18F-FDG PET/MR versus MR Alone in Whole-Body Primary Staging and Restaging of Patients with Rectal Cancer: What Is the Benefit of PET?

Li, Yan; Mueller, Laura Isabel; Neuhaus, Jan; Bertram, Stefanie; Schaarschmidt, Benedikt Michael; Demircioğlu, Aydın; Ludwig, Johannes; Kirchner, Julian; Rischpler, Christoph; Herrmann, Ken; Catalano, Onofrio A.; Umutlu, Lale

doi:10.3390/jcm9103163

Cited by 11 publications

(7 citation statements)

References 26 publications

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“…A composite reference standard of clinical, imaging follow-up, and histopathology was used as the gold standard for staging. Another study investigated the benefit of PET/MRI in the staging and restaging of RC, but did not demonstrate a significant improvement in PET/MRI versus MRI diagnostic accuracy for locoregional T-and N-staging compared to MRI [38]. However, in that study, a mix of treated and untreated patients rendered the reference standard of histopathology difficult to assess.…”

Section: Discussionmentioning

confidence: 94%

Added value of quantitative, multiparametric 18F-FDG PET/MRI in the locoregional staging of rectal cancer

Herold

Wassipaul

Weber

et al. 2022

Eur J Nucl Med Mol Imaging

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Purpose The purpose of this study was to determine whether multiparametric positron emission tomography/magnetic resonance imaging (mpPET/MRI) can improve locoregional staging of rectal cancer (RC) and to assess its prognostic value after resection. Methods In this retrospective study, 46 patients with primary RC, who underwent multiparametric 18F-fluorodeoxyglucose (FDG) PET/MRI, followed by surgical resection without chemoradiotherapy, were included. Two readers reviewed T- and N- stage, mesorectal involvement, sphincter infiltration, tumor length, and distance from anal verge. In addition, diffusion-weighted imaging (DWI) and PET parameters were extracted from the multiparametric protocol and were compared to radiological staging as well as to the histopathological reference standard. Clinical and imaging follow-up was systematically assessed for tumor recurrence and death. Results Locally advanced rectal cancers (LARC) exhibited significantly higher metabolic tumor volume (MTV, AUC 0.74 [95% CI 0.59–0.89], p = 0.004) and total lesion glycolysis (TLG, AUC 0.70 [95% CI 0.53–0.87], p = 0.022) compared to early tumors. T-stage was associated with MTV (AUC 0.70 [95% CI 0.54–0.85], p = 0.021), while N-stage was better assessed using anatomical MRI sequences (AUC 0.72 [95% CI 0.539–0.894], p = 0.032). In the multivariate regression analysis, depending on the model, both anatomical MRI sequences and MTV/TLG were capable of detecting LARC. Combining anatomical MRI stage and MTV/TLG led to a superior diagnostic performance for detecting LARC (AUC 0.81, [95% CI 0.68–0.94], p < 0.001). In the survival analysis, MTV was independently associated with overall survival (HR 1.05 [95% CI 1.01–1.10], p = 0.044). Conclusion Multiparametric PET-MRI can improve identification of locally advanced tumors and, hence, help in treatment stratification. It provides additional information on RC tumor biology and may have prognostic value.

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Section: Discussionmentioning

confidence: 94%

Added value of quantitative, multiparametric 18F-FDG PET/MRI in the locoregional staging of rectal cancer

Herold

Wassipaul

Weber

et al. 2022

Eur J Nucl Med Mol Imaging

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“…Full-texts of the rest 20 articles were read, and 13 studies were removed according to the following reasons: data unavailable for analysis (n = 1), irrelevant subjects (n = 12). Finally, 7 studies regarding the diagnostic efficacy of 18F-FDG PET/MRI for CRC LN-metastatic primary staging were included [ 13 , 22 – 27 ]. The PRISMA flow-diagram of study selection is presented in Fig.…”

Section: Resultsmentioning

confidence: 99%

Lymph nodes primary staging of colorectal cancer in 18F-FDG PET/MRI: a systematic review and meta-analysis

Ren¹,

Chen

Shao³

et al. 2023

Eur J Med Res

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Objective To assess the diagnostic efficacy of 18F-FDG PET/MRI for lymph node (LN) metastasis primary staging in patients with colorectal cancer (CRC). Methods This study was conducted and reported in accordance with the PRISMA-DTA statement. Electronic databases (PubMed, Embase, Cochrane Library) were searched for studies on 18F-FDG PET/MRI for diagnosing LN metastasis. The pooled sensitivity (SEN), specificity (SPE), and area under the curve (AUC) were applied to assess the diagnostic performance. Heterogeneity was identified and processed using meta-regression and sensitivity analysis. All data analyses were performed via STATA 15 and Meta-Disc 1.4 software. Results There were finally 7 studies included, involving a total of 184 patients. The Spearman rank correlation coefficient was 0.108 (P = 0.818), with no threshold-effect observed. The pooled SEN was 0.81 (95%CI 0.66–0.90) and the SPE was 0.89 (95% CI 0.73–0.96). In sub-groups, prospective groups demonstrated to have the highest SEN of 0.92 (95%CI 0.79–1.00). The studies conducted by Catalano et al. and Kang et al. were considered to be potential sources of heterogeneity. Conclusion 18F-FDG PET/MRI has shown remarkable diagnostic performance in identification of LN metastases in newly diagnosed CRC patients. It would be of great application value for the primary staging of CRC lymph node metastases.

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“…However, most of these publications focused on preoperative TNM diagnosis. A study comparing [18F] FDG PET/MRI and MRI alone on preoperative TNM diagnostic performance reported no difference between the two groups [13]. They conclude that TNM staging is relatively accurate with MRI alone and that [18F] FDG PET has little additional diagnostic benefit.…”

Section: Discussionmentioning

confidence: 99%

18F-Fluorodeoxyglucose Positron Emission Tomography/Magnetic Resonance Imaging-Defined Extramural Venous Invasion Predicts Distant Metastasis and Reflects Strong Tumor Invasiveness in Rectal Cancer

Matsunaka¹,

Goi²,

Kurebayashi³

et al. 2023

Oncology

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Introduction: Extramural vascular invasion in patients with rectal cancer is a poor prognostic factor associated with distant metastasis; thus, accurate preoperative diagnosis is important. However, the accurate detection of extramural vascular invasion using magnetic resonance imaging is difficult, and an improved diagnostic modality is required. In addition, the factors involved in the formation of EMVI remain unclear. In this study, we aimed to examine the ability of [18F] FDG PET/MRI to detect EMVI and　elucidate the factors involved in EMVI. Methods: Thirty-one patients with rectal cancer were enrolled in this study between 2017 and 2021. We preoperatively evaluated the pelvic 18F-fluorodeoxyglucose positron emission tomography/ magnetic resonance imaging([18F] FDG PET/MRI) to detect extramural vascular invasion ([18F] FDG PET/MR-defined EMVI: pmrEMVI). To investigate the factors related to pmrEMVI, we confirmed the desmoplastic reaction and TWIST expression in the primary lesions of rectal cancer and examined its relationship with pmrEMVI. Results: Six of the 31 patients were pmrEMVI-positive. Four pmrEMVI-positive patients had distant metastases. The levels of immature desmoplastic reaction and TWIST1 expression were significantly higher in cases with pmrEMVI positivity. Conclusion: PmrEMVI is a useful biomarker for predicting distant metastasis. In addition, pmrEMVI was significantly correlated with factors related to tumor invasiveness.

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18F-FDG PET/MR versus MR Alone in Whole-Body Primary Staging and Restaging of Patients with Rectal Cancer: What Is the Benefit of PET?

Cited by 11 publications

References 26 publications

Added value of quantitative, multiparametric 18F-FDG PET/MRI in the locoregional staging of rectal cancer

Added value of quantitative, multiparametric 18F-FDG PET/MRI in the locoregional staging of rectal cancer

Lymph nodes primary staging of colorectal cancer in 18F-FDG PET/MRI: a systematic review and meta-analysis

18F-Fluorodeoxyglucose Positron Emission Tomography/Magnetic Resonance Imaging-Defined Extramural Venous Invasion Predicts Distant Metastasis and Reflects Strong Tumor Invasiveness in Rectal Cancer

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