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논문 기본 정보

자료유형
학술저널
저자정보
Fraum, Tyler J. (Mallinckrodt Institute of Radiology, Washington University School of Medicine) Fowler, Kathryn J. (Mallinckrodt Institute of Radiology, Washington University School of Medicine) McConathy, Jonathan (Mallinckrodt Institute of Radiology, Washington University School of Medicine) Dehdashti, Farrokh (Mallinckrodt Institute of Radiology, Washington University School of Medicine)
저널정보
대한핵의학회 Nuclear medicine and molecular imaging : NMMI Nuclear medicine and molecular imaging : NMMI 제50권 제4호
발행연도
2016.1
수록면
292 - 299 (8page)

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Background Positron emission tomography/computed tomography (PET/CT) with 2-deoxy-2-[$^{18}F$]fluoro-D-glucose (FDG) has become the standard of care for the initial staging and subsequent treatment response assessment of many different malignancies. Despite this success, PET/CT is often supplemented by MRI to improve assessment of local tumor invasion and to facilitate detection of lesions in organs with high background FDG uptake. Consequently, PET/MRI has the potential to expand the clinical value of PET examinations by increasing reader certainty and reducing the need for subsequent imaging. This study evaluates the ability of FDGPET/MRI to clarify findings initially deemed indeterminate on clinical FDG-PET/CT studies. Methods A total of 190 oncology patients underwent whole-body PET/CT, immediately followed by PET/MRI utilizing the same FDG administration. Each PET/CT was interpreted by our institution's nuclear medicine service as a standard-of-care clinical examination. Review of these PET/CT reports identified 31 patients (16 %) with indeterminate findings. Two readers evaluated all 31 PET/CT studies, followed by the corresponding PET/MRI studies. A consensus was reached for each case, and changes in interpretation directly resulting from PET/MRI review were recorded. Interpretations were then correlated with follow-up imaging, pathology results, and other diagnostic studies. Results In 18 of 31 cases with indeterminate findings on PET/CT, PET/MRI resulted in a more definitive interpretation by facilitating the differentiation of infection/inflammation from malignancy (15/18), the accurate localization of FDG-avid lesions (2/18), and the characterization of incidental non-FDG-avid solid organ lesions (1/18). Explanations for improved reader certainty with PET/MRI included the superior soft tissue contrast of MRI and the ability to assess cellular density with diffusion-weighted imaging. The majority (12/18) of such cases had an appropriate standard of reference; in all 12 cases, the definitive PET/MRI interpretation proved correct. These 12 patients underwent six additional diagnostic studies to clarify the initial indeterminate PET/CT findings. In the remaining 13 of 31 cases with indeterminate findings on both PET/CT and PET/MRI, common reasons for uncertainty included the inability to distinguish reactive from malignant lymphadenopathy (4/13) and local recurrence from treatment effect (2/13). Conclusions Indeterminate PET/CT findings can result in equivocal reads and additional diagnostic studies. PET/MRI may reduce the rate of indeterminate findings by facilitating better tumor staging, FDG activity localization, and lesion characterization. In our study, PET/MRI resulted in more definitive imaging interpretations with high accuracy. PET/MRI also showed potential in reducing the number of additional diagnostic studies prompted by PET/CT findings. Our results suggest that whole-body PET/MRI provides certain diagnostic advantages over PET/CT, promotes more definitive imaging interpretations, and may improve the overall clinical utility of PET.
#Clinical oncology #Magnetic resonance imaging #Multimodal imaging #Positron emission tomography #Whole-body imaging

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참고문헌 (18)

참고문헌 신청
Fletcher JW / 2008 / Recommendations on the use of 18F-FDG PET in oncology / J Nucl Med 49:480~508 google schola Coenegrachts K / 2009 / Comparison of MRI(including SS SE-EPI and SPIO-enhanced MRI)and FDG-PET/CT for the detection of colorectal liver metastases / Eur Radiol 19:370~379 google schola Kitajima K / 2014 / Fusion of PET and MRI for staging of uterine cervical cancer : comparison with contrast-enhanced(18)F-FDG PET/CTand pelvic MRI / Clin Imaging 38:464~469 google schola Schaarschmidt BM / 2015 / Does 18F-FDG PET/MRI reduce the number of indeterminate abdominal incidentalomas compared with 18F-FDG PET/CT? / Nucl Med Commun 36:588~595 google schola Catalano OA / 2013 / Clinical impact of PET/MR imaging in patients with cancer undergoing same-day PET/CT : initial experience in 134 patients—a hypothesis-generating exploratory study / Radiology 269:857~869 google schola

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