Value of fusion of PET and MRI for staging of endometrial cancer: Comparison with 18F-FDG contrast-enhanced PET/CT and dynamic contrast-enhanced pelvic MRI

Abstract

PurposeTo investigate the diagnostic value of retrospective fusion of pelvic MRI and 18F-fluorodeoxyglucose (18F-FDG) PET images for assessment of locoregional extension and nodal staging of endometrial cancer. Materials and methodsThirty patients with biopsy-proven endometrial cancer underwent preoperative contrast-enhanced PET/CT (PET/ceCT) and pelvic dynamic contrast-enhanced MRI for initial staging. Diagnostic performance of PET/ceCT, contrast-enhanced MRI, and retrospective image fusion from PET and MRI (fused PET/MRI) for assessing the extent of the primary tumor (T stage) and metastasis to regional LNs (N stage) was evaluated by two experienced readers. Histopathological and follow-up imaging results were used as the gold standard. The McNemar test was employed for statistical analysis. ResultsFused PET/MRI and MRI detected 96.7% of the primary tumors, whereas PET/ceCT detected 93.3%. Accuracy for T status was 80.0% for fused PET/MRI, and MRI proved significantly more accurate than PET/ceCT, which had an accuracy of 60.0% (p=0.041). Patient-based sensitivity, specificity and accuracy for detecting pelvic nodal metastasis were 100%, 96.3% and 96.7% for both fused PET/MRI and PET/ceCT, and 66.7%, 100% and 96.7% for MRI, respectively. These three parameters were not statistically significant (p=1). ConclusionFused PET/MRI, which complements the individual advantages of MRI and PET, is a valuable technique for assessment of the primary tumor and nodal staging in patients with endometrial cancer.