Nuclear Medicine Division, Department of Radiology and Oncology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Doutor Ovidio Pires de Campos, 872, Sao Paulo, SP, 05403-010, Brazil.
Department of Radiology and Oncology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
Eur J Nucl Med Mol Imaging. 2021 Jan;48(1):186-195. doi: 10.1007/s00259-020-04911-x. Epub 2020 Jun 20.
We compared the diagnostic accuracy of detecting distant metastases for baseline rectal cancer staging between PET/MRI and conventional staging (CS).
This prospective study from November 2016 to April 2018 included 101 rectal adenocarcinoma patients for primary staging. These patients underwent whole-body PET/MRI in addition to CS (pelvic MRI and thoracic and abdominal contrast-enhanced CT). Different readers analyzed CS and PET/MRI findings for primary tumor, nodal, and metastatic staging. The presence, number, and location of metastases were recorded according to the organ involved (non-regional lymph nodes (LNs), liver, lungs, or others). Lesions were defined as positive, negative, or indeterminate. The number of lesions per organ was limited to 10. The McNemar test was used to compare the accuracies.
PET/MRI exhibited a higher accuracy in detecting metastatic disease than CS in all patients (88.4% vs. 82.6%, p = 0.003) and in patients with extramural vascular invasion (EMVI) (88.9% vs. 85.5%, p = 0.013). The detection rate of PET/MRI was superior to that of CS for all lesions [84.1% vs. 68.9%, p = 0.001], as well as those in the liver (89.2% vs. 84.2%), non-regional LNs (90.0% vs. 36.7%), and lungs (76.4% vs. 66.9%). PET/MRI correctly classified 19/33 (57.5%) patients with indeterminate lesions on CS.
PET/MRI yields higher accuracy than CS for detecting distant synchronous metastases in the baseline staging of patients with rectal cancer and EMVI. PET/MRI exhibited a higher detection rate than CS for identifying non-regional LNs, hepatic lesions, and pulmonary lesions as well as correctly classifying patients with indeterminate lesions.
NCT02537340.
我们比较了 PET/MRI 与常规分期（CS）在基线直肠癌分期中检测远处转移的诊断准确性。
这项前瞻性研究于 2016 年 11 月至 2018 年 4 月纳入了 101 例原发性直肠癌患者进行分期。这些患者除了接受 CS（盆腔 MRI 和胸部及腹部增强 CT）外，还进行了全身 PET/MRI 检查。不同的读者分析了 CS 和 PET/MRI 对原发肿瘤、淋巴结和转移性分期的结果。根据受累器官记录转移灶的存在、数量和位置（非区域性淋巴结（LNs）、肝脏、肺部或其他部位）。病变被定义为阳性、阴性或不确定。每个器官的病变数量限制为 10 个。采用 McNemar 检验比较准确性。
在所有患者（88.4%比 82.6%，p=0.003）和有外膜血管侵犯（EMVI）的患者（88.9%比 85.5%，p=0.013）中，PET/MRI 在检测转移性疾病方面的准确性均高于 CS。PET/MRI 对所有病变的检出率均高于 CS[84.1%比 68.9%，p=0.001]，以及肝脏（89.2%比 84.2%）、非区域性 LNs（90.0%比 36.7%）和肺部（76.4%比 66.9%）的病变。PET/MRI 正确分类了 CS 检查中 19/33（57.5%）不确定病变的患者。
与 CS 相比，PET/MRI 可提高直肠癌和 EMVI 患者基线分期中检测远处同步转移的准确性。与 CS 相比，PET/MRI 对识别非区域性 LNs、肝转移灶、肺转移灶的检出率更高，对 CS 不确定病变患者的分类也更准确。
NCT02537340。
