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A lesson in humility: the added values of PET-MRI over PET-CT in detecting malignant hepatic lesions

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Abstract

Purpose

The recent introduction of integrated PET-MRI systems into practice seems promising in oncologic imaging, and efforts are made to specify their added values. The current study evaluates the added values of PET-MRI over PET-CT in detecting active malignant hepatic lesions.

Methods

As part of an ongoing prospective study in our institution that assesses the added values of PET-MRI, subjects undergo PET-CT and subsequent PET-MRI after single radiotracer injection. The current study included 97 pairs of whole-body PET-CT and liver PET-MRI scans, of 61 patients (19/61 had ≥ 2 paired scans), all performed with [18F]FDG and interpreted as showing active malignant hepatic involvement. Primary malignancies were of colorectal/biliary/pancreatic/breast/other origins in 19/9/9/7/17 patients. Monitoring response to therapy was the indication in 86/97 cases. When PET-MRI detected additional malignant lesions over PET-CT, lesions size, their characteristics on PET-MRI, and the influence on the final report were recorded.

Results

In 37/97 (38.1%) cases, a total of 78 malignant lesions were identified on PET-MRI but not on PET-CT: 19 lesions (11 cases) were identified on PET of PET-MRI but not on PET of PET-CT; 37 lesions (14 cases) were small (≤ 0.8 cm) and identified on MRI only; 22 lesions (12 cases) were > 0.8 cm, had low/no [18F]FDG uptake, but were categorized as viable based on MRI. These 78 lesions caused major effect on final reports in 11/97 (11.3%) cases, changing reported response assessment category (10/86 cases) or defining malignant hepatic disease on staging/restaging scans (1/11 cases).

Conclusion

PET-MRI offers several advantages over PET-CT in assessing the extent and response to therapy of malignant hepatic involvement. Additional malignant lesions detected on PET-MRI are attributed to superior PET performance (compared with PET of PET-CT), greater spatial resolution provided by MRI, and improved multi-parametric viability assessment. In around one-tenth of cases, findings identified on PET-MRI but not on PET-CT significantly change the final report’s conclusion.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

[18F]FDG:

18F-fluorodeoxyglucose

PET-MRI:

Positron emission tomography-magnetic resonance imaging

PET-CT:

Positron emission tomography-computed tomography

DWI:

Diffusion-weighted imaging

ADC:

Apparent diffusion coefficient

DCE:

Dynamic contrast enhanced

TOF:

Time of flight

Pv:

P-Value

IQR:

Interquartile range

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Acknowledgements

We thank our department’s research assistants Irina Dana and Liron Maor for their assistance in conducting this study, and the anonymous reviewers of the European Journal of Nuclear Medicine and Molecular Imaging for their insightful feedbacks.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Tel-Aviv Sourasky Medical Center, 6 Weizmann St, 6423906, Tel Aviv, Israel

    Dan Cohen, Mikhail Kesler, Marina Muchnik Kurash, Einat Even-Sapir & Charles Levine

  2. Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 39040, 6997801, Tel Aviv, Israel

    Einat Even-Sapir & Charles Levine

Authors
  1. Dan Cohen
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  2. Mikhail Kesler
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Correspondence to Dan Cohen.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. All patients were enrolled as part of an ongoing prospective study to evaluate the added values of PET-MRI over PET-CT in the imaging of various malignancies (ClinicalTrials.gov identifier: NCT04158414, registered November 8, 2019). This study was approved by the institutional review board (Reference ID 0568–19-TLV), and all participating patients gave written informed consent.

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Cohen, D., Kesler, M., Muchnik Kurash, M. et al. A lesson in humility: the added values of PET-MRI over PET-CT in detecting malignant hepatic lesions. Eur J Nucl Med Mol Imaging 50, 1423–1433 (2023). https://doi.org/10.1007/s00259-022-06099-8

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