Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Mar;35(3):281-290.
doi: 10.1007/s12149-021-01580-0. Epub 2021 Jan 31.

[18F]FDG PET/MRI in rectal cancer

Filippo Crimì  1 , Silvia Valeggia  1 , Luca Baffoni  1 , Roberto Stramare  1 , Carmelo Lacognata  2 , Gaya Spolverato  3 , Laura Albertoni  4 , Alessandro Spimpolo  5 , Laura Evangelista  6 , Pietro Zucchetta  6 , Diego Cecchin  6 , Salvatore Pucciarelli  3
Affiliations

[18F]FDG PET/MRI in rectal cancer

Filippo Crimì et al. Ann Nucl Med. 2021 Mar.

Abstract

We conducted a systematic literature review on the use of [18F]FDG PET/MRI for staging/restaging rectal cancer patients with PubMed, Scopus, and Web of Science, based on the PRISMA criteria. Three authors screened all titles and abstracts and examined the full texts of all the identified relevant articles. Studies containing aggregated or duplicated data, review articles, case reports, editorials, and letters were excluded. Ten reports met the inclusion criteria. Four studies examined T staging and one focused on local recurrences after surgery; the reported sensitivity (94-100%), specificity (73-94%), and accuracy (92-100%) varied only slightly from one study to another. The sensitivity, specificity, and accuracy of [18F]FDG PET/MRI for N staging were 90-93%, 92-94%, and 42-92%. [18F]FDG PET/MRI detected malignant nodes better than MRI, resulting in treatment change. For M staging, [18F]FDG PET/MRI outperformed [18F]FDG PET/CT and CT in detecting liver metastases, whereas it performed worse for lung metastases. The results of this review suggest that [18F]FDG PET/MRI should be used for rectal cancer restaging after chemoradiotherapy and to select patients for rectum-sparing approaches thanks to its accuracy in T and N staging. For M staging, it should be associated at least with a chest CT scan to rule out lung metastases.

Keywords: PET/MRI; Rectal cancer; [18F]FDG.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
The literature review flowchart
Fig. 2
Fig. 2
PET/MR images of a histologically-proven T2 rectal cancer after pCRT. a T2-weighted paraxial image showing an irregular thickening of the right rectal wall (arrow), with no signs of extramural invasion; b paraxial contrast-enhanced volumetric interpolated breath-hold examination (VIBE) with irregular enhancement of the same lesion (arrow); c axial b1000 diffusion-weighted imaging (DWI) showing signal restriction of the mass (arrow); d paraxial PET/MR fused image with hypermetabolism of the rectal tumour (arrow)
Fig. 3
Fig. 3
PET/MR images of a malignant mesorectal lymph node after pCRT. a T2-weighted paracoronal image showing rounded lymph node with short axis of 6 mm, irregular margins and internal signal heterogeneity (arrow); b paracoronal contrast-enhanced VIBE showing the same lymph node (arrow) with internal signs of necrosis; c axial b1000 diffusion-weighted imaging (DWI) identifying the lymph node (arrow); d paracoronal PET/MR fused image with slight hypermetabolism of the small lymph node (arrow)
Fig. 4
Fig. 4
PET/MR images of a small liver metastasis. a T2-weighted axial image showing small area of slight hyperintensity in S8 (arrow); b axial VIBE with a small hypointense lesion of 7 mm in S8 (arrow); c axial b1000 diffusion-weighted imaging (DWI) confirming the signal restriction of the mass (arrow); d axial PET/MR fused image with hypermetabolism of the liver lesion (arrow)
See this image and copyright information in PMC

References

    1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65:5–29. doi: 10.3322/caac.21254. - DOI - PubMed
    1. Fowler KJ, Kaur H, Cash BD, Feig BW, Gage KL, Garcia EM, et al. ACR appropriateness criteria. J Am Coll Radiol. 2017;14:S234–S244. doi: 10.1016/j.jacr.2017.02.012. - DOI - PubMed
    1. Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, et al. The eighth edition AJCC Cancer Staging Manual: continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin. 2017;67:93–99. doi: 10.3322/caac.21388. - DOI - PubMed
    1. Ma B, Gao P, Wang H, Xu Q, Song Y, Huang X, et al. What has preoperative radio(chemo)therapy brought to localized rectal cancer patients in terms of perioperative and long-term outcomes over the past decades? A systematic review and meta-analysis based on 41,121 patients. Int J Cancer. 2017;141:1052–1065. doi: 10.1002/ijc.30805. - DOI - PubMed
    1. Van Cutsem E, Cervantes A, Nordlinger B, Arnold D, Group EGW Metastatic colorectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2014;25(Suppl 3):iii1–9. doi: 10.1093/annonc/mdu260. - DOI - PubMed

Publication types

Substances