Diagnostic value of 18 F-FDG PET/MRI for staging in patients with endometrial cancer
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RESEARCH ARTICLE
Open Access
Diagnostic value of 18F-FDG PET/MRI for staging in patients with endometrial cancer Hideaki Tsuyoshi1* , Tetsuya Tsujikawa2, Shizuka Yamada1, Hidehiko Okazawa2 and Yoshio Yoshida1
Abstract Background: Preoperative accurate assessment of endometrial cancer can assist in the planning of additional surgical options, and in predicting the prognosis. The aim of the present study was to evaluate the diagnostic potential of non-contrast PET/MRI with 18F-fluorodeoxyglucose (18F-FDG) for assessment in preoperative staging of endometrial cancer. Methods: Thirty-six patients with biopsy-proven endometrial cancer underwent preoperative 18F-FDG PET/MRI, contrast-enhanced CT (ceCT) and pelvic dynamic contrast-enhanced MRI (ceMRI) for initial staging. The diagnostic performance of 18F-FDG PET/MRI and ceMRI for assessing the extent of the primary tumor (T stage), and 18F-FDG PET/MRI and ceCT for assessing nodal (N stage) and distant (M stage) metastasis, 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. Results: Accuracy for T status was 77.8 and 75.0% for 18F-FDG PET/MRI and ceMRI, respectively. Patient-based accuracy for detecting regional nodal and distant metastasis was 91.3 and 81.8% for 18F-FDG PET/MRI, and 87.0 and 81.8% for ceCT. None of these parameters was statistically significant (p > 0.05). Lesion-based sensitivity, specificity and accuracy for detecting regional nodal metastasis were 100, 96.9 and 97.0% for 18F-FDG PET/MRI, and 14.3, 97.6 and 93.3% for ceCT; sensitivity was statistically significant (p < 0.05). Conclusions: Non-contrast 18F-FDG PET/MRI, which combines the individual advantages of PET and MRI, offers a high diagnostic value equivalent to that of ceMRI for assessment of the primary tumor, and equivalent to that of ceCT for the assessment of nodal and distant metastatic staging, in patients with endometrial cancer. These findings suggest that 18F-FDG PET/MRI might provide an alternative diagnostic strategy to conventional imaging modalities in the preoperative staging of endometrial cancer. Keywords: cancer
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F-FDG PET/MRI, Contrast-enhanced CT, Contrast-enhanced MRI, Preoperative staging, Endometrial
Introduction Endometrial cancer is the most common gynecological malignancy in developed countries, and its incidence continues to increase. Because endometrial cancer is staged postoperatively, the primary treatment is determined by predicting the FIGO classification [1]. Imaging * Correspondence: [email protected] 1 Department of Obstetrics and Gynecology, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan Full list of author information is available at the end of the article
examinations are thus indispensable in planning optimal treatment, for advanced disease as well as early-stage disease confined to the uterus; however, the FIGO classifications do not currently include imaging findings. Stand
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