Abstract
Multimodal imaging has been increasingly used in oncology, especially in cervical cancer. By using a simultaneous positron emission (PET) and magnetic resonance imaging (MRI, PET/MRI) approach, PET and MRI can be obtained at the same time which minimizes motion artefacts and allows an exact imaging fusion, which is especially important in anatomically complex regions like the pelvis. The associations between functional parameters from MRI and 18F-FDG-PET reflecting different tumor aspects are complex with inconclusive results in cervical cancer. The present study correlates histogram analysis and 18F-FDG-PET parameters derived from simultaneous FDG-PET/MRI in cervical cancer. Overall, 18 female patients (age range: 32–79 years) with histopathologically confirmed squamous cell cervical carcinoma were retrospectively enrolled. All 18 patients underwent a whole-body simultaneous 18F-FDG-PET/MRI, including diffusion-weighted imaging (DWI) using b-values 0 and 1000 s/mm2. Apparent diffusion coefficient (ADC) histogram parameters included several percentiles, mean, min, max, mode, median, skewness, kurtosis, and entropy. Furthermore, mean and maximum standardized uptake values (SUVmean and SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were estimated. No statistically significant correlations were observed between SUVmax or SUVmean and ADC histogram parameters. TLG correlated inversely with p25 (r=−0.486, P=0.041), p75 (r=−0.490, P=0.039), p90 (r=−0.513, P=0.029), ADC median (r=−0.497, P=0.036), and ADC mode (r=−0.546, P=0.019). MTV also showed significant correlations with several ADC parameters: mean (r=−0.546, P=0.019), p10 (r=−0.473, P=0.047), p25 (r=−0.569, P=0.014), p75 (r=−0.576, P=0.012), p90 (r=−0.585, P=0.011), ADC median (r=−0.577, P=0.012), and ADC mode (r=−0.597, P=0.009). ADC histogram analysis and volume-based metabolic 18F-FDG-PET parameters are related to each other in cervical cancer.
Highlights
Cervical cancer is the third most commonly diagnosed cancer and the fourth leading cause of cancer death in females worldwide [1].Magnetic resonance imaging (MRI) has been established as the best imaging modality for staging of cervical cancers due to its excellent soft tissue contrast [2]
No statistically significant correlations were observed between SUVmax or SUVmean and apparent di usion coe cients (ADC) histogram parameters
To the best of our knowledge, this is the first study elucidating possible correlations between ADC histogram analysis and complex 18F-FDG-PET parameters derived from simultaneous PET/MRI in cervical cancer
Summary
Cervical cancer is the third most commonly diagnosed cancer and the fourth leading cause of cancer death in females worldwide [1]. Magnetic resonance imaging (MRI) has been established as the best imaging modality for staging of cervical cancers due to its excellent soft tissue contrast [2]. MRI can provide information regarding tumor microstructure by di usion-weighted imaging (DWI). Previous studies showed that ADC inversely correlated with cell count in several malignant and benign lesions [4]. Another clinically important functional imaging modality is 18F- uorodeoxyglucose positron emission tomography (FDG-PET), which re ects tumor glucose-metabolism [5]. It has been shown that volume-based metabolic PET parameters, such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG), might provide additional information. Wang et al [35] Brandmaier et al [10] Pinker et al [36] Surov et al [14] Lai et al [37]
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