of PET/MRI and PET/CT. J Nucl Med 57:21–26. doi:
  61. Institute NC (2017a). Cancer stat facts: esophageal cancer. 2017.Google Scholar
  62. Institute NC (2017b). Cancer stat facts: non-hodgkin lymphoma. 2017.Google Scholar
  63. Institute NC (2017c). Cancer stat facts: hodgkin lymphoma. 2017.Google Scholar
  64. Jacobsson H, Larsson P, Jonsson C, et al. Normal uptake of 68Ga-DOTA-TOC by the pancreas uncinate process mimicking malignancy at somatostatin receptor PET. Clin Nucl Med. 2012;37:362–5. Scholar
  65. Kaemmerer D, Peter L, Lupp A, et al. Molecular imaging with 68Ga-SSTR PET/CT and correlation to immunohistochemistry of somatostatin receptors in neuroendocrine tumours. Eur J Nucl Med Mol Imaging. 2011;38:1659–68. Scholar
  66. Kanda T, Kitajima K, Suenaga Y, et al. Value of retrospective image fusion of 18F-FDG PET and MRI for preoperative staging of head and neck cancer: Comparison with PET/CT and contrast-enhanced neck MRI. Eur J Radiol. 2013;82:2005–10. Scholar
  67. Kang B, Lee JM, Song YS, et al. Added value of integrated whole-body PET/MRI for evaluation of colorectal cancer: comparison with contrast-enhanced MDCT. AJR Am J Roentgenol. 2016;206:10–20. Scholar
  68. Katyal S, Oliver JH, Peterson MS, et al. Extrahepatic metastases of hepatocellular carcinoma. Radiology. 2000;216:698–703. Scholar
  69. Khan MA, Combs CS, Brunt EM, et al. Positron emission tomography scanning in the evaluation of hepatocellular carcinoma. J Hepatol. 2000;32:792–7.PubMedCrossRefGoogle Scholar
  70. Kirchner J, Deuschl C, Grueneisen J, et al. (18)F-FDG PET/MRI in patients suffering from lymphoma: how much MRI information is really needed? Eur J Nucl Med Mol Imaging. 2017a.
  71. Kirchner J, Sawicki LM, Suntharalingam S, Grueneisen J, Ruhlmann V, Aktas B, Deuschl C, Herrmann K, Antoch G, Forsting M, Umutlu L. Whole-body staging of female patients with recurrent pelvic malignancies: Ultra-fast 18F-FDG PET/MRI compared to 18F-FDG PET/CT and CT. PLoS One. 2017b;12(2):e0172553. eCollection 2017. PubMedPubMedCentralCrossRefGoogle Scholar
  72. Klimstra DS, Beltran H, Lilenbaum R, Bergsland E. The spectrum of neuroendocrine tumors: histologic classification, unique features and areas of overlap. Am Soc Clin Oncol Educ Book Am Soc Clin Oncol Meet. 2015:92–103.  10.14694/EdBook_AM.2015.35.92.
  73. Kochhar R, Liong S, Manoharan P. The role of FDG PET/CT in patients with colorectal cancer metastases. Cancer Biomark Sect Dis Markers. 2010;7:235–48. Scholar
  74. Kong G, Jackson C, Koh DM, et al. The use of 18F-FDG PET/CT in colorectal liver metastases—comparison with CT and liver MRI. Eur J Nucl Med Mol Imaging. 2008;35:1323–9. Scholar
  75. Kulaksiz H, Eissele R, Rössler D, et al. Identification of somatostatin receptor subtypes 1, 2A, 3, and 5 in neuroendocrine tumours with subtype specific antibodies. Gut. 2002;50:52–60.PubMedPubMedCentralCrossRefGoogle Scholar
  76. Landwehr P, Schulte O, Lackner K. MR imaging of the chest: mediastinum and chest wall. Eur Radiol. 1999;9:1737–44. PubMedCrossRefGoogle Scholar
  77. Lardinois D, Weder W, Hany TF, et al. Staging of non–small-cell lung cancer with integrated positron-emission tomography and computed tomography. N Engl J Med. 2003;348:2500–7. Scholar
  78. Laubenbacher C, Saumweber D, Wagner-Manslau C, et al. Comparison of fluorine-18-fluorodeoxyglucose pet, mri and endoscopy for staging head and neck squamous-cell carcinomas. J Nucl Med. 1995;36:1747–57.PubMedGoogle Scholar
  79. Lee G, H I, Kim S-J, et al. Clinical implication of PET/MRI imaging in preoperative esophageal cancer staging: comparison with PET/CT, endoscopic ultrasonography, and CT. J Nucl Med. 2014;55:1242–7. Scholar
  80. Lee JH, Park JY, Kim DY, et al. Prognostic value of 18F-FDG PET for hepatocellular carcinoma patients treated with sorafenib. Liver. 2011;31:1144–9. Scholar
  81. Lell M, Baum U, Greess H, et al. Head and neck tumors: imaging recurrent tumor and post-therapeutic changes with CT and MRI. Eur J Radiol. 2000;33:239–47. Scholar
  82. Leslie A, Fyfe E, Guest P, et al. Staging of squamous cell carcinoma of the oral cavity and oropharynx: a comparison of MRI and CT in T- and N-staging. [miscellaneous article]. J Comput Assist Tomogr. 1999;23:43–9.PubMedCrossRefGoogle Scholar
  83. Lewis P, Marsden P, Gee T, et al. 18F-fluorodeoxyglucose positron emission tomography in preoperative evaluation of lung cancer. Lancet. 1994;344:1265–6.
  84. Leyn PD, Lardinois D, Schil PEV, et al. ESTS guidelines for preoperative lymph node staging for non-small cell lung cancer. Eur J Cardiothorac Surg. 2007;32:1–8. Scholar
  85. Liberale G, Van Laethem JL, Gay F, et al. The role of PET scan in the preoperative management of oesophageal cancer. Eur J Surg Oncol. 2004;30:942–7. Scholar
  86. Lin C-Y, Chen J-H, Liang J-A, et al. 18F-FDG PET or PET/CT for detecting extrahepatic metastases or recurrent hepatocellular carcinoma: a systematic review and meta-analysis. Eur J Radiol. 2012;81:2417–22. Scholar
  87. Liu S-A, Wong Y-K, Lin J-C, et al. Impact of recurrence interval on survival of oral cavity squamous cell carcinoma patients after local relapse. Otolaryngol Head Neck Surg. 2007;136:112–8. Scholar
  88. Loeffelbein DJ, Eiber M, Mayr P, et al. Loco-regional recurrence after surgical treatment of oral squamous cell carcinoma: Proposals for follow-up imaging based on literature, national guidelines and institutional experience. J Cranio-Maxillofac Surg. 2015;43:1546–52. Scholar
  89. Lonneux M, Lawson G, Ide C, et al. Positron emission tomography with fluorodeoxyglucose for suspected head and neck tumor recurrence in the symptomatic patient. Laryngoscope. 2000;110:1493–7. Scholar
  90. Lowe VJ, Booya F, Fletcher JG, et al. Comparison of positron emission tomography, computed tomography, and endoscopic ultrasound in the initial staging of patients with esophageal cancer. Mol Imaging Biol. 2005;7:422–30. Scholar
  91. Martinez-Möller A, Eiber M, Nekolla SG, et al. Workflow and scan protocol considerations for integrated whole-body PET/MRI in oncology. J Nucl Med. 2012;53:1415–26. Scholar
  92. Martini K, Meier A, Opitz I, et al. Diagnostic accuracy of sequential co-registered PET+MR in comparison to PET/CT in local thoracic staging of malignant pleural mesothelioma. Lung Cancer. 2016;94:40–5. Scholar
  93. Mehanna H, Wong W-L, McConkey CC, et al. PET-CT surveillance versus neck dissection in advanced head and neck cancer. N Engl J Med. 2016;374:1444–54. Scholar
  94. Meignan M, Gallamini A, Meignan M, et al. Report on the First International Workshop on interim-PET scan in lymphoma. Leuk Lymphoma. 2009;50:1257–60. Scholar
  95. Mittal S, El-Serag HB. Epidemiology of hepatocellular carcinoma: consider the population. J Clin Gastroenterol. 2013;47(Suppl):S2–6. Scholar
  96. Mücke T, Wagenpfeil S, Kesting MR, et al. Recurrence interval affects survival after local relapse of oral cancer. Oral Oncol. 2009;45:687–91. Scholar
  97. Nahmias C, Carlson ER, Duncan LD, et al. Positron Emission Tomography/Computerized Tomography (PET/CT) scanning for preoperative staging of patients with oral/head and neck cancer. J Oral Maxillofac Surg. 2007;65:2524–35. Scholar
  98. Nakamoto Y, Tamai K, Saga T, et al. Clinical value of image fusion from MR and PET in patients with head and neck cancer. Mol Imaging Biol. 2009;11:46–53. Scholar
  99. National Collaborating Centre for Cancer (UK). The diagnosis and treatment of lung cancer (update). Cardiff, UK: National Collaborating Centre for Cancer (UK); 2011.Google Scholar
  100. NCCN. National Comprehensive Cancer Network Guidelines for Patients. Colon Cancer. Version 1. 2016. Accessed Apr 2017Google Scholar
  101. Nensa F, Beiderwellen K, Heusch P, Wetter A. Clinical applications of PET/MRI: current status and future perspectives. Diagn Interv Radiol. 2014a;20:438–47. Scholar
  102. Nensa F, Stattaus J, Morgan B, et al. Dynamic contrast-enhanced MRI parameters as biomarkers for the effect of vatalanib in patients with non-small-cell lung cancer. Future Oncol. 2014b;10:823–33. Scholar
  103. Neumann V, Löseke S, Nowak D, et al. Malignant pleural mesothelioma. Dtsch Ärztebl Int. 2013;110:319–26. Scholar
  104. Nickell LT, Lichtenberger JP, Khorashadi L, et al. Multimodality imaging for characterization, classification, and staging of malignant pleural mesothelioma. Radiographics. 2014;34:1692–706. Scholar
  105. Nishino M, Hatabu H, Johnson BE, McLoud TC. State of the art: response assessment in lung cancer in the era of genomic medicine. Radiology. 2014;271:6–27. Scholar
  106. Nomori H, Mori T, Ikeda K, et al. Diffusion-weighted magnetic resonance imaging can be used in place of positron emission tomography for N staging of non–small cell lung cancer with fewer false-positive results. J Thorac Cardiovasc Surg. 2008;135:816–22. Scholar
  107. Nougaret S, Reinhold C, Mikhael HW, et al. The use of MR imaging in treatment planning for patients with rectal carcinoma: have you checked the “DISTANCE”? Radiology. 2013;268:330–44. Scholar
  108. Oberg K, Eriksson B. Endocrine tumours of the pancreas. Best Pract Res Clin Gastroenterol. 2005;19:753–81. Scholar
  109. Ogden GR. Second malignant tumours in head and neck cancer. BMJ. 1991;302:193–4.PubMedPubMedCentralCrossRefGoogle Scholar
  110. Ohno Y, Koyama H, Yoshikawa T, et al. Diffusion-weighted MRI versus 18F-FDG PET/CT: performance as predictors of tumor treatment response and patient survival in patients with non–small cell lung cancer receiving chemoradiotherapy. Am J Roentgenol. 2012;198:75–82. Scholar
  111. Opitz I. Management of malignant pleural mesothelioma—The European experience. J Thorac Dis. 2014;6:S238–52. Scholar
  112. Park BK, Kim CK, Kim B, Lee JH. Comparison of delayed enhanced CT and chemical shift MR for evaluating hyperattenuating incidental adrenal masses. Radiology. 2007;243:760–5. Scholar
  113. Park M-S, Kim S, Patel J, et al. Hepatocellular carcinoma: detection with diffusion-weighted versus contrast-enhanced magnetic resonance imaging in pretransplant patients. Hepatology. 2012;56:140–8. Scholar
  114. Partovi S, Kohan A, Vercher-Conejero JL, et al. Qualitative and quantitative performance of 18F-FDG-PET/MRI versus 18F-FDG-PET/CT in patients with head and neck cancer. Am J Neuroradiol. 2014a;35:1970–5. Scholar
  115. Partovi S, Kohan AA, Zipp L, et al. Hybrid PET/MRI imaging in two sarcoma patients – clinical benefits and implications for future trials. Int J Clin Exp Med. 2014b;7:640–8.PubMedPubMedCentralGoogle Scholar
  116. Paul SAM, Stoeckli SJ, von Schulthess GK, Goerres GW. FDG PET and PET/CT for the detection of the primary tumour in patients with cervical non-squamous cell carcinoma metastasis of an unknown primary. Eur Arch Oto Rhino Laryngol. 2007;264:189–95. Scholar
  117. Petersen RK, Hess S, Alavi A, Høilund-Carlsen PF. Clinical impact of FDG-PET/CT on colorectal cancer staging and treatment strategy. Am J Nucl Med Mol Imaging. 2014;4:471–82.PubMedPubMedCentralGoogle Scholar
  118. Peto J, Decarli A, Vecchia CL, et al. The European mesothelioma epidemic. Br J Cancer. 1999;79:666–72. Scholar
  119. Pichler BJ, Kolb A, Nägele T, Schlemmer H-P. PET/MRI: paving the way for the next generation of clinical multimodality imaging applications. J Nucl Med. 2010;51:333–6. Scholar
  120. Plathow C, Staab A, Schmaehl A, et al. Computed tomography, positron emission tomography, positron emission tomography/computed tomography, and magnetic resonance imaging for staging of limited pleural mesothelioma: initial results. Investig Radiol. 2008;43:737–44. Scholar
  121. Platzek I, Beuthien-Baumann B, Schramm G, et al. FDG PET/MRI in initial staging of sarcoma: Initial experience and comparison with conventional imaging. Clin Imaging. 2017;42:126–32. Scholar
  122. Ponisio MR, McConathy J, Laforest R, Khanna G. Evaluation of diagnostic performance of whole-body simultaneous PET/MRI in pediatric lymphoma. Pediatr Radiol. 2016;46:1258–68. Scholar
  123. Posther KE, McCall LM, Harpole DH, et al. Yield of brain 18F-FDG PET in evaluating patients with potentially operable non–small cell lung cancer. J Nucl Med. 2006;47:1607–11.PubMedGoogle Scholar
  124. Pöttgen C, Gauler T, Bellendorf A, et al. Standardized uptake decrease on [18F]-fluorodeoxyglucose positron emission tomography after neoadjuvant chemotherapy is a prognostic classifier for long-term outcome after multimodality treatment: secondary analysis of a randomized trial for resectable stage IIIA/B non–small-cell lung cancer. J Clin Oncol. 2016;34:2526–33. Scholar
  125. Queiroz MA, Hüllner M, Kuhn F, et al. PET/MRI and PET/CT in follow-up of head and neck cancer patients. Eur J Nucl Med Mol Imaging. 2014;41:1066–75. Scholar
  126. Ramalho M, AlObaidy M, Burke LM, et al. MR-PET evaluation of 1-month post-ablation therapy for hepatocellular carcinoma: preliminary observations. Abdom Imaging. 2015;40:1405–14. Scholar
  127. Regier M, Derlin T, Schwarz D, et al. Diffusion weighted MRI and 18F-FDG PET/CT in non-small cell lung cancer (NSCLC): Does the apparent diffusion coefficient (ADC) correlate with tracer uptake (SUV)? Eur J Radiol. 2012;81:2913–8. Scholar
  128. Riedl CC, Akhurst T, Larson S, et al. 18F-FDG PET scanning correlates with tissue markers of poor prognosis and predicts mortality for patients after liver resection for colorectal metastases. J Nucl Med. 2007;48:771–5. Scholar
  129. Robert Koch-Institut, Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V, editor. Krebs in Deutschland 2011/2012. 10th ed. Berlin: Auflage; 2015.Google Scholar
  130. Rodrigues RS, Bozza FA, Christian PE, et al. Comparison of whole-body PET/CT, dedicated high-resolution head and neck PET/CT, and contrast-enhanced CT in preoperative staging of clinically M0 squamous cell carcinoma of the head and neck. J Nucl Med. 2009;50:1205–13. Scholar
  131. Rogers SN, Brown JS, Woolgar JA, et al. Survival following primary surgery for oral cancer. Oral Oncol. 2009;45:201–11. Scholar
  132. Rubens RD. Bone metastases – the clinical problem. Eur J Cancer. 1998;1990(34):210–3.CrossRefGoogle Scholar
  133. Ruhlmann V, Ruhlmann M, Bellendorf A, et al. Hybrid imaging for detection of carcinoma of unknown primary: a preliminary comparison trial of whole-body PET/MRI versus PET/CT. Eur J Radiol. 2016;85:1941–7. Scholar
  134. Samarin A, Hüllner M, Queiroz MA, et al. 18F-FDG-PET/MRI increases diagnostic confidence in detection of bone metastases compared with 18F-FDG-PET/CT. Nucl Med Commun. 2015;36:1165–73. Scholar
  135. Sawicki LM, Deuschl C, Beiderwellen K, et al (2017) Evaluation of 68Ga-DOTATOC PET/MRI for whole-body staging of neuroendocrine tumours in comparison with 68Ga-DOTATOC PET/CT.Google Scholar
  136. Sawicki LM, Grueneisen J, Buchbender C, et al. Comparative performance of 18F-FDG PET/MRI and 18F-FDG PET/CT in detection and characterization of pulmonary lesions in 121 oncologic patients. J Nucl Med. 2016a;57:582–6. Scholar
  137. Sawicki LM, Grueneisen J, Buchbender C, et al. Evaluation of the outcome of lung nodules missed on 18F-FDG PET/MRI compared with 18F-FDG PET/CT in patients with known malignancies. J Nucl Med. 2016b;57:15–20. Scholar
  138. Schaarschmidt B, Buchbender C, Gomez B, et al. Thoracic staging of non-small-cell lung cancer using integrated 18F-FDG PET/MRI imaging: diagnostic value of different MR sequences. Eur J Nucl Med Mol Imaging. 2015a;42:1257–67. Scholar
  139. Schaarschmidt BM, Buchbender C, Nensa F, et al. Correlation of the Apparent Diffusion Coefficient (ADC) with the Standardized Uptake Value (SUV) in lymph node metastases of Non-Small Cell Lung Cancer (NSCLC) patients using hybrid 18F-FDG PET/MRI. PLoS One. 2015b;10:e0116277. Scholar
  140. Schaarschmidt BM, Gomez B, Buchbender C, et al. Is integrated 18F-FDG PET/MRI superior to 18F-FDG PET/CT in the differentiation of incidental tracer uptake in the head and neck area? Diagn Interv Radiol. 2017a;23:127–32. Scholar
  141. Schaarschmidt BM, Grueneisen J, Heusch P, et al. Does 18F-FDG PET/MRI reduce the number of indeterminate abdominal incidentalomas compared with 18F-FDG PET/CT? Nucl Med Commun. 2015c;36:588–95. Scholar
  142. Schaarschmidt BM, Grueneisen J, Metzenmacher M, et al. Thoracic staging with (18)F-FDG PET/MRI in non-small cell lung cancer - does it change therapeutic decisions in comparison to (18)F-FDG PET/CT? Eur Radiol. 2017b;27:681–8. Scholar
  143. Schaarschmidt BM, Heusch P, Buchbender C, et al. Locoregional tumour evaluation of squamous cell carcinoma in the head and neck area: a comparison between MRI, PET/CT and integrated PET/MRI. Eur J Nucl Med Mol Imaging. 2015d;43:92–102. Scholar
  144. Schaarschmidt BM, Sawicki LM, Gomez B, et al. Malignant pleural mesothelioma: initial experience in integrated 18F-FDG PET/MRI imaging. Clin Imaging. 2016;40:956–60. Scholar
  145. Schäfer JF, Gatidis S, Schmidt H, et al. Simultaneous whole-body PET/MRI imaging in comparison to PET/CT in pediatric oncology: initial results. Radiology. 2014;273:220–31. Scholar
  146. Schöder H, Carlson DL, Kraus DH, et al. 18F-FDG PET/CT for detecting nodal metastases in patients with oral cancer staged N0 by clinical examination and CT/MRI. J Nucl Med. 2006;47:755–62.PubMedGoogle Scholar
  147. Schreiter NF, Nogami M, Steffen I, et al. Evaluation of the potential of PET-MRI fusion for detection of liver metastases in patients with neuroendocrine tumours. Eur Radiol. 2012;22:458–67. Scholar
  148. Schroeder U, Dietlein M, Wittekindt C, et al. Is there a need for positron emission tomography imaging to stage the N0 neck in T1-T2 squamous cell carcinoma of the oral cavity or oropharynx? Ann Otol Rhinol Laryngol. 2008;117:854–63.PubMedCrossRefGoogle Scholar
  149. Schuler MK, Platzek I, Beuthien-Baumann B, et al. (18)F-FDG PET/MRI for therapy response assessment in sarcoma: comparison of PET and MR imaging results. Clin Imaging. 2015;39:866–70. Scholar
  150. Schuler MK, Richter S, Beuthien-Baumann B, et al. PET/MRI imaging in high-risk sarcoma: first findings and solving clinical problems. Case Rep Oncol Med. 2013.
  151. von Schulthess GK, Veit-Haibach P. Workflow considerations in PET/MRI imaging. J Nucl Med. 2014. jnumed.113.129239
  152. Schwartz LH, Ozsahin M, Zhang GN, et al. Synchronous and metachronous head and neck carcinomas. Cancer. 1994;74:1933–8.<1933::AID-CNCR2820740718>3.0.CO;2-X.PubMedCrossRefGoogle Scholar
  153. Schwenzer NF, Schraml C, Müller M, et al. Pulmonary lesion assessment: comparison of whole-body hybrid MR/PET and PET/CT imaging—pilot study. Radiology. 2012;264:551–8. Scholar
  154. Seo HJ, Kim M-J, Lee JD, et al. 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. Scholar
  155. Shang J, Ling X, Zhang L, et al. Comparison of RECIST, EORTC criteria and PERCIST for evaluation of early response to chemotherapy in patients with non-small-cell lung cancer. Eur J Nucl Med Mol Imaging. 2016;43:1945–53. Scholar
  156. Sher AC, Seghers V, Paldino MJ, et al. Assessment of sequential PET/MRI in comparison with PET/CT of pediatric lymphoma: a prospective study. AJR Am J Roentgenol. 2016;206:623–31. Scholar
  157. Shimizu A, Oriuchi N, Tsushima Y, et al. High [18F] 2-fluoro-2-deoxy-D-glucose (FDG) uptake of adrenocortical adenoma showing subclinical Cushing’s syndrome. Ann Nucl Med. 2003;17:403–6.PubMedCrossRefGoogle Scholar
  158. Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014;64:9–29. Scholar
  159. Sigal R, Zagdanski AM, Schwaab G, et al. CT and MR imaging of squamous cell carcinoma of the tongue and floor of the mouth. Radiographics. 1996;16:787–810. Scholar
  160. Sobin LH, Gospodarowicz MK, Wittekind C, editors. Lung. In: TNM classification of malignant tumours. Hoboken, NJ: John Wiley & Sons; 2011. p. 138–43.Google Scholar
  161. Sohn B, Koh YW, Kang WJ, et al. Is there an additive value of 18 F-FDG PET-CT to CT/MRI for detecting nodal metastasis in oropharyngeal squamous cell carcinoma patients with palpably negative neck? Acta Radiol. 2016;57:1352–9. Scholar
  162. Spick C, Herrmann K, Czernin J. 18F-FDG PET/CT and PET/MRI perform equally well in cancer: evidence from studies on more than 2,300 patients. J Nucl Med. 2016;57:420–30. Scholar
  163. Stolzmann P, Veit-Haibach P, Chuck N, et al. (2013) detection rate, location, and size of pulmonary nodules in trimodality PET/CT-MR: comparison of low-dose CT and Dixon-based MR imaging. Investig Radiol. 2013;48:241–6. Scholar
  164. Strobel K, Haerle SK, Stoeckli SJ, et al. Head and neck squamous cell carcinoma (HNSCC) – detection of synchronous primaries with (18)F-FDG-PET/CT. Eur J Nucl Med Mol Imaging. 2009;36:919–27. Scholar
  165. Sun L, Guan Y-S, Pan W-M, et al. Metabolic restaging of hepatocellular carcinoma using whole-body F-FDG PET/CT. World J Hepatol. 2009;1:90–7. Scholar
  166. Talbot J-N, Fartoux L, Balogova S, et al. Detection of hepatocellular carcinoma with PET/CT: a prospective comparison of 18F-fluorocholine and 18F-FDG in patients with cirrhosis or chronic liver disease. J Nucl Med. 2010;51:1699–706. Scholar
  167. Tateishi U, Yamaguchi U, Seki K, et al. Bone and soft-tissue sarcoma: preoperative staging with fluorine 18 fluorodeoxyglucose PET/CT and conventional imaging. Radiology. 2007;245:839–47. Scholar
  168. Tian J, Fu L, Yin D, et al. Does the novel integrated PET/MRI offer the same diagnostic performance as PET/CT for oncological indications? PLoS One. 2014;9:e90844. Scholar
  169. Torizuka T, Tamaki N, Inokuma T, et al. In vivo assessment of glucose metabolism in hepatocellular carcinoma with FDG-PET. J Nucl Med. 1995;36:1811–7.PubMedGoogle Scholar
  170. Treglia G, Castaldi P, Rindi G, et al. Diagnostic performance of Gallium-68 somatostatin receptor PET and PET/CT in patients with thoracic and gastroenteropancreatic neuroendocrine tumours: a meta-analysis. Endocrine. 2012;42:80–7. Scholar
  171. Vag T, Slotta-Huspenina J, Rosenberg R, et al. Computerized analysis of enhancement kinetics for preoperative lymph node staging in rectal cancer using dynamic contrast-enhanced magnetic resonance imaging. Clin Imaging. 2014;38:845–9. Scholar
  172. van Westreenen HL, Heeren PAM, van Dullemen HM, et al. Positron emission tomography with F-18-fluorodeoxyglucose in a combined staging strategy of esophageal cancer prevents unnecessary surgical explorations. J Gastrointest Surg. 2005;9:54–61. Scholar
  173. van Westreenen HL, Westerterp M, Bossuyt PMM, et al. Systematic review of the staging performance of 18F-fluorodeoxyglucose positron emission tomography in esophageal cancer. J Clin Oncol. 2004;22:3805–12. Scholar
  174. Vandecaveye V, Dirix P, De Keyzer F, et al. Predictive value of diffusion-weighted magnetic resonance imaging during chemoradiotherapy for head and neck squamous cell carcinoma. Eur Radiol. 2010;20:1703–14. Scholar
  175. Varghese TK, Hofstetter WL, Rizk NP, et al. The society of thoracic surgeons guidelines on the diagnosis and staging of patients with esophageal cancer. Ann Thorac Surg. 2013;96:346–56. Scholar
  176. Veit-Haibach P, Schaefer NG, Steinert HC, et al. Combined FDG-PET/CT in response evaluation of malignant pleural mesothelioma. Lung Cancer. 2010;67:311–7. Scholar
  177. Warburg O. Über den Stoffwechsel der Carcinomzelle. Naturwissenschaften. 1924;12:1131–7.CrossRefGoogle Scholar
  178. Weiler-Sagie M, Bushelev O, Epelbaum R, et al. (18)F-FDG avidity in lymphoma readdressed: a study of 766 patients. J Nucl Med. 2010;51:25–30. Scholar
  179. Wilcox BE, Subramaniam RM, Peller PJ, et al. Utility of integrated computed tomography—positron emission tomography for selection of operable malignant pleural mesothelioma. Clin Lung Cancer. 2009;10:244–8. Scholar
  180. Wolff K-D, Follmann M, Nast A. The diagnosis and treatment of oral cavity cancer. Dtsch Ärztebl Int. 2012;109:829–35. Scholar
  181. Wong KH, Panek R, Welsh L, et al. The predictive value of early assessment after 1 cycle of induction chemotherapy with 18F-FDG PET/CT and diffusion-weighted MRI for response to radical chemoradiotherapy in head and neck squamous cell carcinoma. J Nucl Med. 2016;57:1843–50. Scholar
  182. Wong WL, Saunders M. The impact of FDG PET on the management of occult primary head and neck tumours. Clin Oncol. 2003;15:461–6.CrossRefGoogle Scholar
  183. Wong WL, Sonoda LI, Gharpurhy A, et al. 18F-fluorodeoxyglucose positron emission tomography/computed tomography in the assessment of occult primary head and neck cancers--an audit and review of published studies. Clin Oncol. 2012;24:190–5. Scholar
  184. Xu P-J, Yan F-H, Wang J-H, et al. Contribution of diffusion-weighted magnetic resonance imaging in the characterization of hepatocellular carcinomas and dysplastic nodules in cirrhotic liver. J Comput Assist Tomogr. 2010;34:506–12. Scholar
  185. Yao JC, Hassan M, Phan A, et al. One hundred years after “carcinoid”: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol Off J Am Soc Clin Oncol. 2008;26:3063–72. Scholar
  186. Yildirim H, Metintas M, Entok E, et al. Clinical value of fluorodeoxyglucose-positron emission tomography/computed tomography in differentiation of malignant mesothelioma from asbestos-related benign pleural disease: an observational pilot study. J Thorac Oncol. 2009;4:1480–4. Scholar
  187. Yun M, Kim W, Alnafisi N, et al. 18F-FDG PET in characterizing adrenal lesions detected on CT or MRI. J Nucl Med. 2001;42:1795–9.PubMedGoogle Scholar
  188. Zhang X, Chen Y-LE, Lim R, et al. Synergistic role of simultaneous PET/MRI-MRS in soft tissue sarcoma metabolism imaging. Magn Reson Imaging. 2016;34:276–9. Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Benedikt M. Schaarschmidt
    • 1
  • Lino M. Sawicki
    • 1
  • Gerald Antoch
    • 1
  • Philipp Heusch
    • 1
  1. 1.Department of Diagnostic and Interventional RadiologyUniversity Dusseldorf, Medical FacultyDusseldorfGermany

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