Qualitative and Quantitative Comparison of PET/CT and PET/MR Imaging in Clinical Practice

Published on Jan 1, 2014in The Journal of Nuclear Medicine7.887
· DOI :10.2967/JNUMED.113.123547
Khalsa Al-Nabhani2
Estimated H-index: 2
(UCLH: University College Hospital),
Rizwan Syed12
Estimated H-index: 12
(UCLH: University College Hospital)
+ 7 AuthorsJamshed Bomanji52
Estimated H-index: 52
(UCLH: University College Hospital)
Sources
Abstract
The aim of this study was to prospectively compare whole-body PET/MR imaging and PET/CT, qualitatively and quantitatively, in oncologic patients and assess the confidence and degree of inter- and intraobserver agreement in anatomic lesion localization. Methods: Fifty patients referred for staging with known cancers underwent PET/CT with low-dose CT for attenuation correction immediately followed by PET/MR imaging with 2-point Dixon attenuation correction. PET/CT scans were obtained according to standard protocols (56 6 20 min after injection of an average 367 MBq of 18F-FDG, 150 MBq of 68Ga-DOTATATE, or 333.8 MBq of 18F-fluoro-ethyl-choline; 2.5 min/bed position). PET/MR was performed with 5 min/bed position. Three dual-accredited nuclear medicine physicians/radiologists identified the lesions and assigned each to an exact anatomic location. The image quality, alignment, and confidence in anatomic localization of lesions were scored on a scale of 1‐3 for PET/CT and PET/MR imaging. Quantitative analysis was performed by comparing the standardized uptake values. Intraclass correlation coefficients and the Wilcoxon signed-rank test were used to assess intra- and interobserver agreement in image quality, alignment, and confidence in lesion localization for the 2 modalities. Results: Two hundred twenty-seven tracer-avid lesions were identified in 50 patients. Of these, 225 were correctly identified on PET/CT and 227 on PET/MR imaging by all 3 observers. The confidence in anatomic localization improved by 5.1% when using PET/MR imaging, compared with PET/CT. The mean percentage interobserver agreement was 96% for PET/CT and 99% for PET/MR imaging, and intraobserver agreement in lesion localization across the 2 modalities was 93%. There was 10% (5/50 patients) improvement in local staging with PET/MR imaging, compared with PET/CT. Conclusion: In this first study, we show the effectiveness of whole-body PET/MR imaging in oncology. There is no statistically significant difference between PET/MR imaging and PET/CT in respect of confidence and degree of inter- and intraobserver agreement in anatomic lesion localization. The PET data on both modalities were similar; however, the observed superior soft-tissue resolution of MR imaging in head and neck, pelvis, and colorectal cancers and of CT in lung and mediastinal nodal disease points to future tailored use in these locations.
Figures & Tables
Download
📖 Papers frequently viewed together
422 Citations
116 Citations
102 Citations
References25
Newest
#1Gudrun Wagenknecht (Forschungszentrum Jülich)H-Index: 11
#2H.-J. Kaiser (RWTH Aachen University)H-Index: 15
Last. Hans Herzog (Forschungszentrum Jülich)H-Index: 65
view all 4 authors...
In current combined PET/MR systems, PET attenuation correction is based on MRI, since the small bore inside MRI systems and the strong magnetic field do not permit a rotating PET transmission source or a CT device to be integrated. Unlike CT measurements in PET/CT scanners, the MR signal is not directly correlated to tissue density and thus cannot be converted by a simple transformation of intensity values. Various approaches have been developed based on templates, atlas information, direct segm...
173 CitationsSource
#1Alexander Drzezga (TUM: Technische Universität München)H-Index: 57
Last. Markus SchwaigerH-Index: 148
view all 11 authors...
The recently introduced first integrated whole-body PET/MR scanner allows simultaneous acquisition of PET and MRI data in humans and, thus, may offer new opportunities, particularly regarding diagnostics in oncology. This scanner features major technologic differences from conventional PET/CT devices, including the replacement of photomultipliers with avalanche photodiodes and the need for MRI-based attenuation correction. The aim of this study was to evaluate the comparability of clinical perfo...
422 CitationsSource
Purpose Accurate attenuation correction (AC) is essential for quantitative analysis of PET tracer distribution. In MR, the lack of cortical bone signal makes bone segmentation difficult and may require implementation of special sequences. The purpose of this study was to evaluate the need for accurate bone segmentation in MR-based AC for whole-body PET/MR imaging.
203 CitationsSource
#1Elias J. Antypas (Beaumont Hospital)H-Index: 1
#2Farnoosh Sokhandon (Beaumont Health)H-Index: 8
Last. Duane G. MezwaH-Index: 3
view all 7 authors...
OBJECTIVE. The purpose of this article is to review the process of creating and implementing a comprehensive plan to reduce diagnostic radiation exposure at our institution. CONCLUSION. This process, which was initiated by forming a radiation dose reduction committee, addressed several different issues to improve patient safety. These include avoidance of unnecessary CT examinations, adjusting individual scanning parameters, revising protocols, use of shielding and dose monitoring, and implement...
22 CitationsSource
#1Jeong Won Lee (Jeju National University)H-Index: 1
#1Jeong Won Lee (Jeju National University)H-Index: 1
Last. Tae Sung Kim (National Cancer Research Institute)H-Index: 8
view all 5 authors...
Purpose The purpose of this study was to determine the most useful parameter of dual-time-point 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography/computed tomography (PET/CT) for detection of hepatic metastases in patients with colorectal cancer.
59 CitationsSource
#1Valérie LaurentH-Index: 27
#2Grégory Trausch (GE Healthcare)H-Index: 2
Last. D. RegentH-Index: 2
view all 6 authors...
Abstract The aim of our study was to compare whole-body MRI (Magnetic Resonance Imaging) with a multi-contrast protocol including a DW (Diffusion Weighted) sequence to PET-CT (Positron Emission Tomography) using 18 FDG (18F-fluoroDeoxyGlucose) for staging advanced melanoma. In a first part, we compared the respective overall accuracy of each modality. We analyzed in a second part the benefits of a DW sequence added to the standard whole-body MRI protocol. Among the population of the 35 patients ...
85 CitationsSource
#1Ciprian Catana (Harvard University)H-Index: 40
#2Andre van der KouweH-Index: 44
Last. A. Gregory SorensenH-Index: 82
view all 10 authors...
Several factors have to be considered for implementing an accurate attenuation-correction (AC) method in a combined MR-PET scanner. In this work, some of these challenges were investigated, and an AC method based entirely on the MRI data obtained with a single dedicated sequence was developed and used for neurologic studies performed with the MR-PET human brain scanner prototype. Methods: The focus was on the problem of bone-air segmentation, selection of the linear attenuation coefficient for b...
300 CitationsSource
#1Ronald Boellaard (VUmc: VU University Medical Center)H-Index: 83
Quantitative 18 F -FDG PET is increasingly being recognized as an important tool for diagnosis, determination of prognosis, and response monitoring in oncology. However, PET quantification with, for example, standardized uptake values (SUVs) is affected by many technical and physiologic factors. As a result, some of the variations in the literature on SUV-based patient outcomes are explained by differences in 18 F-FDG PET study methods. Various technical and clinical studies have been performed ...
599 CitationsSource
#1Inas S. Khayal (UCSF: University of California, San Francisco)H-Index: 7
#2Tracy R. McKnight (UCSF: University of California, San Francisco)H-Index: 25
Last. Sarah J. Nelson (UCSF: University of California, San Francisco)H-Index: 93
view all 8 authors...
Distinguishing between low-grade oligodendrogliomas (ODs) and astrocytomas (AC) is of interest for defining prognosis and stratifying patients to specific treatment regimens. The purpose of this study was to determine if the apparent diffusion coefficient (ADC) and fractional anisotropy (FA) from diffusion imaging can help to differentiate between newly diagnosed grade II OD and AC subtypes and to evaluate the ADC and FA values for the mixed population of oligoastrocytomas (OA). Fifty-three pati...
37 CitationsSource
#1Axel Martinez-Möller (TUM: Technische Universität München)H-Index: 15
Last. Stephan G. NekollaH-Index: 72
view all 9 authors...
Attenuation correction (AC) of whole-body PET data in combined PET/MRI tomographs is expected to be a technical challenge. In this study, a potential solution based on a segmented attenuation map is proposed and evaluated in clinical PET/CT cases. METHODS: Segmentation of the attenuation map into 4 classes (background, lungs, fat, and soft tissue) was hypothesized to be sufficient for AC purposes. The segmentation was applied to CT-based attenuation maps from (18)F-FDG PET/CT oncologic examinati...
612 CitationsSource
Cited By75
Newest
#1Seok Hwan Yoon (Seoul National University Hospital)
#2Chan Rok Park (Jeonju University)
Abstract null null The positron emission tomography (PET) system has technological differences between PET/computed tomography (CT) and PET/magnetic resonance imaging (MRI). It is important to compare image quality on acquisition time for equal diagnostic performance. Therefore, the aim of study was to investigate acquisition time as a factor for harmonizing the image quality. NEMA image quality phantom experiments were performed using Siemens Biograph PET/CT and PET/MRI. The phantom was filled ...
Source
#1Ali Cahid Civelek (NIH: National Institutes of Health)H-Index: 14
#2Scot Anthony Niglio (NIH: National Institutes of Health)H-Index: 1
Last. Andrea B. Apolo (NIH: National Institutes of Health)H-Index: 17
view all 10 authors...
Abstract null null Objective null Metastatic bladder cancer is an aggressive disease that can often be difficult to diagnose and stage with conventional cross-sectional imaging. The primary objective of this study was to determine the clinical value of fluorine-18 2-fluoro-2-deoxy-D-glucose (18F-FDG) PET/MRI for surveillance and restaging of patients with muscle-invasive, locally advanced, and metastatic bladder cancer compared to conventional imaging methods. null null null Materials and Method...
Source
#1Mizue Suzuki (Kyoto University)
#2Yasutaka Fushimi (Kyoto University)H-Index: 23
Last. Yuji Nakamoto (Kyoto University)H-Index: 58
view all 9 authors...
PURPOSE To evaluate the clinical feasibility of a newly developed mobile PET system with MR-compatibility (flexible PET; fxPET), compared with conventional PET (cPET)/CT for brain imaging. METHODS Twenty-one patients underwent cPET/CT with subsequent fxPET/MRI using 18F-FDG. As qualitative evaluation, we visually rated image quality of MR and PET images using a four-point scoring system. We evaluated overall image quality for MR, while we evaluated overall image quality, sharpness and lesion con...
Source
#1Jad S Husseini (Harvard University)H-Index: 5
#2Bárbara Juarez Amorim (State University of Campinas)H-Index: 11
Last. Onofrio A. Catalano (Harvard University)H-Index: 39
view all 33 authors...
BACKGROUND MR is an important imaging modality for evaluating musculoskeletal malignancies owing to its high soft tissue contrast and its ability to acquire multiparametric information. PET provides quantitative molecular and physiologic information and is a critical tool in the diagnosis and staging of several malignancies. PET/MR, which can take advantage of its constituent modalities, is uniquely suited for evaluating skeletal metastases. We reviewed the current evidence of PET/MR in assessin...
Source
#1Amy M. Fowler (UW: University of Wisconsin-Madison)H-Index: 15
#2Manoj Kumar (UW: University of Wisconsin-Madison)H-Index: 5
Last. Alan B. McMillanH-Index: 20
view all 11 authors...
Measurement agreement of the glucose uptake in primary invasive breast cancer was demonstrated between PET/CT, the current reference standard, and simultaneous time-of-flight breast fluorine 18 flu...
1 CitationsSource
#1Eric WolsztynskiH-Index: 9
#2Janet F. EaryH-Index: 68
Source
#1Mueez AizazH-Index: 1
#2R.P.M. Moonen (UM: Maastricht University)H-Index: 1
Last. M. Eline KooiH-Index: 21
view all 6 authors...
Myocardial infarction and stroke are the most prevalent global causes of death. Each year 15 million people worldwide die due to myocardial infarction or stroke. Rupture of a vulnerable atherosclerotic plaque is the main underlying cause of stroke and myocardial infarction. Key features of a vulnerable plaque are inflammation, a large lipid-rich necrotic core (LRNC) with a thin or ruptured overlying fibrous cap, and intraplaque hemorrhage (IPH). Noninvasive imaging of these features could have a...
4 CitationsSource
#1Babak Saboury (NIH: National Institutes of Health)H-Index: 25
#1Babak Saboury (NIH: National Institutes of Health)H-Index: 3
Last. Abass AlaviH-Index: 2
view all 4 authors...
Source
#1Irina Velikyan (Science for Life Laboratory)H-Index: 22
#1I. Velikyan (Science for Life Laboratory)H-Index: 1
The role of nuclear medicine in the management of oncological patients has expanded during last two decades. The number of radiopharmaceuticals contributing to the realization of theranostics/radiotheranostics in the context of personalized medicine is increasing. This review is focused on the examples of targeted (radio)pharmaceuticals for the imaging and therapy of neuroendocrine neoplasms (NENs), prostate cancer, and breast cancer. These examples strongly demonstrate the tendency of nuclear m...
6 CitationsSource
#1Akshat C. Pujara (UM: University of Michigan)H-Index: 2
#1Akshat C. Pujara (UM: University of Michigan)H-Index: 2
Last. Amy N. Melsaether (NYU: New York University)H-Index: 12
view all 4 authors...
: Positron emission tomography / magnetic resonance imaging (PET/MRI) is an emerging imaging technology that allows for the acquisition of multiple MRI parameters simultaneously with PET data. In this review, we address the technical requirements of PET/MRI including protocols and tracers, the potential of integrated localized breast PET/MRI exams, and possible applications of whole-body PET/MRI in breast cancer patients. Currently, PET/MRI can be performed on sequential and integrated PET/MRI s...
6 CitationsSource