Advertisement

Improving liver lesion characterisation using retrospective fusion of FDG PET/CT and MRI

      Highlights

      • MRI and fused FDG PET/MRI detected all indeterminate liver lesions.
      • FDG PET/MRI could better characterise liver lesions compared to MRI or FDG PET/CT alone.
      • Fused PET/MRI was superior to MRI and PET/CT for identifying malignant lesions.

      Abstract

      Aim

      To compare retrospectively fused FDG PET/CT and MRI (PET/MRI) to FDG PET/CT and MRI for characterisation of indeterminate focal liver lesions as malignant or benign in patients with a known primary malignancy.

      Materials and method

      A retrospective review of 70 patients (30 females, 40 males; mean age 56 ± 14 years) with 150 indeterminate lesions after FDG PET/CT and MRI (mean scan time interval 21 ± 11 days). HERMES® software was used to fuse PET/CT and MRI scans which were reviewed by 2 readers using the Likert score (scale 1–5) to characterise lesions as benign (1–3) or malignant (4–5). Final diagnosis was determined by histopathology or follow up imaging. Results for fused PET/MRI were compared to PET/CT and MRI alone.

      Results

      For detection, MRI and fused PET/MRI detected all the lesions while PET/CT detected 89.4%. Characterisation of liver lesions as malignant on PET/CT alone yielded sensitivity, specificity, accuracy, PPV and NPV of 55.6%, 83.3%, 66.7%, 83.3%, 55.6% respectively and 67.6%, 92.1%, 80%, 89.3%, 74.5% for MRI, respectively. The sensitivity, specificity, accuracy, PPV and NPV for characterising lesions as malignant increased to 91.9%, 97.4%, 94.7%, 97.1%, 92.5% with PET/MRI fusion. The sensitivity, specificity, accuracy, PPV and NPV of fused PET/MRI for characterising lesions as malignant remained superior to PET/CT and MRI.

      Conclusion

      Retrospective fusion of PET with MRI has improved characterisation of indeterminate focal liver lesions compared to MRI or FDG PET/CT alone.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Imaging
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Wiering B.
        • Vogel W.V.
        • Ruers T.J.
        • Oyen W.J.
        Controversies in the management of colorectal liver metastases: role of PET and PET/CT.
        Dig Surg. 2008; 25: 413-420
        • Sacks A.
        • Peller P.J.
        • Surasi D.S.
        • Chatburn L.
        • Mercier G.
        • Subramaniam R.M.
        Value of PET/CT in the management of liver metastases, part 1.
        AJR Am J Roentgenol. 2011; 197: W256-W259
        • Parsai A.
        • Zerizer I.
        • Hohmann J.
        • Bongartz G.
        • Beglinger C.
        • Sperandeo G.
        Remote sonographic interpretation: comparison of standardized video clips to still images.
        J Clin Ultrasound. 2012; 40: 495-501
        • Furuhata T.
        • Okita K.
        • Tsuruma T.
        • Hata F.
        • Kimura Y.
        • Katsuramaki T.
        • et al.
        Efficacy of SPIO-MR imaging in the diagnosis of liver metastases from colorectal carcinomas.
        Dig Surg. 2003; 20: 321-325
        • Valls C.
        • Andia E.
        • Sanchez A.
        • Guma A.
        • Figueras J.
        • Torras J.
        • et al.
        Hepatic metastases from colorectal cancer: preoperative detection and assessment of resectability with helical CT.
        Radiology. 2001; 218: 55-60
        • Kinkel K.
        • Lu Y.
        • Both M.
        • Warren R.S.
        • Thoeni R.F.
        Detection of hepatic metastases from cancers of the gastrointestinal tract by using noninvasive imaging methods (US, CT, MR imaging, PET): a meta-analysis.
        Radiology. 2002; 224: 748-756
        • Lai D.T.
        • Fulham M.
        • Stephen M.S.
        • Chu K.M.
        • Solomon M.
        • Thompson J.F.
        • et al.
        The role of whole-body positron emission tomography with [18F]fluorodeoxyglucose in identifying operable colorectal cancer metastases to the liver.
        Arch Surg. 1996; 131: 703-707
        • Frankel T.L.
        • Gian R.K.
        • Jarnagin W.R.
        Preoperative imaging for hepatic resection of colorectal cancer metastasis.
        J Gastrointest Oncol. 2012; 3: 11-18
        • Grassetto G.
        • Fornasiero A.
        • Bonciarelli G.
        • Banti E.
        • Rampin L.
        • Marzola M.C.
        • et al.
        Additional value of FDG-PET/CT in management of “solitary” liver metastases: preliminary results of a prospective multicenter study.
        Mol Imaging Biol. 2010; 12: 139-144
        • Donati O.F.
        • Hany T.F.
        • Reiner C.S.
        • von Schulthess G.K.
        • Marincek B.
        • Seifert B.
        • et al.
        Value of retrospective fusion of PET and MR images in detection of hepatic metastases: comparison with 18F-FDG PET/CT and Gd-EOB-DTPA-enhanced MRI.
        J Nucl Med. 2010; 51: 692-699
        • Beiderwellen K.
        • Gomez B.
        • Buchbender C.
        • Hartung V.
        • Poeppel T.D.
        • Nensa F.
        • et al.
        Depiction and characterization of liver lesions in whole body [(1)(8)F]-FDG PET/MRI.
        Eur J Radiol. 2013; 82: e669-e675
        • Boellaard R.
        • O'Doherty M.J.
        • Weber W.A.
        • Mottaghy F.M.
        • Lonsdale M.N.
        • Stroobants S.G.
        • et al.
        FDG PET and PET/CT: EANM procedure guidelines for tumour PET imaging: version 1.0.
        Eur J Nucl Med Mol Imaging. 2010; 37: 181-200
        • Niekel M.C.
        • Bipat S.
        • Stoker J.
        Diagnostic imaging of colorectal liver metastases with CT, MR imaging, FDG PET, and/or FDG PET/CT: a meta-analysis of prospective studies including patients who have not previously undergone treatment.
        Radiology. 2010; 257: 674-684
        • Coenegrachts K.
        • De Geeter F.
        • ter Beek L.
        • Walgraeve N.
        • Bipat S.
        • Stoker J.
        • et al.
        Comparison of MRI (including SS SE-EPI and SPIO-enhanced MRI) and FDG-PET/CT for the detection of colorectal liver metastases.
        Eur Radiol. 2009; 19: 370-379
        • Truant S.
        • Huglo D.
        • Hebbar M.
        • Ernst O.
        • Steinling M.
        • Pruvot F.R.
        Prospective evaluation of the impact of [18F]fluoro‑2‑deoxy‑d‑glucose positron emission tomography of resectable colorectal liver metastases.
        Br J Surg. 2005; 92: 362-369
        • Rakheja R.
        • Chandarana H.
        • DeMello L.
        • Jackson K.
        • Geppert C.
        • Faul D.
        • et al.
        Correlation between standardized uptake value and apparent diffusion coefficient of neoplastic lesions evaluated with whole-body simultaneous hybrid PET/MRI.
        AJR Am J Roentgenol. 2013; 201: 1115-1119
        • Dirisamer A.
        • Halpern B.S.
        • Schima W.
        • Heinisch M.
        • Wolf F.
        • Beheshti M.
        • et al.
        Dual-time-point FDG-PET/CT for the detection of hepatic metastases.
        Mol Imaging Biol. 2008; 10: 335-340