Whole-Body Dual-Modality PET/CT and Whole-Body MRI for Tumor Staging in Oncology
- Gerald Antoch, MD;
- Florian M. Vogt, MD;
- Lutz S. Freudenberg, MD;
- Fridun Nazaradeh, MD;
- Susanne C. Goehde, MD;
- Jörg Barkhausen, MD;
- Gerlinde Dahmen, MSc;
- Andreas Bockisch, MD, PhD;
- Jörg F. Debatin, MD, MBA;
- Stefan G. Ruehm, MD
- Author Affiliations: Departments of Diagnostic and Interventional Radiology (Drs Antoch, Vogt, Nazaradeh, Goehde, Barkhausen, Debatin, and Ruehm) and Nuclear Medicine (Drs Freudenberg and Bockisch), University Hospital Essen, Essen, Germany; and Institute of Medical Biometry and Statistics, University at Lübeck, Lübeck, Germany (Ms Dahmen).
Abstract
Context Deciding on the appropriate therapy for patients with malignant diseases mandates accurate tumor staging with whole-body coverage. Magnetic resonance imaging (MRI) and a combined modality including positron emission tomography (PET) and computed tomography (CT) provide whole-body tumor staging in a single session.
Objective To determine the staging accuracies of both whole-body PET/CT and whole-body MRI for different malignant diseases.
Design, Setting, and Patients Prospective, blinded, investigator-initiated study of 98 patients (mean age, 58 years; range, 27-94 years) with various oncological diseases who underwent back-to-back whole-body glucose analog [18F]-fluorodeoxyglucose–PET/CT and whole-body MRI for tumor staging. The study was conducted at a university hospital from December 2001 through October 2002 and had a mean follow-up of 273 days (range, 75-515 days). The images were evaluated by 2 different, blinded reader teams. The diagnostic accuracies of the 2 imaging procedures were compared.
Main Outcome Measures Correct classification of the primary tumor, regional lymph nodes, and distant metastasis (overall TNM stage) using whole-body PET/CT and whole-body MRI. Secondary outcome measures were accurate assessment of T-stage, N-stage, and M-stage by the 2 imaging procedures.
Results Of 98 patients, the overall TNM stage was correctly determined in 75 with PET/CT (77%; 95% confidence interval [CI], 67%-85%) and in 53 with MRI (54%; 95% CI, 44%-64%) (P<.001). Compared with MRI, PET/CT had a direct impact on patient management in 12 patients. Results from MRI changed the therapy regimen in 2 patients compared with PET/CT. Separate assessment of T-stage (with pathological verification) in 46 patients revealed PET/CT to be accurate in 37 (80%; 95% CI, 66%-91%) and MRI to be accurate in 24 (52%; 95% CI, 37%-67%) (P<.001). Of 98 patients, N-stage was correctly determined in 91 patients with PET/CT (93%; 95% CI, 86%-97%) and in 77 patients with MRI (79%; 95% CI, 69%-86%) (P = .001). Both imaging procedures showed a similar performance in detecting distant metastases.
Conclusions The feasibility and diagnostic accuracy of the whole-body staging strategies of PET/CT and MRI are established. Superior performance in overall TNM staging suggests the use of [18F]-fluorodeoxyglucose–PET/CT as a possible first-line modality for whole-body tumor staging.
