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Fast non-enhanced abdominal examination protocols in PET/MRI for patients with neuroendocrine tumors (NET): comparison to multiphase contrast-enhanced PET/CT

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Abstract

Purpose

To evaluate fast non-enhanced protocols for abdominal PET/MRI in comparison to contrast-enhanced PET/CT with somatostatin receptor (SSR)-specific radiotracers regarding effectiveness of lesion detection in NET patients.

Methods

This was a retrospective analysis of 29 patients (12 male, 57 ± 13 years) who underwent PET/CT and subsequently PET/MRI at the same day. Two readers evaluated independently four PET/MRI setups: (I) PET + T2 Half Fourier Acquisition Single Shot Turbo Spin Echo (T2 HASTE), (II) PET + T2 HASTE + T2-weighted spin-echo sequence (T2 TSE), III) PET + T2 HASTE + Diffusion Weighted Imaging (DWI) and (IV) PET + T2 HASTE + T2 TSE + DWI. A consensus reading of PET/MRI and PET/CT including follow-up examinations served as the reference standard for lesion-based analysis. Lesion sizes were assessed.

Results

Setup IV provided comparable overall detection rates as PET/CT in both readers: PET/MRI 91.5%/92.9% versus 89.7% in PET/CT. In liver and bone lesions (mean diameter: 1.9 and 1.5 cm), PET/MRI was equal or superior to PET/CT: 98%/98% versus 85% in PET/CT; 100%/95% versus 100% in PET/CT, but inferior in pancreatic lesions, small bowel lesions and lymph node metastases (mean diameter: 1.3, 0.5 and 1.8 cm).

Conclusion

A non-enhanced MR protocol comprising T2 HASTE, T2 TSE and DWI for SSR-PET/MRI seems to provide comparable effectiveness in lesions detection as multiphase contrast-enhanced PET/CT. It might, therefore, serve as valid alternative, e.g., for follow-up examinations in patients with unresectable NET and kidney failure.

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Authors and Affiliations

  1. Diagnostic and Interventional Radiology, University Department of Radiology, Eberhard Karls University, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany

    Ferdinand Seith, Christina Schraml, Konstantin Nikolaou, Christina Pfannenberg & Nina Schwenzer

  2. Nuclear Medicine and Clinical Molecular Imaging, University Department of Radiology, Eberhard Karls University, Otfried-Mueller-Strasse 14, 72076, Tuebingen, Germany

    Christian la Fougère

  3. Preclinical Imaging and Radiopharmacy, University Department of Radiology, Eberhard Karls University, Roentgenweg 15, 72076, Tuebingen, Germany

    Gerald Reischl

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Correspondence to Ferdinand Seith.

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All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

The patient population included 9 patients as a part of a larger, prospectively conducted study which was designed as a feasibility study for PET/MRI. This study was approved by the German Federal Institute for Drugs and Medical Devices as well as the local ethics committee. Written informed consent was obtained from all patients concerning both examinations and the scientific evaluation of their data. So far, the data of those 9 patients have not been included in any study comparing the diagnostic accuracy of both modalities. 20 patients underwent a clinically indicated PET/MRI subsequently to PET/CT. From those patients, written informed consent was obtained for the additional PET/MRI examination. Regarding the retrospective scientific evaluation of the pseudonymized data, the local ethics committee waived informed consent.

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Seith, F., Schraml, C., Reischl, G. et al. Fast non-enhanced abdominal examination protocols in PET/MRI for patients with neuroendocrine tumors (NET): comparison to multiphase contrast-enhanced PET/CT. Radiol med 123, 860–870 (2018). https://doi.org/10.1007/s11547-018-0917-0

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