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

Rutegård, Miriam K.; Båtsman, Malin; Axelsson, Jan; Brynolfsson, Patrik; Brännström, Fredrik; Rutegård, Jörgen; Ljuslinder, Ingrid; Blomqvist, Lennart; Palmqvist, Richard; Rutegård, Martin; Riklund, Katrine

doi:10.1186/s40644-019-0237-1

Cited by 38 publications

(21 citation statements)

References 29 publications

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“…Rutegard et al [25] investigated the role of adding hybrid imaging ([18F]FDG PET/MRI and [18F]FDG PET/CT) in the staging and restaging of rectal cancer in 24 patients. In one case, PET alone detected a liver metastasis, thus upstaging the patient to M1 and prompting a change of therapeutic approach that led to a hepatic metastasectomy.…”

Section: Resultsmentioning

confidence: 99%

“…PET/MRI showed an advantage over PET/CT or contrast-enhanced CT in characterizing liver lesions that would have otherwise been too small to characterize or remained indeterminate. This is thanks to the opportunity to obtain diffusionweighted imaging sequences and use hepatocyte-specific contrast media, which can detect lesions in the hepatobiliary phase, providing an excellent contrast between liver and lesion [16,19,21,22,25,26].…”

Section: Discussionmentioning

confidence: 99%

“…Five studies examined the accuracy of [18F]FDG PET/MRI for the purpose of M staging [19,21,22,25,26], three of them prospective [22,25,26] and two retrospective [19,21] (Fig. 4).…”

Section: Stagingmentioning

confidence: 99%

“…Kang et al [21] demonstrated that PET/MRI provided additional information vis-à-vis the findings of other imaging modalities (such as CT) in a fair number of patients (27.5%). Compared with PET/CT, PET/MRI was also able to identify three more metastatic lesions involving the rectal and perirectal region in one study on 12 patients [23], and one additional metastatic lesion in a sample of 24 patients in another report [25].…”

Section: Stagingmentioning

confidence: 99%

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[18F]FDG PET/MRI in rectal cancer

et al. 2021

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We conducted a systematic literature review on the use of [18F]FDG PET/MRI for staging/restaging rectal cancer patients with PubMed, Scopus, and Web of Science, based on the PRISMA criteria. Three authors screened all titles and abstracts and examined the full texts of all the identified relevant articles. Studies containing aggregated or duplicated data, review articles, case reports, editorials, and letters were excluded. Ten reports met the inclusion criteria. Four studies examined T staging and one focused on local recurrences after surgery; the reported sensitivity (94–100%), specificity (73–94%), and accuracy (92–100%) varied only slightly from one study to another. The sensitivity, specificity, and accuracy of [18F]FDG PET/MRI for N staging were 90–93%, 92–94%, and 42–92%. [18F]FDG PET/MRI detected malignant nodes better than MRI, resulting in treatment change. For M staging, [18F]FDG PET/MRI outperformed [18F]FDG PET/CT and CT in detecting liver metastases, whereas it performed worse for lung metastases. The results of this review suggest that [18F]FDG PET/MRI should be used for rectal cancer restaging after chemoradiotherapy and to select patients for rectum-sparing approaches thanks to its accuracy in T and N staging. For M staging, it should be associated at least with a chest CT scan to rule out lung metastases.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Five studies examined the accuracy of [18F]FDG PET/MRI for the purpose of M staging [19,21,22,25,26], three of them prospective [22,25,26] and two retrospective [19,21] (Fig. 4).…”

Section: Stagingmentioning

confidence: 99%

Section: Stagingmentioning

confidence: 99%

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[18F]FDG PET/MRI in rectal cancer

et al. 2021

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“…This methodological study is based on the patients included in the prospective observational cohort study, RECTOPET (REctal Cancer Trial on PET/MRI/CT [NCT03846882]). The inclusion criteria for the ongoing RECTOPET study, as well as a flow chart presenting the path of the included patients through the various examinations, have been published elsewhere [ 21 ]. In summary, patients included in the RECTOPET study had a biopsy-proven rectal cancer and underwent a staging FDG-PET/CT and FDG-PET/MRI.…”

Section: Methodsmentioning

confidence: 99%

Rectal cancer: a methodological approach to matching PET/MRI to histopathology

et al. 2020

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Purpose To enable the evaluation of locoregional disease in the on-going RECTOPET (REctal Cancer Trial on PET/MRI/CT) study; a methodology to match mesorectal imaging findings to histopathology is presented, along with initial observations. Methods FDG-PET/MRI examinations were performed in twenty-four consecutively included patients with rectal adenocarcinoma. In nine patients, of whom five received neoadjuvant treatment, a postoperative MRI of the surgical specimen was performed. The pathological cut-out was performed according to clinical routine with the addition of photo documentation of each slice of the surgical specimen, meticulously marking the location, size, and type of pathology of each mesorectal finding. This allowed matching individual nodal structures from preoperative MRI, via the specimen MRI, to histopathology. Results Preoperative MRI identified 197 mesorectal nodal structures, of which 92 (47%) could be anatomically matched to histopathology. Of the matched nodal structures identified in both MRI and histopathology, 25% were found to be malignant. These malignant structures consisted of lymph nodes (43%), tumour deposits (48%), and extramural venous invasion (9%). One hundred eleven nodal structures (55%) could not be matched anatomically. Of these, 97 (87%) were benign lymph nodes, and 14 (13%) were malignant nodal structures. Five were malignant lymph nodes, and nine were tumour deposits, all of which had a short axis diameter < 5 mm. Conclusions We designed a method able to anatomically match and study the characteristics of individual mesorectal nodal structures, enabling further research on the impact of each imaging modality. Initial observations suggest that small malignant nodal structures assessed as lymph nodes in MRI often comprise other forms of mesorectal tumour spread. Trial registration Clinical Trials Identifier:NCT03846882.

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Development of a joint prediction model based on both the radiomics and clinical factors for preoperative prediction of circumferential resection margin in middle‐low rectal cancer using T2WI images

Ju,

Zheng,

et al. 2023

Medical Physics

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ObjectivesA circumferential resection margin (CRM) is an independent risk factor for local recurrence, distant metastasis, and poor overall survival of rectal cancer. In this study, we developed and validated a radiomics prediction model to predict perioperative surgical margins in patients with middle and low rectal cancer following neoadjuvant treatment and for decisions about treatment plans for patients.MethodsThis study retrospectively analyzed 275 patients from center 1(training cohort) and 120 patients from center 2(verification cohort) with rectal cancer diagnosed at two centers from July 2020 to July 2022 who underwent neoadjuvant therapy and had their CRM status confirmed by preoperative high‐resolution magnetic resonance imaging (MRI) scans. Radiomics signatures were extracted and screened from MRI images and a radiomics signature was built by the least absolute shrinkage and selection operator (LASSO) logistic regression model, which was combined with clinical signatures to construct a nomogram. The receiver operating characteristic (ROC) curve and area under the curve (AUC) value, sensitivity, specificity, positive predictive value, negative predictive value, and calibration curve were used to evaluate the predictive performance of the model.ResultsIn our research, the combined model has the best performance. In the training group, the radiomics model based on high‐spatial‐resolution T2‐weighted imaging (HR‐T2WI), clinical model and combined model demonstrated an AUC of 0.819 (0.802–0.833), 0.843 (0.822–0.861), and 0.910 (0.880‐0.940), respectively. In the validation group, they demonstrated an AUC of 0.745 (0.715–0.788), 0.827 (0.798–0.850), and 0.848 (0.779‐0.917), respectively. The calibration curve confirmed the clinical applicability of the model.ConclusionsThe individualized prediction model established by combining radiomics signatures and clinical signatures can efficiently and objectively predict perioperative margin invasion in patients with middle and low rectal cancer.

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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

Cited by 38 publications

References 29 publications

[18F]FDG PET/MRI in rectal cancer

[18F]FDG PET/MRI in rectal cancer

Rectal cancer: a methodological approach to matching PET/MRI to histopathology

Development of a joint prediction model based on both the radiomics and clinical factors for preoperative prediction of circumferential resection margin in middle‐low rectal cancer using T2WI images

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