Skip to main content
Top
Published in: EJNMMI Research 1/2020

Open Access 01-12-2020 | Magnetic Resonance Imaging | Original research

Diagnostic value of [18F]FDG PET/MRI for staging in patients with ovarian cancer

Authors: Hideaki Tsuyoshi, Tetsuya Tsujikawa, Shizuka Yamada, Hidehiko Okazawa, Yoshio Yoshida

Published in: EJNMMI Research | Issue 1/2020

Login to get access

Abstract

Purpose

To evaluate the diagnostic potential of PET/MRI with 2-[18F]fluoro-2-deoxy-d-glucose ([18F]FDG) in ovarian cancer.

Materials and methods

Participants comprised 103 patients with suspected ovarian cancer underwent pretreatment [18F]FDG PET/MRI, contrast-enhanced CT (ceCT) and pelvic dynamic contrast-enhanced MRI (ceMRI). Diagnostic performance of [18F]FDG PET/MRI and ceMRI for assessing the characterization and the extent of the primary tumor (T stage) and [18F]FDG PET/MRI and ceCT for assessing nodal (N stage) and distant (M stage) metastases was evaluated by two experienced readers. Histopathological and follow-up imaging results were used as the gold standard. The McNemar test was employed for statistical analysis.

Results

Accuracy for the characterization of suspected ovarian cancer was significantly better for [18F]FDG PET/MRI (92.5%) [95% confidence interval (CI) 0.84–0.95] than for ceMRI (80.6%) (95% CI 0.72–0.83) (p < 0.05). Accuracy for T status was 96.4% (95% CI 0.96–0.96) and 92.9% (95% CI 0.93–0.93) for [18F]FDG PET/MRI and ceMRI/ceCT, respectively. Patient-based accuracies for N and M status were 100% (95% CI 0.88–1.00) and 100% (95% CI 0.88–1.00) for [18F]FDG PET/MRI and 85.2% (95% CI 0.76–0.85) and 30.8% (95% CI 0.19–0.31) for ceCT and M staging representing significant differences (p < 0.01). Lesion-based sensitivity, specificity and accuracy for N status were 78.6% (95% CI 0.57–0.91), 95.7% (95% CI 0.93–0.97) and 93.9% (95% CI 0.89–0.97) for [18F]FDG PET/MRI and 42.9% (95% CI 0.24–0.58), 96.6% (95% CI 0.94–0.98) and 90.8% (95% CI 0.87–0.94) for ceCT.

Conclusions

[18F]FDG PET/MRI offers better sensitivity and specificity for the characterization and M staging than ceMRI and ceCT, and diagnostic value for T and N staging equivalent to ceMRI and ceCT, suggesting that [18F]FDG PET/MRI might represent a useful diagnostic alternative to conventional imaging modalities in ovarian cancer.
Appendix
Available only for authorised users
Literature
1.
go back to reference Mutch DG, Prat J. FIGO staging for ovarian, fallopian tube and peritoneal cancer. Gynecol Oncol. 2014;133(3):401–4.PubMedCrossRef Mutch DG, Prat J. FIGO staging for ovarian, fallopian tube and peritoneal cancer. Gynecol Oncol. 2014;133(3):401–4.PubMedCrossRef
2.
go back to reference Coleridge SL, Bryant A, Lyons TJ, Goodall RJ, Kehoe S, Morrison J. Chemotherapy versus surgery for initial treatment in advanced ovarian epithelial cancer. Cochrane Database Syst Rev. 2019;2019(10):CD005343. Coleridge SL, Bryant A, Lyons TJ, Goodall RJ, Kehoe S, Morrison J. Chemotherapy versus surgery for initial treatment in advanced ovarian epithelial cancer. Cochrane Database Syst Rev. 2019;2019(10):CD005343.
3.
go back to reference Anthoulakis C, Nikoloudis N. Pelvic MRI as the "gold standard" in the subsequent evaluation of ultrasound-indeterminate adnexal lesions: a systematic review. Gynecol Oncol. 2014;132(3):661–8.PubMedCrossRef Anthoulakis C, Nikoloudis N. Pelvic MRI as the "gold standard" in the subsequent evaluation of ultrasound-indeterminate adnexal lesions: a systematic review. Gynecol Oncol. 2014;132(3):661–8.PubMedCrossRef
4.
go back to reference Kinkel K, Lu Y, Mehdizade A, Pelte MF, Hricak H. Indeterminate ovarian mass at US: incremental value of second imaging test for characterization–meta-analysis and Bayesian analysis. Radiology. 2005;236(1):85–94.PubMedCrossRef Kinkel K, Lu Y, Mehdizade A, Pelte MF, Hricak H. Indeterminate ovarian mass at US: incremental value of second imaging test for characterization–meta-analysis and Bayesian analysis. Radiology. 2005;236(1):85–94.PubMedCrossRef
5.
go back to reference Forstner R, Thomassin-Naggara I, Cunha TM, Kinkel K, Masselli G, Kubik-Huch R, et al. ESUR recommendations for MR imaging of the sonographically indeterminate adnexal mass: an update. Eur Radiol. 2017;27(6):2248–57.PubMedCrossRef Forstner R, Thomassin-Naggara I, Cunha TM, Kinkel K, Masselli G, Kubik-Huch R, et al. ESUR recommendations for MR imaging of the sonographically indeterminate adnexal mass: an update. Eur Radiol. 2017;27(6):2248–57.PubMedCrossRef
6.
go back to reference Han S, Woo S, Suh CH, Lee JJ. Performance of pre-treatment (1)(8)F-fluorodeoxyglucose positron emission tomography/computed tomography for detecting metastasis in ovarian cancer: a systematic review and meta-analysis. J Gynecol Oncol. 2018;29(6):e98.PubMedPubMedCentralCrossRef Han S, Woo S, Suh CH, Lee JJ. Performance of pre-treatment (1)(8)F-fluorodeoxyglucose positron emission tomography/computed tomography for detecting metastasis in ovarian cancer: a systematic review and meta-analysis. J Gynecol Oncol. 2018;29(6):e98.PubMedPubMedCentralCrossRef
7.
go back to reference Kim SJ, Lee SW. Diagnostic accuracy of (18)F-FDG PET/CT for detection of peritoneal carcinomatosis; a systematic review and meta-analysis. Br J Radiol. 2018;91(1081):20170519.PubMedCrossRef Kim SJ, Lee SW. Diagnostic accuracy of (18)F-FDG PET/CT for detection of peritoneal carcinomatosis; a systematic review and meta-analysis. Br J Radiol. 2018;91(1081):20170519.PubMedCrossRef
8.
go back to reference Yuan Y, Gu ZX, Tao XF, Liu SY. Computer tomography, magnetic resonance imaging, and positron emission tomography or positron emission tomography/computer tomography for detection of metastatic lymph nodes in patients with ovarian cancer: a meta-analysis. Eur J Radiol. 2012;81(5):1002–6.PubMedCrossRef Yuan Y, Gu ZX, Tao XF, Liu SY. Computer tomography, magnetic resonance imaging, and positron emission tomography or positron emission tomography/computer tomography for detection of metastatic lymph nodes in patients with ovarian cancer: a meta-analysis. Eur J Radiol. 2012;81(5):1002–6.PubMedCrossRef
9.
go back to reference Gu P, Pan LL, Wu SQ, Sun L, Huang G. CA 125, PET alone, PET-CT, CT and MRI in diagnosing recurrent ovarian carcinoma: a systematic review and meta-analysis. Eur J Radiol. 2009;71(1):164–74.PubMedCrossRef Gu P, Pan LL, Wu SQ, Sun L, Huang G. CA 125, PET alone, PET-CT, CT and MRI in diagnosing recurrent ovarian carcinoma: a systematic review and meta-analysis. Eur J Radiol. 2009;71(1):164–74.PubMedCrossRef
10.
go back to reference Limei Z, Yong C, Yan X, Shuai T, Jiangyan X, Zhiqing L. Accuracy of positron emission tomography/computed tomography in the diagnosis and restaging for recurrent ovarian cancer: a meta-analysis. Int J Gynecol Cancer. 2013;23(4):598–607.PubMedCrossRef Limei Z, Yong C, Yan X, Shuai T, Jiangyan X, Zhiqing L. Accuracy of positron emission tomography/computed tomography in the diagnosis and restaging for recurrent ovarian cancer: a meta-analysis. Int J Gynecol Cancer. 2013;23(4):598–607.PubMedCrossRef
11.
go back to reference Tsuyoshi H, Yoshida Y. Diagnostic imaging using positron emission tomography for gynecological malignancy. J Obstet Gynaecol Res. 2017;43(11):1687–99.PubMedCrossRef Tsuyoshi H, Yoshida Y. Diagnostic imaging using positron emission tomography for gynecological malignancy. J Obstet Gynaecol Res. 2017;43(11):1687–99.PubMedCrossRef
12.
go back to reference Zheng M, Xie D, Pan C, Xu Y, Yu W. Diagnostic value of 18F-FDG PET/MRI in recurrent pelvis malignancies of female patients: a systematic review and meta-analysis. Nucl Med Commun. 2018;39(6):479–85.PubMedCrossRef Zheng M, Xie D, Pan C, Xu Y, Yu W. Diagnostic value of 18F-FDG PET/MRI in recurrent pelvis malignancies of female patients: a systematic review and meta-analysis. Nucl Med Commun. 2018;39(6):479–85.PubMedCrossRef
13.
go back to reference Queiroz MA, Kubik-Huch RA, Hauser N, Freiwald-Chilla B, von Schulthess G, Froehlich JM, et al. PET/MRI and PET/CT in advanced gynaecological tumours: initial experience and comparison. Eur Radiol. 2015;25(8):2222–30.PubMedCrossRef Queiroz MA, Kubik-Huch RA, Hauser N, Freiwald-Chilla B, von Schulthess G, Froehlich JM, et al. PET/MRI and PET/CT in advanced gynaecological tumours: initial experience and comparison. Eur Radiol. 2015;25(8):2222–30.PubMedCrossRef
14.
go back to reference Fiaschetti V, Calabria F, Crusco S, Meschini A, Nucera F, Schillaci O, et al. MR-PET fusion imaging in evaluating adnexal lesions: a preliminary study. Radiol Med. 2011;116(8):1288–302.PubMedCrossRef Fiaschetti V, Calabria F, Crusco S, Meschini A, Nucera F, Schillaci O, et al. MR-PET fusion imaging in evaluating adnexal lesions: a preliminary study. Radiol Med. 2011;116(8):1288–302.PubMedCrossRef
15.
go back to reference Roze JF, Hoogendam JP, van de Wetering FT, Spijker R, Verleye L, Vlayen J, et al. Positron emission tomography (PET) and magnetic resonance imaging (MRI) for assessing tumour resectability in advanced epithelial ovarian/fallopian tube/primary peritoneal cancer. Cochrane Database Syst Rev. 2018;10:CD012567.PubMed Roze JF, Hoogendam JP, van de Wetering FT, Spijker R, Verleye L, Vlayen J, et al. Positron emission tomography (PET) and magnetic resonance imaging (MRI) for assessing tumour resectability in advanced epithelial ovarian/fallopian tube/primary peritoneal cancer. Cochrane Database Syst Rev. 2018;10:CD012567.PubMed
16.
go back to reference Forstner R, Sala E, Kinkel K, Spencer JA, European Society of Urogenital R. ESUR guidelines: ovarian cancer staging and follow-up. Eur Radiol. 2010;20(12):2773–80.PubMedCrossRef Forstner R, Sala E, Kinkel K, Spencer JA, European Society of Urogenital R. ESUR guidelines: ovarian cancer staging and follow-up. Eur Radiol. 2010;20(12):2773–80.PubMedCrossRef
18.
go back to reference van der Vos CS, Koopman D, Rijnsdorp S, Arends AJ, Boellaard R, van Dalen JA, et al. Quantification, improvement, and harmonization of small lesion detection with state-of-the-art PET. Eur J Nucl Med Mol Imaging. 2017;44(Suppl 1):4–16.PubMedPubMedCentral van der Vos CS, Koopman D, Rijnsdorp S, Arends AJ, Boellaard R, van Dalen JA, et al. Quantification, improvement, and harmonization of small lesion detection with state-of-the-art PET. Eur J Nucl Med Mol Imaging. 2017;44(Suppl 1):4–16.PubMedPubMedCentral
19.
go back to reference Forstner R, Hricak H, Occhipinti KA, Powell CB, Frankel SD, Stern JL. Ovarian cancer: staging with CT and MR imaging. Radiology. 1995;197(3):619–26.PubMedCrossRef Forstner R, Hricak H, Occhipinti KA, Powell CB, Frankel SD, Stern JL. Ovarian cancer: staging with CT and MR imaging. Radiology. 1995;197(3):619–26.PubMedCrossRef
20.
go back to reference Kinkel K, Forstner R, Danza FM, Oleaga L, Cunha TM, Bergman A, et al. Staging of endometrial cancer with MRI: guidelines of the European Society of Urogenital Imaging. Eur Radiol. 2009;19(7):1565–74.PubMedCrossRef Kinkel K, Forstner R, Danza FM, Oleaga L, Cunha TM, Bergman A, et al. Staging of endometrial cancer with MRI: guidelines of the European Society of Urogenital Imaging. Eur Radiol. 2009;19(7):1565–74.PubMedCrossRef
21.
go back to reference Bipat S, Glas AS, van der Velden J, Zwinderman AH, Bossuyt PM, Stoker J. Computed tomography and magnetic resonance imaging in staging of uterine cervical carcinoma: a systematic review. Gynecol Oncol. 2003;91(1):59–66.PubMedCrossRef Bipat S, Glas AS, van der Velden J, Zwinderman AH, Bossuyt PM, Stoker J. Computed tomography and magnetic resonance imaging in staging of uterine cervical carcinoma: a systematic review. Gynecol Oncol. 2003;91(1):59–66.PubMedCrossRef
22.
go back to reference Antonsen SL, Jensen LN, Loft A, Berthelsen AK, Costa J, Tabor A, et al. MRI, PET/CT and ultrasound in the preoperative staging of endometrial cancer: a multicenter prospective comparative study. Gynecol Oncol. 2013;128(2):300–8.PubMedCrossRef Antonsen SL, Jensen LN, Loft A, Berthelsen AK, Costa J, Tabor A, et al. MRI, PET/CT and ultrasound in the preoperative staging of endometrial cancer: a multicenter prospective comparative study. Gynecol Oncol. 2013;128(2):300–8.PubMedCrossRef
23.
go back to reference Kitajima K, Suenaga Y, Ueno Y, Kanda T, Maeda T, Deguchi M, et al. Fusion of PET and MRI for staging of uterine cervical cancer: comparison with contrast-enhanced (18)F-FDG PET/CT and pelvic MRI. Clin Imaging. 2014;38(4):464–9.PubMedCrossRef Kitajima K, Suenaga Y, Ueno Y, Kanda T, Maeda T, Deguchi M, et al. Fusion of PET and MRI for staging of uterine cervical cancer: comparison with contrast-enhanced (18)F-FDG PET/CT and pelvic MRI. Clin Imaging. 2014;38(4):464–9.PubMedCrossRef
24.
go back to reference Sarabhai T, Schaarschmidt BM, Wetter A, Kirchner J, Aktas B, Forsting M, et al. Comparison of (18)F-FDG PET/MRI and MRI for pre-therapeutic tumor staging of patients with primary cancer of the uterine cervix. Eur J Nucl Med Mol Imaging. 2018;45(1):67–766.PubMedCrossRef Sarabhai T, Schaarschmidt BM, Wetter A, Kirchner J, Aktas B, Forsting M, et al. Comparison of (18)F-FDG PET/MRI and MRI for pre-therapeutic tumor staging of patients with primary cancer of the uterine cervix. Eur J Nucl Med Mol Imaging. 2018;45(1):67–766.PubMedCrossRef
25.
go back to reference Schmidt S, Meuli RA, Achtari C, Prior JO. Peritoneal carcinomatosis in primary ovarian cancer staging: comparison between MDCT, MRI, and 18F-FDG PET/CT. Clin Nucl Med. 2015;40(5):371–7.PubMedCrossRef Schmidt S, Meuli RA, Achtari C, Prior JO. Peritoneal carcinomatosis in primary ovarian cancer staging: comparison between MDCT, MRI, and 18F-FDG PET/CT. Clin Nucl Med. 2015;40(5):371–7.PubMedCrossRef
26.
go back to reference Nam EJ, Yun MJ, Oh YT, Kim JW, Kim JH, Kim S, et al. Diagnosis and staging of primary ovarian cancer: correlation between PET/CT, Doppler US, and CT or MRI. Gynecol Oncol. 2010;116(3):389–94.PubMedCrossRef Nam EJ, Yun MJ, Oh YT, Kim JW, Kim JH, Kim S, et al. Diagnosis and staging of primary ovarian cancer: correlation between PET/CT, Doppler US, and CT or MRI. Gynecol Oncol. 2010;116(3):389–94.PubMedCrossRef
27.
go back to reference Morsing A, Hildebrandt MG, Vilstrup MH, Wallenius SE, Gerke O, Petersen H, et al. Hybrid PET/MRI in major cancers: a scoping review. Eur J Nucl Med Mol Imaging. 2019;46(10):2138–51.PubMedCrossRef Morsing A, Hildebrandt MG, Vilstrup MH, Wallenius SE, Gerke O, Petersen H, et al. Hybrid PET/MRI in major cancers: a scoping review. Eur J Nucl Med Mol Imaging. 2019;46(10):2138–51.PubMedCrossRef
28.
go back to reference Pelissier A, Bonneau C, Chereau E, de La Motte RT, Fourchotte V, Darai E, et al. CA125 kinetic parameters predict optimal cytoreduction in patients with advanced epithelial ovarian cancer treated with neoadjuvant chemotherapy. Gynecol Oncol. 2014;135(3):542–6.PubMedCrossRef Pelissier A, Bonneau C, Chereau E, de La Motte RT, Fourchotte V, Darai E, et al. CA125 kinetic parameters predict optimal cytoreduction in patients with advanced epithelial ovarian cancer treated with neoadjuvant chemotherapy. Gynecol Oncol. 2014;135(3):542–6.PubMedCrossRef
29.
go back to reference Vallius T, Peter A, Auranen A, Carpen O, Kemppainen J, Matomaki J, et al. 18F-FDG-PET/CT can identify histopathological non-responders to platinum-based neoadjuvant chemotherapy in advanced epithelial ovarian cancer. Gynecol Oncol. 2016;140(1):29–35.PubMedCrossRef Vallius T, Peter A, Auranen A, Carpen O, Kemppainen J, Matomaki J, et al. 18F-FDG-PET/CT can identify histopathological non-responders to platinum-based neoadjuvant chemotherapy in advanced epithelial ovarian cancer. Gynecol Oncol. 2016;140(1):29–35.PubMedCrossRef
30.
go back to reference Sarabhai T, Tschischka A, Stebner V, Nensa F, Wetter A, Kimmig R, et al. Simultaneous multiparametric PET/MRI for the assessment of therapeutic response to chemotherapy or concurrent chemoradiotherapy of cervical cancer patients: preliminary results. Clin Imaging. 2018;49:163–8.PubMedCrossRef Sarabhai T, Tschischka A, Stebner V, Nensa F, Wetter A, Kimmig R, et al. Simultaneous multiparametric PET/MRI for the assessment of therapeutic response to chemotherapy or concurrent chemoradiotherapy of cervical cancer patients: preliminary results. Clin Imaging. 2018;49:163–8.PubMedCrossRef
31.
go back to reference Morgan RJ Jr, Alvarez RD, Armstrong DK, Burger RA, Chen LM, Copeland L, et al. Ovarian cancer, version 2.2013. J Natl Compr Cancer Netw. 2013;11(10):1199–209.CrossRef Morgan RJ Jr, Alvarez RD, Armstrong DK, Burger RA, Chen LM, Copeland L, et al. Ovarian cancer, version 2.2013. J Natl Compr Cancer Netw. 2013;11(10):1199–209.CrossRef
32.
go back to reference Jung SE, Lee JM, Rha SE, Byun JY, Jung JI, Hahn ST. CT and MR imaging of ovarian tumors with emphasis on differential diagnosis. Radiographics. 2002;22(6):1305–25.PubMedCrossRef Jung SE, Lee JM, Rha SE, Byun JY, Jung JI, Hahn ST. CT and MR imaging of ovarian tumors with emphasis on differential diagnosis. Radiographics. 2002;22(6):1305–25.PubMedCrossRef
Metadata
Title
Diagnostic value of [18F]FDG PET/MRI for staging in patients with ovarian cancer
Authors
Hideaki Tsuyoshi
Tetsuya Tsujikawa
Shizuka Yamada
Hidehiko Okazawa
Yoshio Yoshida
Publication date
01-12-2020
Publisher
Springer Berlin Heidelberg
Published in
EJNMMI Research / Issue 1/2020
Electronic ISSN: 2191-219X
DOI
https://doi.org/10.1186/s13550-020-00712-3

Other articles of this Issue 1/2020

EJNMMI Research 1/2020 Go to the issue