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Value of integrated PET-IVIM MR in assessing metastases in hypermetabolic pelvic lymph nodes in cervical cancer: a
Chen Xu1,2, Siyao Du1, Siyu Zhang1
1Department of Radiology, Shengjing Hospital of China Medical University, Sanhao Street No 36, Heping District, Shenyang, 110004, Liaoning, China.
Purpose:
To evaluate the value of integrated multi-parameter positron emission tomography-intravoxel incoherent motion magnetic resonance (PET-IVIM MR) imaging for pelvic lymph nodes with high FDG uptake in cervical cancer, and to determine the best combination of parameters.
Methods:
A total of 38 patients with 59 lymph nodes with high FDG uptake were included. The imaging parameters of the lymph nodes were calculated by PET-IVIM MR, and the differences between lymph nodes diagnosed by postoperative pathology as metastasis versus non-metastasis were compared. We used the receiver operating characteristic (ROC) curve and logistic regression to construct a combination prediction model to filter low value and similar parameters, in order to search the optimal combination of PET/MR parameters for predicting pathologically confirmed metastatic lymph nodes. The correlation between diffusion parameters and metabolic parameters was analyzed by Spearman's rank correlation.
Results:
The maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), total metabolic tumor volume (MTV), total lesion glycolysis (TLG), apparent diffusion coefficient (ADC), diffusion-related coefficient (D), and perfusion-related parameter (F) showed significant differences between the metastatic and non-metastatic groups (p < 0.05). The combination of MTV, SUVmax, and D had the strongest predictive value (area under the ROC 0.983, p < 0.05). SUVmax, SUVmean, and TLG weakly correlated with F (R = - 0.306, - 0.290, and - 0.310; p < 0.05).
Conclusions:
The combination of MTV, SUVmax, and D may have a better diagnostic performance than PET- or IVIM-derived parameters either in combination or individually. No strong correlation exists between diffusion parameters and metabolic parameters.
Key Points:
• Integrated PET-IVIM MR may assist to characterize lymph node status. • The combination of MTV, SUVmax, and D may have a better diagnostic performance than PET- or IVIM-derived parameters either in combination or individually for the assessment of pelvic lymph nodes with high FDG uptake. • No strong correlation exists between diffusion parameters and metabolic parameters in pelvic lymph nodes with high FDG uptake.
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