Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Annals of Nuclear Medicine
Published in: Annals of Nuclear Medicine 6/2013

01-07-2013 | Original Article

The usefulness of 18F-FDG PET/MRI fusion image in diagnosing pancreatic tumor: comparison with 18F-FDG PET/CT

Authors: Shigeki Nagamachi, Ryuichi Nishii, Hideyuki Wakamatsu, Youichi Mizutani, Shogo Kiyohara, Seigo Fujita, Shigemi Futami, Tatefumi Sakae, Eiji Furukoji, Shozo Tamura, Hideo Arita, Kazuo Chijiiwa, Keiichi Kawai

Published in: Annals of Nuclear Medicine | Issue 6/2013

Login to get access

Abstract

Purpose

This study aimed at demonstrating the feasibility of retrospectively fused 18F FDG-PET and MRI (PET/MRI fusion image) in diagnosing pancreatic tumor, in particular differentiating malignant tumor from benign lesions. In addition, we evaluated additional findings characterizing pancreatic lesions by FDG-PET/MRI fusion image.

Methods

We analyzed retrospectively 119 patients: 96 cancers and 23 benign lesions. FDG-PET/MRI fusion images (PET/T1 WI or PET/T2WI) were made by dedicated software using 1.5 Tesla (T) MRI image and FDG-PET images. These images were interpreted by two well-trained radiologists without knowledge of clinical information and compared with FDG-PET/CT images. We compared the differential diagnostic capability between PET/CT and FDG-PET/MRI fusion image. In addition, we evaluated additional findings such as tumor structure and tumor invasion.

Results

FDG-PET/MRI fusion image significantly improved accuracy compared with that of PET/CT (96.6 vs. 86.6 %). As additional finding, dilatation of main pancreatic duct was noted in 65.9 % of solid types and in 22.6 % of cystic types, on PET/MRI-T2 fusion image. Similarly, encasement of adjacent vessels was noted in 43.1 % of solid types and in 6.5 % of cystic types. Particularly in cystic types, intra-tumor structures such as mural nodule (35.4 %) or intra-cystic septum (74.2 %) were detected additionally. Besides, PET/MRI-T2 fusion image could detect extra benign cystic lesions (9.1 % in solid type and 9.7 % in cystic type) that were not noted by PET/CT.

Conclusions

In diagnosing pancreatic lesions, FDG-PET/MRI fusion image was useful in differentiating pancreatic cancer from benign lesions. Furthermore, it was helpful in evaluating relationship between lesions and surrounding tissues as well as in detecting extra benign cysts.
Literature
1.
Murakami K. FDG-PET for hepatobiliary and pancreatic cancer: advances and current limitations. World J Clin Oncol. 2011;2:229–36.PubMed
2.
Takanami K, Hiraide T, Tsuda M, Nakamura Y, Kaneta T, Takase K, et al. Additional value of FDG PET/CT to contrast-enhanced CT in the differentiation between benign and malignant intraductal papillary mucinous neoplasms of the pancreas with mural nodules. Ann Nucl Med. 2011;25:501–10.PubMedCrossRef
3.
Berberat P, Friess H, Kashiwagi M, Beger HG, Buchler MW. Diagnosis and staging of pancreatic cancer by positron emission tomography. World J Surg. 1999;23:882–7.PubMedCrossRef
4.
Nakamoto Y, Saga T, Ishimori T, Higashi T, Mamede M, Okazaki K, et al. FDG-PET of autoimmune-related pancreatitis: preliminary results. Eur J Nucl Med. 2000;27:1835–8.PubMedCrossRef
5.
Okano K, Kakinoki K, Akamoto S, Hagiike M, Usuki H, Yamamoto Y, et al. 18F-fluorodeoxyglucose positron emission tomography in the diagnosis of small pancreatic cancer. World J Gastroenterol. 2011;17:231–5.PubMedCrossRef
6.
Lyshchik A, Higashi T, Nakamoto Y, Fujimoto K, Doi R, Imamura M, et al. Dual-phase 18F-fluoro-2-deoxy-d-glucose positron emission tomography as a prognostic parameter in patients with pancreatic cancer. Eur J Nucl Med Mol Imaging. 2005;32:389–97.PubMedCrossRef
7.
Friess H, Langhans J, Ebert M, Beger HG, Stollfuss J, Reske SN, et al. Diagnosis of pancreatic cancer by 2[18F]-fluoro-2-deoxy-d-glucose positron emission tomography. Gut. 1995;36:771–7.PubMedCrossRef
8.
Stollfuss JC, Glatting G, Friess H, Kocher F, Berger HG, Reske SN. 2-(fluorine-18)-fluoro-2-deoxy-d-glucose PET in detection of pancreatic cancer: value of quantitative image interpretation. Radiology. 1995;195:339–44.PubMed
9.
Higashi T, Saga T, Nakamoto Y, Ishimori T, Fujimoto K, Doi R, et al. Diagnosis of pancreatic cancer using fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET)—usefulness and limitations in “clinical reality”. Ann Nucl Med. 2003;17:261–79.PubMedCrossRef
10.
Schick V, Franzius C, Beyna T, Oei ML, Schnekenburger J, Weckesser M, et al. Diagnostic impact of 18F-FDG PET-CT evaluating solid pancreatic lesions versus endosonography, endoscopic retrograde cholangio-pancreatography with intraductal ultrasonography and abdominal ultrasound. Eur J Nucl Med Mol Imaging. 2008;35:1775–85.PubMedCrossRef
11.
Nguyen VX, Nguyen CC, Nguyen BD. (18)F-FDG PET/CT imaging of the pancreas: spectrum of diseases. J Pancreas 2011;12:557–66.
12.
Nagamachi S, Wakamatsu H, Kiyohara S, Fujita S, Futami S, Arita H, et al. Usefulness of a deep-inspiration breath-hold 18F-FDG PET/CT technique in diagnosing liver, bile duct, and pancreas tumors. Nucl Med Commun. 2009;30:326–32.PubMedCrossRef
13.
Mergo PJ, Helmberger TK, Buetow PC, Helmberger RC, Ros PR. Pancreatic neoplasms: mR imaging and pathologic correlation. Radiographics. 1997;17:281–301.PubMed
14.
Schlemmer HP, Pichler BJ, Krieg R, Heiss WD. An integrated MR/PET system: prospective applications. Abdom Imaging. 2009;34:668–74.PubMedCrossRef
15.
Schwenzer NF, Schraml C, Muller M, Brendle C, Sauter A, Spengler W, et al.: Pulmonary lesion assessment: comparison of whole-body hybrid MR/PET and PET/CT imaging—pilot study. Radiology. 2012;264:551–8.PubMedCrossRef
16.
Drzezga A, Souvatzoglou M, Eiber M, Beer AJ, Furst S, Martinez-Moller 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;53:845–55.PubMedCrossRef
17.
Donati OF, Hany TF, Reiner CS, von Schulthess GK, Marincek B, Seifert B, 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. 2010;51:692–9.PubMedCrossRef
18.
Nakajo K, Tatsumi M, Inoue A, Isohashi K, Higuchi I, Kato H, et al. Diagnostic performance of fluorodeoxyglucose positron emission tomography/magnetic resonance imaging fusion images of gynecological malignant tumors: comparison with positron emission tomography/computed tomography. Jpn J Radiol. 2010;28:95–100.PubMedCrossRef
19.
Ruf J. Lopez Hanninen E, Bohmig M, Koch I, Denecke T, Plotkin M, et al.: Impact of FDG-PET/MRI image fusion on the detection of pancreatic cancer. Pancreatology. 2006;6:512–9.PubMedCrossRef
20.
Tatsumi M, Isohashi K, Onishi H, Hori M, Kim T, Higuchi I, et al. 18F-FDG PET/MRI fusion in characterizing pancreatic tumors: comparison to PET/CT. Int J Clin Oncol. 2011;16:408–15.PubMedCrossRef
21.
Miller FH, Keppke AL, Wadhwa A, Ly JN, Dalal K, Kamler VA. MRI of pancreatitis and its complications: part 2, chronic pancreatitis. Am J Roentgenol. 2004;183:1645–52.CrossRef
22.
Ros PR, Mortele KJ. Imaging features of pancreatic neoplasms. JBR-BTR. 2001;84:239–49.PubMed
23.
Vitellas KM, Keogan MT, Spritzer CE, Nelson RC. MR cholangiopancreatography of bile and pancreatic duct abnormalities with emphasis on the single-shot fast spin-echo technique. Radiographics. 2000;20:939–57.PubMed
24.
Buchs NC, Chilcott M, Poletti PA, Buhler LH, Morel P. Vascular invasion in pancreatic cancer: imaging modalities, preoperative diagnosis and surgical management. World J Gastroenterol. 2010;16:818–31.PubMedCrossRef
25.
Lu DS, Reber HA, Krasny RM, Kadell BM, Sayre J. Local staging of pancreatic cancer: criteria for unresectability of major vessels as revealed by pancreatic-phase, thin-section helical CT. Am J Roentgenol. 1997;168:1439–43.CrossRef
26.
Nakayama Y, Yamashita Y, Kadota M, Takahashi M, Kanemitsu K, Hiraoka T, et al. Vascular encasement by pancreatic cancer: correlation of CT findings with surgical and pathologic results. J Comput Assist Tomogr. 2001;25:337–42.PubMedCrossRef
27.
Li H, Zeng MS, Zhou KR, Jin DY, Lou WH. Pancreatic adenocarcinoma: the different CT criteria for peripancreatic major arterial and venous invasion. J Comput Assist Tomogr. 2005;29:170–5.PubMedCrossRef
28.
Arakawa A, Yamashita Y, Namimoto T, Tang Y, Tsuruta J, Kanemitsu K, et al. Intraductal papillary tumors of the pancreas. Histopathologic correlation of MR cholangiopancreatography findings. Acta Radiol. 2000;41:343–7.PubMedCrossRef
29.
Lopez HE, Amthauer H, Hosten N, Ricke J, Bohmig M, Langrehr J, et al. Prospective evaluation of pancreatic tumors: accuracy of MR imaging with MR cholangiopancreatography and MR angiography. Radiology. 2002;224:34–41.CrossRef
30.
Irie H, Honda H, Aibe H, Kuroiwa T, Yoshimitsu K, Shinozaki K, et al. MR cholangiopancreatographic differentiation of benign and malignant intraductal mucin-producing tumors of the pancreas. AJR Am J Roentgenol. 2000;174:1403–8.PubMedCrossRef
31.
Ardengh JC, Goldman SM, de Lima-Filho ER. Current role of imaging methods in the diagnosis of cystic solid pancreas neoplasms: part II. Rev Col Bras Cir. 2011;38:192–7.PubMedCrossRef
32.
Zimny M, Schumpelick V. Fluorodeoxyglucose positron emission tomography (FDG-PET) in the differential diagnosis of pancreatic lesions. Chirurg. 2001;72:989–94.PubMedCrossRef
33.
Sahani DV, Sainani NI, Deshpande V, Shaikh MS, Frinkelberg DL. Fernandez-del Castillo C: Autoimmune pancreatitis: disease evolution, staging, response assessment, and CT features that predict response to corticosteroid therapy. Radiology. 2009;250:118–29.PubMedCrossRef
34.
Hakime A, Giraud M, Vullierme MP, Vilgrain V. MR imaging of the pancreas. J Radiol. 2007;88:11–25.PubMedCrossRef
35.
Sugiyama M, Izumisato Y, Abe N, Masaki T, Mori T, Atomi Y. Pancreatic carcinoma that completely obstructs the Wirsung duct without dilatation of the main pancreatic duct. J Gastroenterol Hepatol. 2006;21:1154–6.PubMedCrossRef
36.
Takuma K, Kamisawa T, Gopalakrishna R, Hara S, Tabata T, Inaba Y, et al. Strategy to differentiate autoimmune pancreatitis from pancreas cancer. World J Gastroenterol. 2012;18:1015–20.PubMedCrossRef
37.
Sahani DV, Kalva SP, Farrell J, Maher MM, Saini S, Mueller PR, et al. Autoimmune pancreatitis: imaging features. Radiology. 2004;233:345–52.PubMedCrossRef
38.
Fischer MA, Donati O, Heinrich S, Weber A, Hany TF, Soldini D, et al. Intraductal oncocytic papillary neoplasm of the pancreas: a radio-pathological case study. J Pancreas. 2010;11:49–54.
39.
Sperti C, Pasquali C, Chierichetti F, Liessi G, Ferlin G, Pedrazzoli S. Value of 18-fluorodeoxyglucose positron emission tomography in the management of patients with cystic tumors of the pancreas. Ann Surg. 2001;234:675–80.PubMedCrossRef
40.
Baiocchi GL, Portolani N, Bertagna F, Gheza F, Pizzocaro C, Giubbini R, et al. Possible additional value of 18FDG-PET in managing pancreas intraductal papillary mucinous neoplasms: preliminary results. J Exp Clin Cancer Res. 2008;27:10.PubMedCrossRef
41.
Ku YM, Shin SS, Lee CH, Semelka RC. Magnetic resonance imaging of cystic and endocrine pancreatic neoplasms. Top Magn Reson Imaging. 2009;20:11–8.PubMedCrossRef
42.
Kalb B, Sarmiento JM, Kooby DA, Adsay NV, Martin DR. MR imaging of cystic lesions of the pancreas. Radiographics. 2009;29:1749–65.PubMedCrossRef
43.
Pilleul F, Rochette A, Partensky C, Scoazec JY, Bernard P, Valette PJ. Preoperative evaluation of intraductal papillary mucinous tumors performed by pancreatic magnetic resonance imaging and correlated with surgical and histopathologic findings. J Magn Reson Imaging. 2005;21:237–44.PubMedCrossRef
44.
Schima W. MRI of the pancreas: tumours and tumour-simulating processes. Cancer Imaging. 2006;6:199–203.PubMedCrossRef
45.
Izuishi K, Yamamoto Y, Sano T, Takebayashi R, Masaki T, Suzuki Y. Impact of 18-fluorodeoxyglucose positron emission tomography on the management of pancreatic cancer. J Gastrointest Surg. 2010;14:1151–8.PubMedCrossRef
46.
Zhang XM, Mitchell DG, Witkiewicz A, Verma S, Bergin D. Extrapancreatic neural plexus invasion by pancreatic carcinoma: characteristics on magnetic resonance imaging. Abdom Imaging. 2009;34:634–41.PubMedCrossRef
47.
Mochizuki K, Gabata T, Kozaka K, Hattori Y, Zen Y, Kitagawa H, et al. MDCT findings of extrapancreatic nerve plexus invasion by pancreas head carcinoma: correlation with en bloc pathological specimens and diagnostic accuracy. Eur Radiol. 2010;20:1757–67.PubMedCrossRef
48.
Inagi E, Shimodan S, Amizuka H, Kigawa S, Shimizu Y, Nagashima K, et al. Pancreatic cancer initially presenting with a pseudocyst at the splenic flexure. Pathol Int. 2006;56:558–62.PubMedCrossRef
Metadata
Title
The usefulness of 18F-FDG PET/MRI fusion image in diagnosing pancreatic tumor: comparison with 18F-FDG PET/CT
Authors
Shigeki Nagamachi
Ryuichi Nishii
Hideyuki Wakamatsu
Youichi Mizutani
Shogo Kiyohara
Seigo Fujita
Shigemi Futami
Tatefumi Sakae
Eiji Furukoji
Shozo Tamura
Hideo Arita
Kazuo Chijiiwa
Keiichi Kawai
Publication date
01-07-2013
Publisher
Springer Japan
Published in
Annals of Nuclear Medicine / Issue 6/2013
Print ISSN: 0914-7187
Electronic ISSN: 1864-6433
DOI
https://doi.org/10.1007/s12149-013-0719-3

Other articles of this Issue 6/2013

Annals of Nuclear Medicine 6/2013 Go to the issue

Original Article

Scintigraphic comparison of renal ischemia–reperfusion injury models in rats: correlations with biochemical and histopathological findings

Original Article

Therapeutic efficacy of 188Re-MN-16ET lipiodol in an animal model of hepatocellular carcinoma

Original Article

Role of 2-[18F]fluoro-2-deoxyglucose positron emission tomography in preoperative management of solid-type small-sized lung cancer

Original Article

The clinical value of tumor FDG uptake for predicting axillary lymph node metastasis in breast cancer with clinically negative axillary lymph nodes

Original Article

Voxel-based analysis of 201Tl SPECT for grading and diagnostic accuracy of gliomas: comparison with ROI analysis

Original Article

Underestimation of the ejection fraction using the quantitative gated SPECT for patients with myocardial hypertrophy