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CC BY-NC-ND 4.0 · World J Nucl Med 2021; 20(02): 150-155
DOI: 10.4103/wjnm.WJNM_53_20
Original Article

Fluorodeoxyglucose positron-emission tomography-magnetic resonance hybrid imaging: An emerging tool for staging of cancer of the uterine cervix

Alina Nazir
Department of Radiology, Stony Brook University Hospital in Stony Brook, NY, USA
,
Robert Matthews
Department of Radiology, Stony Brook University Hospital in Stony Brook, NY, USA
,
Annapurneswara Chimpiri
Department of Radiology, Stony Brook University Hospital in Stony Brook, NY, USA
,
Melissa Henretta
1   Division of Gynecologic Oncology, Trinity Health of New England, Hartford, CT, USA
,
Joyce Varughese
2   Gynecologic Oncology, Capital Health Surgical Group, Pennington, NJ, USA
,
Dinko Franceschi
Department of Radiology, Stony Brook University Hospital in Stony Brook, NY, USA
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Abstract

Positron-emission tomography-magnetic resonance imaging (PET-MRI) is an emerging hybrid imaging modality that utilizes the superior soft tissue resolution of MR with the metabolic data from PET. In this study, we sought to assess the clinical value of fluorodeoxyglucose (FDG) PET-MRI with dedicated pelvic PET-MR in the initial staging of cervical cancer. In this institutional-approved study, we identified 23 adult females who underwent FDG PET-MRI on hybrid camera for staging of primary uterine cervical cancer that included a dedicated PET-MR of the pelvis. A nuclear medicine physician and a radiologist reviewed the PET, MRI, and fusion-body and pelvis images alone and then with consensus read characterizing PET and MR abnormal findings. There were 23 patients who underwent FDG PET-MRI for initial staging of cervical cancer with an average age of 52.2 ± 14.0 years. A total of 23 suspected lymph nodes in eight different patients were detected within the pelvis with increased metabolic activity on PET. Both the dedicated pelvis and whole-body PET imaging detected the same corresponding pelvic lymph nodes, although the pelvic PET imaging had better lymph node uptake delineation due to longer acquisition time. Using a 10-mm short-axis criterion, MRI identified only 43.5% of the FDG avid lymph nodes. The average SUVmax on the pelvis PET sequences was higher with SUV 8.9 ± 5.2 compared to the whole-body PET with SUV 7.8 ± 5.4 but was not statistically significant (P > 0.05). Primary cervical cancer was identified in 18 patients on both PET imaging and MRI with dedicated MR pelvis providing better characterization. Based on our results of the patients with cervical cancer evaluated for initial staging, combining dedicated pelvic PET-MRI with whole-body PET/MR provides the most complete status of malignant disease in reference to delineation of primary tumor, involvement of surrounding tissues, and regional lymph nodes.

Keywords

Cervical cancer - fluorodeoxyglucose - lymph nodes - positron-emission tomography-magnetic resonance imaging

Financial support and sponsorship

Nil.




Publication History

Received: 04 May 2020

Accepted: 06 May 2020

Article published online:
24 March 2022

© 2021. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Small W Jr., Bacon MA, Bajaj A, Chuang LT, Fisher BJ, Harkenrider MM, et al. Cervical cancer: A global health crisis. Cancer 2017;123:2404-12.
  • 2 Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68:394-424.
  • 3 Bosch FX, Lorincz A, Muñoz N, Meijer CJ, Shah KV. The causal relation between human papillomavirus and cervical cancer. J Clin Pathol 2002;55:244-65.
  • 4 Sawaya GF, Smith-McCune K. Cervical cancer screening. Obstet Gynecol 2016;127:459-67.
  • 5 Li H, Wu X, Cheng X. Advances in diagnosis and treatment of metastatic cervical cancer. J Gynecol Oncol 2016;27:e43.
  • 6 Mirpour S, Mhlanga JC, Logeswaran P, Russo G, Mercier G, Subramaniam RM. The role of PET/CT in the management of cervical cancer. AJR Am J Roentgenol 2013;201:W192-205.
  • 7 Liu B, Gao S, Li S. A comprehensive comparison of CT, MRI, positron emission tomography or positron emission tomography/CT, and diffusion weighted imaging-mri for detecting the lymph nodes metastases in patients with cervical cancer: A meta-analysis based on 67 studies. Gynecol Obstet Invest 2017;82:209-22.
  • 8 Rockall AG, Cross, S, Flanagan S, Moore E, Avril N. The role of FDG-PET/CT in gynaecological cancer. Cancer Imaging 2012;12:49-65.
  • 9 Bailey JJ, Jordan EJ, Burke C, Ohliger MA, Wang ZJ, et al. Does extended PET acquisition in PET/MRI rectal cancer staging improve results? AJR Am J Roentgenol 2018,211:896-900.
  • 10 Lake ST, Greene KL, Westphalen AC, Behr SC, Zagoria R, Small EJ, et al. Optimal MRI sequences for 68Ga-PSMA-11 PET/MRI in evaluation of biochemically recurrent prostate cancer. EJNMMI Res 2017;7:77.
  • 11 Dappa E, Elger T, Hasenburg A, Düber C, Battista MJ, Hötker AM. The value of advanced MRI techniques in the assessment of cervical cancer: A review. Insights Imaging 2017;8:471-81.
  • 12 Shen G, Zhou H, Jia Z, Deng H. Diagnostic performance of diffusion-weighted MRI for detection of pelvic metastatic lymph nodes in patients with cervical cancer: A systematic review and meta-analysis. Br J Radiol 2015;88:20150063.
  • 13 Choi HJ, Kim SH, Seo SS, Kang S, Lee S, Kim JY, et al. MRI for pretreatment lymph node staging in uterine cervical cancer. AJR Am J Roentgenol 2006;187:W538-43.
  • 14 Sawicki LM, Kirchner J, Grueneisen J, Ruhlmann V, Aktas B, Schaarschmidt BM, et al. Comparison of 18F-FDG PET/MRI and MRI alone for whole-body staging and potential impact on therapeutic management of women with suspected recurrent pelvic cancer: A follow-up study. Eur J Nucl Med Mol Imaging 2018;45:622-9.
  • 15 Sarabhai T, Schaarschmidt BM, Wetter A, Kirchner J, Aktas B, Forsting M, et al. Comparison of 18F-FDG PET/MRI and MRI for pre-therapeutic tumor staging of patients with primary cancer of the uterine cervix. Eur J Nucl Med Mol Imaging 2018;45:67-76.
  • 16 Beiderwellen K, Grueneisen J, Ruhlmann V, Buderath P, Aktas B, Heusch P, et al. [18F]FDG PET/MRI vs. PET/CT for whole-body staging in patients with recurrent malignancies of the female pelvis: initial results. Eur J Nucl Med Mol Imaging 2015;42:56-65.
  • 17 Kitajima K, Suenaga Y, Ueno Y, Kanda T, Maeda T, Deguchi M, et al. Fusion of PET and MRI for staging of uterine cervical cancer: Comparison with contract-enhanced 18F-FDG PET/CT and pelvic MRI. Clin Imaging 2014;38:464-9.
  • 18 Bourgioti C, Chatoupis K, Moulopoulos LA. Current imaging strategies for the evaluation of uterine cervical cancer. World J Radiol 2016;8:342-54.