PET/MRI versus PET/CT in oncology: a prospective single-center study of 330 examinations focusing on implications for patient management and cost considerations

Abstract

PurposePET/MRI has recently been introduced into clinical practice. We prospectively investigated the clinical impact of PET/MRI compared with PET/CT, in a mixed population of cancer patients, and performed an economic evaluation of PET/MRI.MethodsCancer patients referred for routine staging or follow-up by PET/CT underwent consecutive PET/CT and PET/MRI, using single applications of [18F]FDG, [68Ga]Ga-DOTANOC, or [18F]FDOPA, depending on tumor histology. PET/MRI and PET/CT were rated separately, and lesions were assessed per anatomic region; based on regions, per-examination and per-patient accuracies were determined. A simulated, multidisciplinary team meeting served as reference standard and determined whether differences between PET/CT and PET/MRI affected patient management. The McNemar tests were used to compare accuracies, and incremental cost-effectiveness ratios (ICERs) for PET/MRI were calculated.ResultsTwo hundred sixty-three patients (330 same-day PET/CT and PET/MRI examinations) were included. PET/MRI was accurate in 319/330 examinations and PET/CT in 277/330 examinations; the respective accuracies of 97.3% and 83.9% differed significantly (P < 0.001). The additional findings on PET/MRI—mainly liver and brain metastases—had implications for patient management in 21/263 patients (8.0%). The per-examination cost was 596.97 EUR for PET/MRI and 405.95 EUR for PET/CT. ICERs for PET/MRI were 14.26 EUR per percent of diagnostic accuracy and 23.88 EUR per percent of correctly managed patients.ConclusionsPET/MRI enables more appropriate management than PET/CT in a nonnegligible fraction of cancer patients. Since the per-examination cost is about 50% higher for PET/MRI than for PET/CT, a histology-based triage of patients to either PET/MRI or PET/CT may be meaningful.

Diagnostic performance of PET/computed tomography versus PET/MRI and diffusion-weighted imaging in the N- and M-staging of breast cancer patients

“…PET/MRI, a multimodal and multiparametric technique, may provide more quantitative information than PET/CT [ 58 ]. Even though the per-examination cost of 18F-FDG PET/MRI is approximately 50% higher, the possibility of a one-stop-shop solution for, for example, node-positive breast cancer patients could not only reduce costs in initial staging but could also reduce the burden on the patient [ 59 ].…”

Performance of Multiparametric Functional Imaging and Texture Analysis in Predicting Synchronous Metastatic Disease in Pancreatic Ductal Adenocarcinoma Patients by Hybrid PET/MR: Initial Experience

“…Hybrid PET/MR has been introduced into the clinical application setting since 2011. Studies on the feasibility and potential applications of PET/MR imaging have been reported soon after that, and oncology was one of the hot topic (4)(5)(6)(7)(8). Because multiparametric PET/MR imaging can provide many biomarkers of the studied diseases non-invasively, it was widely used in oncological research, especially for the tumor diagnosis, treatment planning, surveillance, and follow-up.…”

The spectrum of malignancies presenting with neurological manifestations: A prospective observational study

“…[1525] With recent advances in imaging, different groups have studied the predictive value of whole body CT, positron-emission CT (PET-CT), and PET-MRI in their respective settings; they recommend initial use of these techniques to increase the yield of cancer detection. [262728] Overall, PET-CT appears to be a reasonable choice depending on the availability and cost constraints, especially in patients presenting with solitary lesions. [29]…”