Integrated 18F-FDG PET/MRI compared to MRI alone for identification of local recurrences of soft tissue sarcomas: a comparison trial

Abstract

Purpose: To assess and compare the diagnostic accuracy of PET/MRI and MRI alone for the detection of local recurrences of soft tissue sarcomas (STS) after initial surgical resection of the primary tumors.

Material and methods: A total of 41 patients with clinically suspected tumor relapse of STS underwent an ¹⁸F-FDG-PET/MRI examination for assessment of local recurrence. Two experienced physicians interpreted the MRI data and subsequently the PET/MRI datasets in two separate reading sessions and were instructed to identify potential local tumor recurrences. Additionally, the diagnostic confidence in each reading for the identification of malignant lesions was determined. A McNemar test was applied to test for differences of both ratings and a Wilcoxon signed-rank test was used to identify differences of the confidence levels. Histopathological verification and follow-up imaging were applied for standard of reference.

Results: Tumor relapse was present in 27/41 patients. Calculated sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy for the detection of local tumor recurrence was 82%, 86%, 92%, 71% and 83% for MRI, and 96%, 79%, 90%, 92% and 90% for PET/MRI (p > 0.05). Furthermore, PET/MRI showed significantly higher confidence levels (p < 0.05) for the determination of malignant lesions.

Conclusion: Our results endorse ¹⁸F-FDG PET/MRI to be an excellent imaging method in the evaluation of recurrent STS after surgical excision, yielding superior tumor detection when compared to MRI alone.

Keywords: Hybrid imaging; Integrated PET/MRI; Soft tissue sarcoma.