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European Journal of Nuclear Medicine and Molecular Imaging

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Open Access 01-03-2014 | Original Article

Detection and quantification of focal uptake in head and neck tumours: ¹⁸F-FDG PET/MR versus PET/CT

Authors: Arthur Varoquaux, Olivier Rager, Antoine Poncet, Bénédicte M. A. Delattre, Osman Ratib, Christoph D. Becker, Pavel Dulguerov, Nicolas Dulguerov, Habib Zaidi, Minerva Becker

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 3/2014

Abstract

Purpose

Our objectives were to assess the quality of PET images and coregistered anatomic images obtained with PET/MR, to evaluate the detection of focal uptake and SUV, and to compare these findings with those of PET/CT in patients with head and neck tumours.

Methods

The study group comprised 32 consecutive patients with malignant head and neck tumours who underwent whole-body ¹⁸F-FDG PET/MR and PET/CT. PET images were reconstructed using the attenuation correction sequence for PET/MR and CT for PET/CT. Two experienced observers evaluated the anonymized data. They evaluated image and fusion quality, lesion conspicuity, anatomic location, number and size of categorized (benign versus assumed malignant) lesions with focal uptake. Region of interest (ROI) analysis was performed to determine SUVs of lesions and organs for both modalities. Statistical analysis considered data clustering due to multiple lesions per patient.

Results

PET/MR coregistration and image fusion was feasible in all patients. The analysis included 66 malignant lesions (tumours, metastatic lymph nodes and distant metastases), 136 benign lesions and 470 organ ROIs. There was no statistically significant difference between PET/MR and PET/CT regarding rating scores for image quality, fusion quality, lesion conspicuity or anatomic location, number of detected lesions and number of patients with and without malignant lesions. A high correlation was observed for SUV_mean and SUV_max measured on PET/MR and PET/CT for malignant lesions, benign lesions and organs (ρ = 0.787 to 0.877, p < 0.001). SUV_mean and SUV_max measured on PET/MR were significantly lower than on PET/CT for malignant tumours, metastatic neck nodes, benign lesions, bone marrow, and liver (p < 0.05). The main factor affecting the difference between SUVs in malignant lesions was tumour size (p < 0.01).

Conclusion

In patients with head and neck tumours, PET/MR showed equivalent performance to PET/CT in terms of qualitative results. Comparison of SUVs revealed an excellent correlation for measurements on both modalities, but underestimation of SUVs measured on PET/MR as compared to PET/CT.

Argiris A, Karamouzis MV, Raben D, Ferris RL. Head and neck cancer. Lancet. 2008;371(9625):1695–709.PubMedCrossRef

Becker M, Zbären P, Casselman JW, Kohler R, Dulguerov P, Becker CD. Neoplastic invasion of laryngeal cartilage: reassessment of criteria for diagnosis at MR imaging. Radiology. 2008;249(2):551–9.PubMedCrossRef

Hustinx R, Lucignani G. PET/CT in head and neck cancer: an update. Eur J Nucl Med Mol Imaging. 2010;37(3):645–51.PubMedCrossRef

Chawla SC, Federman N, Zhang D, Nagata K, Nuthakki S, McNitt-Gray M, et al. Estimated cumulative radiation dose from PET/CT in children with malignancies: a 5-year retrospective review. Pediatr Radiol. 2010;40(5):681–6.PubMedCentralPubMedCrossRef

Pichler BJ, Judenhofer MS, Catana C, Walton JH, Kneilling M, Nutt RE, et al. Performance test of an LSO-APD detector in a 7-T MRI scanner for simultaneous PET/MRI. J Nucl Med. 2006;47(4):639–47.PubMed

Zaidi H, Ojha N, Morich M, Griesmer J, Hu Z, Maniawski P, et al. Design and performance evaluation of a whole-body Ingenuity TF PET-MRI system. Phys Med Biol. 2011;56(10):3091–106.PubMedCrossRef

Zaidi H, Del Guerra A. An outlook on future design of hybrid PET/MRI systems. Med Phys. 2011;38(10):5667–89.PubMedCrossRef

Boss A, Bisdas S, Kolb A, Hofmann M, Ernemann U, Claussen CD, et al. Hybrid PET/MRI of intracranial masses: initial experiences and comparison to PET/CT. J Nucl Med. 2010;51(8):1198–205.PubMedCrossRef

Boss A, Stegger L, Bisdas S, Kolb A, Schwenzer N, Pfister M, et al. Feasibility of simultaneous PET/MR imaging in the head and upper neck area. Eur Radiol. 2011;21(7):1439–46.PubMedCrossRef

10.

Schlemmer H-PW, Pichler BJ, Schmand M, Burbar Z, Michel C, Ladebeck R, et al. Simultaneous MR/PET imaging of the human brain: feasibility study. Radiology. 2008;248(3):1028–35.PubMedCrossRef

11.

Vargas MI, Becker M, Garibotto V, Heinzer S, Loubeyre P, Gariani J, et al. Approaches for the optimization of MR protocols in clinical hybrid PET/MRI studies. MAGMA. 2013;26(1):57–69PubMedCrossRef

12.

Drzezga A, Souvatzoglou M, Eiber M, Beer AJ, Fürst S, Martinez-Möller A, et al. First clinical experience with integrated whole-body PET/MR: comparison to PET/CT in patients with oncologic diagnoses. J Nucl Med. 2012;53(6):845–55.PubMedCrossRef

13.

Eiber M, Martinez-Möller A, Souvatzoglou M, Holzapfel K, Pickhard A, Löffelbein D, 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(9):1691–701.PubMedCrossRef

14.

Eiber M, Souvatzoglou M, Pickhard A, Loeffelbein DJ, Knopf A, Holzapfel K, et al. Simulation of a MR-PET protocol for staging of head-and-neck cancer including Dixon MR for attenuation correction. Eur J Radiol. 2012;81(10):2658–65.PubMedCrossRef

15.

Delso G, Fürst S, Jakoby B, Ladebeck R, Ganter C, Nekolla SG, et al. Performance measurements of the Siemens mMR integrated whole-body PET/MR scanner. J Nucl Med. 2011;52(12):1914–22.PubMedCrossRef

16.

Kalemis A, Delattre BMA, Heinzer S. Sequential whole-body PET/MR scanner: concept, clinical use, and optimisation after two years in the clinic. The manufacturer’s perspective. MAGMA. 2013;26(1):5–23.PubMedCrossRef

17.

Ma J. Dixon techniques for water and fat imaging. J Magn Reson Imaging. 2008;28(3):543–58.PubMedCrossRef

18.

Schulz V, Torres-Espallardo I, Renisch S, Hu Z, Ojha N, Börnert P, et al. Automatic, three-segment, MR-based attenuation correction for whole-body PET/MR data. Eur J Nucl Med Mol Imaging. 2011;38(1):138–52.PubMedCrossRef

19.

Huang SC. Anatomy of SUV. Standardized uptake value. Nucl Med Biol. 2000;27(7):643–6.PubMedCrossRef

20.

Murakami R, Uozumi H, Hirai T, Nishimura R, Shiraishi S, Ota K, et al. Impact of FDG-PET/CT imaging on nodal staging for head-and-neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys. 2007;68(2):377–82.PubMedCrossRef

21.

Kim SY, Lee S, Nam SY, Im KC, Kim J-S, Oh SJ, et al. The feasibility of 18F-FDG PET scans 1 month after completing radiotherapy of squamous cell carcinoma of the head and neck. J Nucl Med. 2007;48(3):373–8.PubMed

22.

Varoquaux A, Rager O, Lovblad K-O, Masterson K, Dulguerov P, Ratib O, et al. Functional imaging of head and neck squamous cell carcinoma with diffusion-weighted MRI and FDG PET/CT: quantitative analysis of ADC and SUV. Eur J Nucl Med Mol Imaging. 2013;40(6):842–52.PubMedCentralPubMedCrossRef

23.

Kwiecien R, Kopp-Schneider A, Blettner M. Concordance analysis: part 16 of a series on evaluation of scientific publications. Dtsch Arztebl Int. 2011;108(30):515–21.PubMedCentralPubMed

24.

Bland JM, Altman DG. Measuring agreement in method comparison studies. Stat Methods Med Res. 1999;8(2):135–60.PubMedCrossRef

25.

Gönen M, Panageas KS, Larson SM. Statistical issues in analysis of diagnostic imaging experiments with multiple observations per patient. Radiology. 2001;221(3):763–7.PubMedCrossRef

26.

Galbraith S, Daniel JA, Vissel B. A study of clustered data and approaches to its analysis. J Neurosci. 2010;30(32):10601–8.PubMedCrossRef

27.

Wiesmüller M, Quick HH, Navalpakkam B, Lell MM, Uder M, Ritt P, et al. Comparison of lesion detection and quantitation of tracer uptake between PET from a simultaneously acquiring whole-body PET/MR hybrid scanner and PET from PET/CT. Eur J Nucl Med Mol Imaging. 2013;40(1):12–21.PubMedCrossRef

28.

Platzek I, Beuthien-Baumann B, Schneider M, Gudziol V, Langner J, Schramm G, et al. PET/MRI in head and neck cancer: initial experience. Eur J Nucl Med Mol Imaging. 2013;40(1):6–11.PubMedCentralPubMedCrossRef

29.

Matthies A, Hickeson M, Cuchiara A, Alavi A. Dual time point 18F-FDG PET for the evaluation of pulmonary nodules. J Nucl Med. 2002;43(7):871–5.PubMed

30.

Zhuang H, Pourdehnad M, Lambright ES, Yamamoto AJ, Lanuti M, Li P, et al. Dual time point 18F-FDG PET imaging for differentiating malignant from inflammatory processes. J Nucl Med. 2001;42(9):1412–7.PubMed

31.

Heusch P, Buchbender C, Beiderwellen K, Nensa F, Hartung-Knemeyer V, Lauenstein TC, et al. Standardized uptake values for [18F] FDG in normal organ tissues: comparison of whole-body PET/CT and PET/MRI. Eur J Radiol. 2013;82(5):870–6.PubMedCrossRef

32.

Bini J, Izquierdo-Garcia D, Mateo J, Machac J, Narula J, Fuster V, et al. Preclinical evaluation of MR attenuation correction versus CT attenuation correction on a sequential whole-body MR/PET scanner. Invest Radiol. 2013;48(5):313–22.PubMedCrossRef

33.

Ul-Hassan F, Simo R, Guerrero-Urbano T, Oakley R, Jeannon JP, Cook GJ. Can (18)F-FDG PET/CT reliably assess response to primary treatment of head and neck cancer? Clin Nucl Med. 2013;38(4):263–5.PubMedCrossRef

34.

Hoang JK, Das SK, Choudhury KR, Yoo DS, Brizel DM. Using FDG-PET to measure early treatment response in head and neck squamous cell carcinoma: quantifying intrinsic variability in order to understand treatment-induced change. AJNR Am J Neuroradiol. 2013;34(7):1428–33PubMedCrossRef

35.

Powell C, Schmidt M, Borri M, Koh DM, Partridge M, Riddell A, et al. Changes in functional imaging parameters following induction chemotherapy have important implications for individualized patient-based treatment regimens for advanced head and neck cancer. Radiother Oncol. 2013;106(1):112–7.PubMedCrossRef

36.

Hickeson M, Yun M, Matthies A, Zhuang H, Adam L-E, Lacorte L, et al. Use of a corrected standardized uptake value based on the lesion size on CT permits accurate characterization of lung nodules on FDG-PET. Eur J Nucl Med Mol Imaging. 2002;29(12):1639–47.PubMedCrossRef

37.

Adams MC, Turkington TG, Wilson JM, Wong TZ. A systematic review of the factors affecting accuracy of SUV measurements. AJR Am J Roentgenol. 2010;195(2):310–20.PubMedCrossRef

38.

Boellaard R, Krak NC, Hoekstra OS, Lammertsma AA. Effects of noise, image resolution, and ROI definition on the accuracy of standard uptake values: a simulation study. J Nucl Med. 2004;45(9):1519–27.PubMed

39.

Martinez-Möller A, Souvatzoglou M, Delso G, Bundschuh RA, Chefd’hotel C, Ziegler SI, et al. Tissue classification as a potential approach for attenuation correction in whole-body PET/MRI: evaluation with PET/CT data. J Nucl Med. 2009;50(4):520–6.PubMedCrossRef

40.

Berker Y, Franke J, Salomon A, Palmowski M, Donker H, Temur Y, et al. MRI-based attenuation correction for hybrid PET/MRI systems: a 4-class tissue segmentation technique using a combined ultrashort-echo-time/Dixon MRI sequence. J Nucl Med. 2012;53(5):796–804.PubMedCrossRef

41.

Akbarzadeh A, Ay MR, Ahmadian A, Riahi Alam N, Zaidi H. MRI-guided attenuation correction in whole-body PET/MR: assessment of the effect of bone attenuation. Ann Nucl Med. 2013;27(2):152–62.PubMedCrossRef

Title: Detection and quantification of focal uptake in head and neck tumours: 18F-FDG PET/MR versus PET/CT
Authors: Arthur Varoquaux
Olivier Rager
Antoine Poncet
Bénédicte M. A. Delattre
Osman Ratib
Christoph D. Becker
Pavel Dulguerov
Nicolas Dulguerov
Habib Zaidi
Minerva Becker
Publication date: 01-03-2014
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 3/2014
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-013-2580-y

At a glance: The STEP trials

Springer Medicine

Detection and quantification of focal uptake in head and neck tumours: ¹⁸F-FDG PET/MR versus PET/CT

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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