Institut und Poliklinik fuer Radiologische Diagnostik, Universitaetsklinikum Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany.
Klinik und Poliklinik fuer Viszeral-, Thorax- und Gefäßchirurgie, Universitaetsklinikum Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany.
Eur Radiol. 2019 Jan;29(1):422-428. doi: 10.1007/s00330-018-5589-6. Epub 2018 Jul 6.
To determine the value of F-FDG-PET/MRI in the diagnosis and management of patients with pelvic recurrence of rectal cancer.
Forty-four patients (16 women, 28 men) with a history of rectal cancer who received FDG-PET/MRI between June 2011 and February 2017 at our institution were retrospectively enrolled. Three patients received two FDG-PET/MRIs; thus a total of 47 examinations were included. Pelvic recurrence was confirmed either with histology (n = 27) or imaging follow-up (n = 17) (> 4 months). Two readers (one radiologist, one nuclear medicine physician) interpreted the images in consensus. Pelvic lesions were assessed regarding FDG uptake and morphology. Sensitivity, specificity, positive and negative predictive values as well as accuracy of PET/MRI in detecting recurrence were determined.
In 47 FDG-PET/MRIs 30 suspicious pelvic lesions were identified, 29 of which were malignant. Two patients underwent resection and had histologically proven pelvic recurrence without showing suspicious findings on FDG-PET/MRI. Changes in management due to FDG-PET/MRI findings had been implemented in eight patients. Eighty per cent (16/20) of resected patients had histologically negative resection margins (R0), one patient had uncertain resection margins. Sensitivity of FDG-PET/MRI in detecting recurrence was 94%, specificity 94%, positive/negative predictive value and accuracy were 97%, 90% and 94%, respectively.
FDG-PET/MRI is a valuable tool in the diagnosis and staging of pelvic recurrence in patients with rectal cancer.
• Metabolic information obtained from PET coupled with excellent soft tissue contrast from MRI could facilitate detection of rectal cancer recurrence and assist in treatment planning. • PET/MRI demonstrates high sensitivity and specificity for the diagnosis of local recurrence of rectal cancer • PET/MRI led to alterations in management in 18.2% of patients.
评估 F-FDG-PET/MRI 在诊断和治疗直肠癌盆腔复发中的价值。
回顾性分析 2011 年 6 月至 2017 年 2 月在我院行 FDG-PET/MRI 的 44 例（16 例女性，28 例男性）直肠癌病史患者。其中 3 例患者接受了两次 FDG-PET/MRI 检查；因此共纳入 47 次检查。盆腔复发通过组织学（n=27）或影像学随访（n=17，>4 个月）证实。2 位读者（1 位放射科医生，1 位核医学医师）进行共识解读。评估盆腔病变的 FDG 摄取和形态。确定 PET/MRI 检测复发的敏感性、特异性、阳性和阴性预测值以及准确性。
在 47 次 FDG-PET/MRI 中，共发现 30 个可疑的盆腔病变，其中 29 个为恶性病变。2 例患者接受了手术，且组织学证实有盆腔复发，但 FDG-PET/MRI 未见可疑表现。8 例患者因 FDG-PET/MRI 结果改变了治疗方案。20 例接受手术的患者中，80%（16/20）有组织学阴性的切缘（R0），1 例患者切缘不确定。FDG-PET/MRI 检测复发的敏感性为 94%，特异性为 94%，阳性/阴性预测值和准确性分别为 97%、90%和 94%。
FDG-PET/MRI 是诊断和分期直肠癌盆腔复发的有价值的工具。
来自 PET 的代谢信息与 MRI 的出色软组织对比相结合，可有助于发现直肠癌复发并辅助治疗计划制定。
PET/MRI 对直肠癌局部复发的诊断具有高敏感性和特异性。
PET/MRI 导致 18.2%的患者治疗方案发生改变。
