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18F-FDG-PET/MR increases diagnostic confidence in detection of bone metastases compared with 18F-FDG-PET/CT
Andrei Samarin1, Martin Hüllner, Marcelo A Queiroz
1Departments of aNuclear Medicine bDiagnostic and Interventional Radiology cDepartment of Neuroradiology, University Hospital Zurich, University of Zurich dUniversity of Zurich, Zurich, Switzerland eDepartment of Medical Radiology, North Estonia Medical Centre, Tallinn, Estonia.
Purpose:
The aim of this study was to compare detection, lesion conspicuity and reader confidence of F-fluorodeoxyglucose (F-FDG)-PET/MR and F-FDG-PET/computed tomography (CT) in patients with F-FDG avid bone metastases.
Materials And Methods:
In this prospective study, a total of 30 PET/CT and PET/MRI data sets were performed in 24 patients. Each examination was evaluated for the presence of PET-positive bone lesions consistent with metastatic involvement. Conspicuity of PET-positive bone lesions was evaluated on the corresponding PET/CT and PET/MR images and compared using the Wilcoxon signed-ranks test. Reader confidence was determined to evaluate whether PET/CT or PET/MR was more useful for the assessment of the bone metastases and was compared using Student's t-test.
Results:
Overall, in both examinations, PET/CT and PET/MRI detected 86 F-FDG-positive bone lesions. On all 30 PET/MRI examinations, at least one morphological correlate for F-FDG-positive bone lesions was found on the MR component (82 out of 86 lesions). PET/CT imaging allowed identification of corresponding structural changes on the CT component in 23 out of 30 studies (65 out of 86 lesions). In lesion-by-lesion analysis, the mean lesion conspicuity was significantly better on T1 fat MR imaging compared with CT imaging (P=0.005). In seven out of 30 studies, a significant increase in reader confidence of PET/MRI compared with PET/CT was found.
Conclusion:
PET/MRI offers higher reader confidence and improved conspicuity in bone metastases compared with PET/CT. However, the overall detection rate was not different. The highest possible clinical impact of PET/MRI appears to be in patients with limited, early bone metastatic disease.
Insights
Fluorodeoxyglucose (F-FDG)-PET/MRI improves reader confidence and lesion conspicuity for bone metastases compared to F-FDG-PET/CT. Detection rates were similar, but PET/MRI shows promise for early-stage metastatic disease.
Area of Science:
- Oncology
- Radiology
- Nuclear Medicine
Background:
- Bone metastases are a common complication of various cancers.
- Accurate detection and characterization of bone metastases are crucial for treatment planning and patient management.
- Fluorodeoxyglucose Positron Emission Tomography (F-FDG-PET) is a valuable tool for identifying metabolically active bone lesions.
Purpose of the Study:
- To compare the efficacy of F-FDG-PET/Magnetic Resonance (MR) imaging versus F-FDG-PET/Computed Tomography (CT) in detecting F-FDG avid bone metastases.
- To assess lesion conspicuity and reader confidence between the two imaging modalities.
Main Methods:
- A prospective study involving 24 patients with 30 paired F-FDG-PET/CT and F-FDG-PET/MR examinations.
- Evaluation of PET-positive bone lesions for presence, conspicuity, and correlation with morphological imaging (MR or CT).
- Comparison of reader confidence using statistical tests (Wilcoxon signed-ranks test, Student's t-test).
Main Results:
- Both PET/CT and PET/MR detected 86 F-FDG-positive bone lesions.
- Morphological correlates were found on MR in 82/86 lesions and on CT in 65/86 lesions.
- Lesion conspicuity was significantly better on MR imaging (T1 fat) compared to CT (P=0.005), and reader confidence increased with PET/MR in 7/30 studies.
Conclusions:
- F-FDG-PET/MRI demonstrates superior lesion conspicuity and enhanced reader confidence for bone metastases compared to F-FDG-PET/CT.
- Overall detection rates for bone metastases were comparable between the two methods.
- PET/MRI holds significant clinical potential, particularly for patients with limited or early-stage bone metastatic disease.
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