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. 2021 Dec 13;5(1):23.
doi: 10.1186/s41824-021-00117-y.

Initial experience in staging primary oesophageal/gastro-oesophageal cancer with 18F-FDG PET/MRI

Amy R Sharkey  1   2 , Bert-Ram Sah  3 , Samuel J Withey  4   5 , Shaheel Bhuva  6 , Radhouene Neji  7 , Sami Jeljeli  6 , Adrian Green  4 , Gary J R Cook  4   6 , Vicky Goh  4   5 ; Guy’s & St Thomas’ Oesophago-Gastric Research Group
Collaborators, Affiliations

Initial experience in staging primary oesophageal/gastro-oesophageal cancer with 18F-FDG PET/MRI

Amy R Sharkey et al. Eur J Hybrid Imaging. .

Abstract

Background: 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (18F-FDG PET/MRI) may improve cancer staging by combining sensitive cancer detection with high-contrast resolution and detail. We compared the diagnostic performance of 18F-FDG PET/MRI to 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for staging oesophageal/gastro-oesophageal cancer. Following ethical approval and informed consent, participants with newly diagnosed primary oesophageal/gastro-oesophageal cancer were enrolled. Exclusions included prior/concurrent malignancy. Following 324 ± 28 MBq 18F-FDG administration and 60-min uptake, PET/CT was performed, immediately followed by integrated PET/MRI from skull base to mid-thigh. PET/CT was interpreted by two dual-accredited nuclear medicine physicians and PET/MRI by a dual-accredited nuclear medicine physician/radiologist and cancer radiologist in consensus. Per-participant staging was compared with the tumour board consensus staging using the McNemar test, with statistical significance at 5%.

Results: Out of 26 participants, 22 (20 males; mean ± SD age 68.8 ± 8.7 years) completed 18F-FDG PET/CT and PET/MRI. Compared to the tumour board, the primary tumour was staged concordantly in 55% (12/22) with PET/MRI and 36% (8/22) with PET/CT; the nodal stage was concordant in 45% (10/22) with PET/MRI and 50% (11/22) with PET/CT. There was no statistical difference in PET/CT and PET/MRI staging performance (p > 0.05, for T and N staging). The staging of distant metastases was concordant with the tumour board in 95% (21/22) with both PET/MRI and PET/CT. Of participants with distant metastatic disease, PET/MRI detected additional metastases in 30% (3/10).

Conclusion: In this preliminary study, compared to 18F-FDG PET/CT, 18F-FDG PET/MRI showed non-significant higher concordance with T-staging, but no difference with N or M-staging. Additional metastases detected by 18F-FDG PET/MRI may be of additive clinical value.

Keywords: Gastro-oesophageal cancer; Oesophageal cancer; PET/CT; PET/MR.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Participant flow diagram
Fig. 2
Fig. 2
a, b A gastro-oesophageal adenocarcinoma, where uptake is noted on 18F-FDG PET/MRI (b) (highlighted by arrow), but lower corresponding uptake is noted on the 18F-FDG PET/CT (a). SUVmax was 9.4 on the 18F-FDG PET/MRI vs. 3.4 on the 18F-FDG PET/CT. c and d A lower oesophageal adenocarcinoma (highlighted by arrow), for which corresponding uptake is noted on both 18F-FDG PET/CT (c) and 18F-FDG PET/MRI (d). The SUVmax was 11.8 on the 18F-FDG PET/MRI vs. 7.2 on the 18F-FDG PET/CT
Fig. 3
Fig. 3
Graph showing the correlation between the 18F-FDG PET/MRI SUVmax and the diffusion-weighted apparent diffusion coefficient, ADC (top), with Bland–Altman plot of PET/CT SUVmax vs PET/MRI SUVmax (below)
Fig. 4
Fig. 4
Oesophageal adenocarcinoma with additional liver metastases demonstrated by MRI. A non-FDG avid subcentimetre metastasis (highlighted by arrow) is demonstrated on diffusion-weighted and post-contrast-enhanced MRI, which was not detected by 18F-FDG PET/CT or contrast-enhanced CT
See this image and copyright information in PMC

References

    1. Belmouhand M, et al. Early response evaluation of neoadjuvant therapy with PET/MRI to predict resectability in patients with adenocarcinoma of the esophagogastric junction. Abdom Radiol. 2019;44(3):836–844. doi: 10.1007/s00261-018-1841-4. - DOI - PubMed
    1. Chan W, et al. Dual-time-point 18F-FDG-PET/CT imaging in the assessment of suspected malignancy. J Med Imag Radiat on. 2011;55(4):379–390. doi: 10.1111/j.1754-9485.2011.02287.x. - DOI - PubMed
    1. DaVee T, Ajani JA, Lee JH. Is endoscopic ultrasound examination necessary in the management of esophageal cancer? World J Gastroenterol. 2017;23(5):751–762. doi: 10.3748/wjg.v23.i5.751. - DOI - PMC - PubMed
    1. Enzinger PC, Mayer RJ. Esophageal Cancer. N Engl J Med. 2003;349(23):2241–2252. doi: 10.1056/nejmra035010. - DOI - PubMed
    1. Kelly S, et al. A systematic review of the staging performance of endoscopic ultrasound in gastro-oesophageal carcinoma. Gut. 2001;49(4):534. doi: 10.1136/gut.49.4.534. - DOI - PMC - PubMed