PET/MRI Improves Lesion Detection

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PET/MRI Improves Lesion Detection

By: Vikki Harmonay

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• A study by a German research team has determined that PET/MRI exams improved lesion detection by more than 15% when compared with PET/CT in selected cancers.

• The study at the University of Duisburg-Essen in Essen, Germany consisted of more than 1,000 exams. The selected cancers were malignant bone disease and lung cancer.

• The study also showed that PET/MRI reduced ionizing radiation by almost 80% when compared with PET/CT. In 15.4% of all exams, additional lesions were identified on PET/MRI that weren’t detected on PET/CT, according to the article appearing in the August 2020 edition of the Journal of Nuclear Medicine.

• The lead co-authors of the study, Dr. Ole Martin from the department of diagnostic and interventional radiology at University Dusseldorf, Medical Faculty and Dr. Benedikt Schaarschmidt from the University of Duisburg-Essen’s department of diagnostic and interventional radiology and neuroradiology, said, “PET/MRI improves lesion detection for selected cancers and potentially reduces the need for additional examinations in comparison with PET/CT.“ • For lung cancer and lymphoma, PET/CT had become the go-to method to improve cancer staging accuracy, optimize therapy strategies and improve patient outcome.

But the modality has low soft-tissue contrast and emits radiation, unlike PET/MRI.

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• Several other studies have also shown PET/MRI’s effectiveness in imaging cancers, especially in prostate and the breast.

• However, the lack of high-quality data regarding other cancers has hindered PET/MRI’s widespread introduction into clinical practice, according to the study’s co-authors.

• They wanted to remedy this situation by comparing PET/MRI with PET/CT in different oncologic diseases at the German institution.

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The patients at their institution underwent a whole-body PET/CT scan from skull to mid-thighs, as well as a whole-body PET/MRI. The patients presented with the following cancers: • Lung cancer (17.9%) • Gastrointestinal cancer or neuroendocrine tumors (17.2%) • Gynecologic or breast cancer (14.8%) • Prostate cancer (14.8%) • Lymphoma (12.0%) • Melanoma (8.7%) • Head and neck cancer (8.0%) • Cancer of unknown primary (4.3%) • Malignant bone disease (2.4%)

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• Following some exclusions, 1,003 PET/MRI scans of 918 patients were examined, with PET/MRI outperforming PET/CT in terms of providing more tumor information—26.3% more, in fact. These were detected in patients with malignant bone cancer, lung cancer, prostate cancer and gynecologic or breast cancer.

• PET/MRI identified additional malignant findings in 5.3% of cases, which lead to a change in tumor, node, and metastases (TNM) staging in 2.9% of cases.

• PET/MRI also clearly classified indeterminate PET/CT lesions in 115 of cases.

2.9% of lesions were detected on PET/CT versus PET/MRI, with 1.2% of those being malignant and resulted in a change in TNM staging in 0.5%.

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• The authors said that PET’MRI missed a negligibly small amount (.8%) of lung metastases, which contradicted previous beliefs that the chest required additional CT. • New MRI sequences like ultrashort echo-time sequences are expected to improve lung nodule detection, which would also enhance the sensitivity of PET/MRI even more.

• The estimated mean effective radiation dose between PET/CT and PET/MRI was an important difference: 17.6 ± 8.7 mSv for PET/CT and 3.6 ± 1.4 mSv for PET/MRI. That represents a reduction of 79.6%.

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• This is significant for younger patients when considering the cumulative radiation dose required for staging, therapy monitoring and aftercare using CT. • The researchers said, “"Future studies addressing the technical and operational challenges of PET/MRI, as well as involving different vendors and even larger cohorts, will hopefully further pave the way toward a widespread introduction of PET/MRI into clinical patient

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