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Comparative Study
. 2015 Sep 3;10(9):e0137285.
doi: 10.1371/journal.pone.0137285. eCollection 2015.

Accuracy of [18F]FDG PET/MRI for the Detection of Liver Metastases

Karsten Beiderwellen  1 , Llanos Geraldo  2 , Verena Ruhlmann  3 , Philipp Heusch  4 , Benedikt Gomez  3 , Felix Nensa  1 , Lale Umutlu  1 , Thomas C Lauenstein  1
Affiliations
Comparative Study

Accuracy of [18F]FDG PET/MRI for the Detection of Liver Metastases

Karsten Beiderwellen et al. PLoS One. .

Abstract

Background: The aim of this study was to compare the diagnostic accuracy of [18F]FDG-PET/MRI with PET/CT for the detection of liver metastases.

Methods: 32 patients with solid malignancies underwent [18F]FDG-PET/CT and subsequent PET/MRI of the liver. Two readers assessed both datasets regarding lesion characterization (benign, indeterminate, malignant), conspicuity and diagnostic confidence. An imaging follow-up (mean interval: 185±92 days) and/-or histopathological specimen served as standards of reference. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for both modalities. Accuracy was determined by calculating the area under the receiver operating characteristic (ROC) curve. Values of conspicuity and diagnostic confidence were compared using Wilcoxon-signed-rank test.

Results: The standard of reference revealed 113 liver lesions in 26 patients (malignant: n = 45; benign: n = 68). For PET/MRI a higher accuracy (PET/CT: 82.4%; PET/MRI: 96.1%; p<0.001) as well as sensitivity (67.8% vs. 92.2%, p<0.01) and NPV (82.0% vs. 95.1%, p<0.05) were observed. PET/MRI offered higher lesion conspicuity (PET/CT: 2.0±1.1 [median: 2; range 0-3]; PET/MRI: 2.8±0.5 [median: 3; range 0-3]; p<0.001) and diagnostic confidence (PET/CT: 2.0±0.8 [median: 2; range: 1-3]; PET/MRI 2.6±0.6 [median: 3; range: 1-3]; p<0.001). Furthermore, PET/MRI enabled the detection of additional PET-negative metastases (reader 1: 10; reader 2: 12).

Conclusions: PET/MRI offers higher diagnostic accuracy compared to PET/CT for the detection of liver metastases.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Study flow diagram.
Fig 2
Fig 2. Patient with breast cancer.
Both PET/CT (A,B) as well as PET/MRI (C; D; VIBE, portal venous phase) show a lesion with elevated FDG-uptake and ill-defined lesion borders as well as central contrast enhancement as signs of malignancy. Based on these findings the lesion was correctly identified as metastasis in both modalities.
Fig 3
Fig 3. Patient with uveal melanoma.
cePET/CT (A+B) shows a hypodense liver lesion of 10 mm in diameter without elevated tracer uptake which is therefore rated as indeterminate. In PET/MRI (C-F) the lesion is hyperintense in T2w TSE (D) and shows signs of restricted diffusion (E: b1000; F: ADC map). Therefore, based on PET/MRI the lesion is rated as metastasis. Based on T2w imaging additional 4 metastases are visualized in PET/MRI in the contralateral lobe.
Fig 4
Fig 4. Patient without liver metastases.
PET/CT with a false positive result showing a hypodense pseudolesion with a diameter 9 mm in the CT dataset without correlate in PET. In the later acquired PET/MRI (C-E) no correlate in PET nor in the morphological datasets (D: T1w VIBE portal-venous phase; E: T2w TSE fs).
Fig 5
Fig 5. Receiver operating characteristic (ROC) curve for PET/CT and PET/MRI for reader 1 (left), reader 2 (middle) and both readers (right).
Significantly higher accuracy (area under the curve, AUC) for PET/MRI (p<0.01 for reader 1 and 2; p<0.001 overall).
See this image and copyright information in PMC

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