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Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging 11/2017

31.05.2017 | Original Article

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

verfasst von: Youssef Erfanian, Johannes Grueneisen, Julian Kirchner, Axel Wetter, Lars Erik Podleska, Sebastian Bauer, Thorsten Poeppel, Michael Forsting, Ken Herrmann, Lale Umutlu

Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging | Ausgabe 11/2017

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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.
Literatur
2.
Zurück zum Zitat Fletcher CD, Unni KK, Mertens F. Pathology and genetics of tumours of soft tissue and bone: Iarc; 2002. Fletcher CD, Unni KK, Mertens F. Pathology and genetics of tumours of soft tissue and bone: Iarc; 2002.
3.
Zurück zum Zitat Ferrari A, Sultan I, Huang TT, Galindo CR, Shehadeh A, Meazza C, et al. Soft tissue sarcoma across the age Spectrum: a population-based study from the surveillance epidemiology and end results database. Pediatr Blood Cancer. 2011;57:943–9. doi:10.1002/pbc.23252.CrossRefPubMedPubMedCentral Ferrari A, Sultan I, Huang TT, Galindo CR, Shehadeh A, Meazza C, et al. Soft tissue sarcoma across the age Spectrum: a population-based study from the surveillance epidemiology and end results database. Pediatr Blood Cancer. 2011;57:943–9. doi:10.​1002/​pbc.​23252.CrossRefPubMedPubMedCentral
5.
Zurück zum Zitat Goodlad JR, Fletcher CD, Smith MA. Surgical resection of primary soft-tissue sarcoma. Incidence of residual tumour in 95 patients needing re-excision after local resection. J Bone Joint Surg. 1996;78:658–61. Goodlad JR, Fletcher CD, Smith MA. Surgical resection of primary soft-tissue sarcoma. Incidence of residual tumour in 95 patients needing re-excision after local resection. J Bone Joint Surg. 1996;78:658–61.
6.
Zurück zum Zitat Ferrario T, Karakousis CP. Retroperitoneal sarcomas: grade and survival. Arch Surg (Chicago, Ill : 1960). 2003;138:248–51.CrossRefPubMed Ferrario T, Karakousis CP. Retroperitoneal sarcomas: grade and survival. Arch Surg (Chicago, Ill : 1960). 2003;138:248–51.CrossRefPubMed
7.
Zurück zum Zitat Diana Afonso P, Kosinski AS, Spritzer CE. Following unenhanced MRI assessment for local recurrence after surgical resection of mesenchymal soft tissue tumors, do additional gadolinium-enhanced images change reader confidence or diagnosis? Eur J Radiol. 2013;82:806–13. doi:10.1016/j.ejrad.2012.11.025.CrossRefPubMed Diana Afonso P, Kosinski AS, Spritzer CE. Following unenhanced MRI assessment for local recurrence after surgical resection of mesenchymal soft tissue tumors, do additional gadolinium-enhanced images change reader confidence or diagnosis? Eur J Radiol. 2013;82:806–13. doi:10.​1016/​j.​ejrad.​2012.​11.​025.CrossRefPubMed
10.
Zurück zum Zitat Tateishi U, Yamaguchi U, Seki K, Terauchi T, Arai Y, Kim EE. Bone and soft-tissue sarcoma: preoperative staging with fluorine 18 fluorodeoxyglucose PET/CT and conventional imaging. Radiology. 2007;245:839–47. doi:10.1148/radiol.2453061538.CrossRefPubMed Tateishi U, Yamaguchi U, Seki K, Terauchi T, Arai Y, Kim EE. Bone and soft-tissue sarcoma: preoperative staging with fluorine 18 fluorodeoxyglucose PET/CT and conventional imaging. Radiology. 2007;245:839–47. doi:10.​1148/​radiol.​2453061538.CrossRefPubMed
11.
Zurück zum Zitat Drzezga A, Souvatzoglou M, Eiber M, Beer AJ, Furst S, Martinez-Moller A, et al. First clinical experience with integrated whole-body PET/MR: comparison to PET/CT in patients with oncologic diagnoses. J Nucl Med. 2012;53:845–55. doi:10.2967/jnumed.111.098608.CrossRefPubMed Drzezga A, Souvatzoglou M, Eiber M, Beer AJ, Furst S, Martinez-Moller A, et al. First clinical experience with integrated whole-body PET/MR: comparison to PET/CT in patients with oncologic diagnoses. J Nucl Med. 2012;53:845–55. doi:10.​2967/​jnumed.​111.​098608.CrossRefPubMed
13.
Zurück zum Zitat Heusch P, Buchbender C, Kohler J, Nensa F, Beiderwellen K, Kuhl H, et al. Correlation of the apparent diffusion coefficient (ADC) with the standardized uptake value (SUV) in hybrid 18F-FDG PET/MRI in non-small cell lung cancer (NSCLC) lesions: initial results. RoFo. 2013;185:1056–62. doi:10.1055/s-0033-1350110.CrossRefPubMed Heusch P, Buchbender C, Kohler J, Nensa F, Beiderwellen K, Kuhl H, et al. Correlation of the apparent diffusion coefficient (ADC) with the standardized uptake value (SUV) in hybrid 18F-FDG PET/MRI in non-small cell lung cancer (NSCLC) lesions: initial results. RoFo. 2013;185:1056–62. doi:10.​1055/​s-0033-1350110.CrossRefPubMed
14.
Zurück zum Zitat Beiderwellen KJ, Poeppel TD, Hartung-Knemeyer V, Buchbender C, Kuehl H, Bockisch A, et al. Simultaneous 68Ga-DOTATOC PET/MRI in patients with gastroenteropancreatic neuroendocrine tumors: initial results. Investig Radiol. 2013;48:273–9. doi:10.1097/RLI.0b013e3182871a7f.CrossRef Beiderwellen KJ, Poeppel TD, Hartung-Knemeyer V, Buchbender C, Kuehl H, Bockisch A, et al. Simultaneous 68Ga-DOTATOC PET/MRI in patients with gastroenteropancreatic neuroendocrine tumors: initial results. Investig Radiol. 2013;48:273–9. doi:10.​1097/​RLI.​0b013e3182871a7f​.CrossRef
16.
Zurück zum Zitat Partovi S, Kohan AA, Zipp L, Faulhaber P, Kosmas C, Ros PR, et al. Hybrid PET/MR imaging in two sarcoma patients – clinical benefits and implications for future trials. Int J Clin Exp Med. 2014;7:640–8.PubMedPubMedCentral Partovi S, Kohan AA, Zipp L, Faulhaber P, Kosmas C, Ros PR, et al. Hybrid PET/MR imaging in two sarcoma patients – clinical benefits and implications for future trials. Int J Clin Exp Med. 2014;7:640–8.PubMedPubMedCentral
17.
Zurück zum Zitat Schuler MK, Richter S, Beuthien-Baumann B, Platzek I, Kotzerke J, van den Hoff J, et al. PET/MRI imaging in high-risk sarcoma: first findings and solving clinical problems. Case Rep Oncol Med. 2013;2013:793927. doi:10.1155/2013/793927.PubMedPubMedCentral Schuler MK, Richter S, Beuthien-Baumann B, Platzek I, Kotzerke J, van den Hoff J, et al. PET/MRI imaging in high-risk sarcoma: first findings and solving clinical problems. Case Rep Oncol Med. 2013;2013:793927. doi:10.​1155/​2013/​793927.PubMedPubMedCentral
18.
Zurück zum Zitat De Schepper AM. Grading and characterization of soft tissue tumors. In: De Schepper AM, Parizel PM, De Beuckeleer L, Vanhoenacker F, editors. Imaging of soft tissue tumors. Berlin: Springer Berlin Heidelberg; 2001. p. 123–41.CrossRef De Schepper AM. Grading and characterization of soft tissue tumors. In: De Schepper AM, Parizel PM, De Beuckeleer L, Vanhoenacker F, editors. Imaging of soft tissue tumors. Berlin: Springer Berlin Heidelberg; 2001. p. 123–41.CrossRef
19.
Zurück zum Zitat Berquist TH, Ehman RL, King BF, Hodgman CG, Ilstrup DM. Value of MR imaging in differentiating benign from malignant soft-tissue masses: study of 95 lesions. Am J Roentgenol. 1990;155:1251–5. doi:10.2214/ajr.155.6.2122675.CrossRef Berquist TH, Ehman RL, King BF, Hodgman CG, Ilstrup DM. Value of MR imaging in differentiating benign from malignant soft-tissue masses: study of 95 lesions. Am J Roentgenol. 1990;155:1251–5. doi:10.​2214/​ajr.​155.​6.​2122675.CrossRef
20.
Zurück zum Zitat Hermann G, Abdelwahab IF, Miller TT, Klein MJ, Lewis MM. Tumour and tumour-like conditions of the soft tissue: magnetic resonance imaging features differentiating benign from malignant masses. Br J Radiol. 1992;65:14–20. doi:10.1259/0007-1285-65-769-14.CrossRefPubMed Hermann G, Abdelwahab IF, Miller TT, Klein MJ, Lewis MM. Tumour and tumour-like conditions of the soft tissue: magnetic resonance imaging features differentiating benign from malignant masses. Br J Radiol. 1992;65:14–20. doi:10.​1259/​0007-1285-65-769-14.CrossRefPubMed
21.
Zurück zum Zitat Schwarzbach MHM, Dimitrakopoulou-Strauss A, Willeke F, Hinz U, Strauss LG, Zhang Y-M, et al. Clinical value of [18-F] Fluorodeoxyglucose positron emission tomography imaging in soft tissue sarcomas. Ann Surg. 2000;231:380–6.CrossRefPubMedPubMedCentral Schwarzbach MHM, Dimitrakopoulou-Strauss A, Willeke F, Hinz U, Strauss LG, Zhang Y-M, et al. Clinical value of [18-F] Fluorodeoxyglucose positron emission tomography imaging in soft tissue sarcomas. Ann Surg. 2000;231:380–6.CrossRefPubMedPubMedCentral
24.
Zurück zum Zitat Vanel D, Shapeero LG, Tardivon A, Western A, Guinebretière JM. Dynamic contrast-enhanced MRI with subtraction of aggressive soft tissue tumors after resection. Skelet Radiol. 1998;27:505–10. doi:10.1007/s002560050428.CrossRef Vanel D, Shapeero LG, Tardivon A, Western A, Guinebretière JM. Dynamic contrast-enhanced MRI with subtraction of aggressive soft tissue tumors after resection. Skelet Radiol. 1998;27:505–10. doi:10.​1007/​s002560050428.CrossRef
27.
Zurück zum Zitat Park SY, Chung HW, Chae SY, Lee JS. Comparison of MRI and PET-CT in detecting the loco-regional recurrence of soft tissue sarcomas during surveillance. Skelet Radiol. 2016;45:1375–84. doi:10.1007/s00256-016-2440-5.CrossRef Park SY, Chung HW, Chae SY, Lee JS. Comparison of MRI and PET-CT in detecting the loco-regional recurrence of soft tissue sarcomas during surveillance. Skelet Radiol. 2016;45:1375–84. doi:10.​1007/​s00256-016-2440-5.CrossRef
28.
30.
Zurück zum Zitat Reuther G, Mutschler W. Detection of local recurrent disease in musculoskeletal tumors: magnetic resonance imaging versus computed tomography. Skelet Radiol. 1990;19:85–90.CrossRef Reuther G, Mutschler W. Detection of local recurrent disease in musculoskeletal tumors: magnetic resonance imaging versus computed tomography. Skelet Radiol. 1990;19:85–90.CrossRef
31.
Zurück zum Zitat Moulton JS, Blebea JS, Dunco DM, Braley SE, Bisset GS, Emery KH. MR imaging of soft-tissue masses: diagnostic efficacy and value of distinguishing between benign and malignant lesions. Am J Roentgenol. 1995;164:1191–9. doi:10.2214/ajr.164.5.7717231.CrossRef Moulton JS, Blebea JS, Dunco DM, Braley SE, Bisset GS, Emery KH. MR imaging of soft-tissue masses: diagnostic efficacy and value of distinguishing between benign and malignant lesions. Am J Roentgenol. 1995;164:1191–9. doi:10.​2214/​ajr.​164.​5.​7717231.CrossRef
32.
Zurück zum Zitat Lucas JD, O’Doherty MJ, Wong JC, Bingham JB, McKee PH, Fletcher CD, et al. Evaluation of fluorodeoxyglucose positron emission tomography in the management of soft-tissue sarcomas. J Bone Joint Surg. 1998;80:441–7.CrossRef Lucas JD, O’Doherty MJ, Wong JC, Bingham JB, McKee PH, Fletcher CD, et al. Evaluation of fluorodeoxyglucose positron emission tomography in the management of soft-tissue sarcomas. J Bone Joint Surg. 1998;80:441–7.CrossRef
35.
Zurück zum Zitat Friedman H, Harrelson J, Scully S, Coleman R. Monitoring of neoadjuvant therapy response of soft-tissue and musculoskeletal sarcoma using fluorine-18-FDG PET. J Nucl Med. 1996;37:1438–44.PubMed Friedman H, Harrelson J, Scully S, Coleman R. Monitoring of neoadjuvant therapy response of soft-tissue and musculoskeletal sarcoma using fluorine-18-FDG PET. J Nucl Med. 1996;37:1438–44.PubMed
36.
Zurück zum Zitat Iagaru A, Masamed R, Chawla SP, Menendez LR, Fedenko A, Conti PS. F-18 FDG PET and PET/CT evaluation of response to chemotherapy in bone and soft tissue sarcomas. Clin Nucl Med. 2008;33:8–13.CrossRefPubMed Iagaru A, Masamed R, Chawla SP, Menendez LR, Fedenko A, Conti PS. F-18 FDG PET and PET/CT evaluation of response to chemotherapy in bone and soft tissue sarcomas. Clin Nucl Med. 2008;33:8–13.CrossRefPubMed
37.
Metadaten
Titel
Integrated 18F–FDG PET/MRI compared to MRI alone for identification of local recurrences of soft tissue sarcomas: a comparison trial
verfasst von
Youssef Erfanian
Johannes Grueneisen
Julian Kirchner
Axel Wetter
Lars Erik Podleska
Sebastian Bauer
Thorsten Poeppel
Michael Forsting
Ken Herrmann
Lale Umutlu
Publikationsdatum
31.05.2017
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Nuclear Medicine and Molecular Imaging / Ausgabe 11/2017
Print ISSN: 1619-7070
Elektronische ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-017-3736-y

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