Abstract
PurposeThis study aims to determine the diagnostic performance of whole-body FDG PET/CT plus delayed abdomen PET/MR imaging in the pretherapeutic assessment of pancreatic cancer in comparison with that of contrast-enhanced (CE)-CT/MR imaging.Materials and MethodsForty patients with pancreatic cancer underwent nonenhanced whole-body FDG PET/CT, delayed abdomen PET/MR imaging, and CE-CT/MR imaging. Two nuclear medicine physicians independently reviewed these images and discussed to reach a consensus, determining tumor resectability according to a 5-point scale, N stage (N0 or N positive), and M stage (M0 or M1). With use of clinical-surgical-pathologic findings as the reference standard, diagnostic performances of the two imaging sets were compared by using the McNemar test.ResultsThe diagnostic performance of FDG PET/CT plus delayed PET/MR imaging was not significantly different from that of CE-CT/MR imaging in the assessment of tumor resectability [area under the receiver operating characteristic curve: 0.927 vs. 0.925 (p = 0.975)], N stage (accuracy: 80% (16 of 20 patients) vs. 55% (11 of 20 patients), p = 0.125), and M stage (accuracy: 100% (40 of 40 patients) vs. 93% (37 of 40 patients), p = 0.250). Moreover, 14 of 40 patients had liver metastases. The number of liver metastases detected by CE-CT/MR imaging, PET/CT, and PET/MR imaging were 33, 18, and 61, respectively. Compared with CE-CT/MR imaging, PET/MR imaging resulted in additional findings of more liver metastases in 9/14 patients, of which 3 patients were upstaged. Compared with PET/CT, PET/MR imaging resulted in additional findings of more liver metastases in 12/14 patients, of which 6 patients were upstaged.ConclusionsAlthough FDG PET/CT plus delayed PET/MR imaging showed a diagnostic performance similar to that of CE-CT/MR imaging in the pretherapeutic assessment of the resectability and staging of pancreatic tumors, it still has potential as the more efficient and reasonable work-up approach for the additional value of metastatic information provided by delayed PET/MR imaging.
Highlights
Pancreatic cancer remains a highly lethal malignancy, with a 5year survival rate of less than 10%, and is the seventh most common cause of cancer death in both men and women worldwide [1,2,3]
The purpose of this study was to compare the diagnostic performance of nonenhanced whole-body FDG positron emission tomography (PET)/CT plus delayed abdomen PET/magnetic resonance (MR) in evaluating tumor staging and resectability of pancreatic cancer with that of the conventional contrastenhanced computed tomography (CE-CT)/MR, which would be useful for simplifying the multistep process and even choosing the more efficient and reasonable workup flow
The key eligibility criteria were as follows: (a) confirmatory evidence with either histology or metastases at follow-up imaging; (b) patients have undergone chest CT, abdomen, and pelvis CE-CT/MR, and the interval time between PET and CT/MR was less than 30 days; and (c) no contraindication to PET/MR imaging
Summary
Pancreatic cancer remains a highly lethal malignancy, with a 5year survival rate of less than 10%, and is the seventh most common cause of cancer death in both men and women worldwide [1,2,3]. At the time of initial staging work-up, approximately 80%–85% of patients present with either unresectable or metastatic disease owing to lack of early and specific symptoms when the cancer is still localized, and high metastasis rate [1, 3, 4]. In addition to anatomical imaging examinations, another modality that has shown potential is fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT, which is sensitive for initial TNM staging [8], evaluation of treatment response [9], detection of recurrence [10], and prediction of treatment efficacy and clinical outcome and has been reported to improve the detection of occult metastases, sparing these patients from unnecessary surgery [11,12,13]. PET/MR, as an emerging imaging technology, provides both multiparametric functional imaging, including diffusion-weighted imaging (DWI), and metabolic information from PET, with many potential advantages over PET/CT, including inherently lower radiation exposure, higher soft-tissue contrast, and multiparametric imaging capabilities [5, 7, 14,15,16,17,18,19]
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