Grueneisen Johannes, Beiderwellen Karsten, Heusch Philipp, Gratz Marcel, Schulze-Hagen Antonia, Heubner Martin, Kinner Sonja, Forsting Michael, Lauenstein Thomas, Ruhlmann Verena, Umutlu Lale
From the *Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen; †Department of Diagnostic and Interventional Radiology, University Hospital Dusseldorf, University of Dusseldorf, Dusseldorf; ‡The Erwin L. Hahn Institute for Magnetic Resonance Imaging, Departments of §Obstetrics and Gynecology, and ∥Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Invest Radiol. 2014 Dec;49(12):808-15. doi: 10.1097/RLI.0000000000000086.
The objective of this study was to assess the diagnostic value of integrated positron emission tomography/magnetic resonance imaging (PET/MRI) for whole-body staging of patients with recurrent gynecological pelvic malignancies, in comparison to whole-body MRI alone.
The study was approved by the local institutional ethics committee. Written informed consent was obtained before each examination. Thirty-four consecutive patients with a suspected recurrence of cervical (n = 18) or ovarian (n = 16) cancer were prospectively enrolled for an integrated PET/MRI examination, which comprised a diagnostic, contrast-enhanced whole-body MRI protocol including dedicated sagittal dynamic imaging of the pelvis. Two radiologists separately evaluated the data sets regarding lesion count, lesion detection, lesion characterization, and diagnostic confidence. Mean and median values were calculated for each rating. Statistical analyses were performed both per-patient and per-lesion bases using a Wilcoxon signed-rank test to indicate potential significant differences among PET/MRI and MRI (alone) data sets.
Malignant lesions were present in 25 of the 34 patients. Positron emission tomography/magnetic resonance imaging offered correct and superior identification of all 25 patients with cancer recurrence, compared with MRI alone (23/25). A total of 118 lesions (malignant, 89; benign, 29) were detected. Positron emission tomography/magnetic resonance imaging correctly identified 88 (98.9%) of 89 malignant lesions, whereas MRI alone allowed for correct identification of 79 (88.8%) of the 89 malignant lesions. In addition, PET/MRI provided significantly higher lesion contrast and diagnostic confidence in the detection of malignant lesions (P < 0.001) compared with MRI alone.
These first results demonstrate the high diagnostic potential of integrated PET/MRI for the assessment of recurrence of female pelvic malignancies compared with MRI alone.
本研究的目的是评估正电子发射断层扫描/磁共振成像（PET/MRI）与单纯全身MRI相比，在复发性妇科盆腔恶性肿瘤患者全身分期中的诊断价值。
本研究经当地机构伦理委员会批准。每次检查前均获得书面知情同意书。连续34例疑似宫颈癌（n = 18）或卵巢癌（n = 16）复发的患者被前瞻性纳入PET/MRI综合检查，该检查包括一个诊断性的、对比增强的全身MRI方案，包括骨盆的专用矢状面动态成像。两名放射科医生分别评估数据集的病变数量、病变检测、病变特征和诊断置信度。计算每个评分的平均值和中位数。使用Wilcoxon符号秩检验在患者和病变基础上进行统计分析，以表明PET/MRI和MRI（单独）数据集之间的潜在显著差异。
34例患者中有25例存在恶性病变。与单纯MRI（23/25）相比，正电子发射断层扫描/磁共振成像能够正确且更好地识别所有25例癌症复发患者。共检测到118个病变（恶性89个，良性29个）。正电子发射断层扫描/磁共振成像正确识别了89个恶性病变中的88个（98.9%），而单纯MRI仅能正确识别89个恶性病变中的79个（88.8%）。此外，与单纯MRI相比，PET/MRI在检测恶性病变方面提供了显著更高的病变对比度和诊断置信度（P < 0.001）。
这些初步结果表明，与单纯MRI相比，PET/MRI综合成像在评估女性盆腔恶性肿瘤复发方面具有很高的诊断潜力。
