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Nuklearmedizin 2021; 60(05): 355-367
DOI: 10.1055/a-1486-3671
Original Article

Diagnosis and staging of hepatobiliary malignancies: Potential incremental value of (18)F-FDG-PET/MRI compared to MRI of the liver

Diagnostik und Staging von hepatobiliären Malignomen: Potenzieller Zusatznutzen von (18)F-FDG-PET/MRI im Vergleich zur MRT der Leber
Verena Carola Obmann
1   Diagnostic, Interventional and Pediatric Radiology, Inselspital, University Hospital, University of Bern, Switzerland
2   Radiology, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, United States
,
Nils Grosse-Hokamp
3   Department of Diagnostic and Interventional Radiology, University Cologne, Faculty of Medicine and University Hospital Cologne, Germany
2   Radiology, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, United States
,
Ian Alberts
4   Nuclear Medicine, Inselspital University Hospital Bern, Switzerland
,
Nicholas Fulton
5   Akron Radiology Inc., Akron, United States
,
Negin Rassouli
2   Radiology, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, United States
,
Christopher Siegel
6   Department of General Surgery, Cleveland Clinic Foundation, Hillcrest Hospital, Mayfield Heights, United States
,
Norbert Avril
2   Radiology, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, United States
,
Karin Anna Herrmann
2   Radiology, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, United States
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Abstract

Objective The purpose of the study was to investigate the potential added value of 18F-FDG-PET/MRI (functional information derived from PET) over standard diagnostic liver MRI (excellent soft tissue characterization) in diagnosing and staging suspected primary hepatobiliary malignancies including extrahepatic cholangiocarcinoma (ECC), intrahepatic cholangiocellular carcinoma (ICC) and gallbladder cancer (GBCA).

Methods Twenty consecutive patients with suspected hepatobiliary malignancy were included in this retrospective study. All patients underwent combined whole-body (WB) 18F-FDG-PET/MRI including contrast-enhanced MRI of the liver, contrast-enhanced WB-MRI and WB 18F-FDG-PET. Two experienced readers staged hepatobiliary disease using TNM criteria: first based on MRI alone and then based on combined 18F-FDG-PET/MRI. Subsequently, the impact of FDG-PET/MRI on clinical management compared to MRI alone was recorded. Histopathologic proof served as the reference standard.

Results Hepatobiliary neoplasms were present in 16/20 patients (ECC n = 3, ICC n = 8, GBCA n = 5), two patients revealed benign disease, two were excluded. TNM staging with 18F-FDG-PET/MRI was identical to MRI alone in 11/18 (61.1 %) patients and correctly changed the stage in 4/18 (22.2 %), resulting in a change in management for 2/4 patients (11.1 %). 18F-FDG-PET/MRI was false-positive in 3/18 cases (16.7 %). Both MRI and 18F-FDG-PET/MRI were falsely positive in 1 case without malignancy.

Conclusions A small incremental benefit of 18F-FDG-PET/MRI over standard MRI of the liver was observed. However, in some cases 18F-FDG-PET/MRI may lead to false-positive findings. Overall there is seemingly limited role of 18F-FDG-PET/MRI in patients with suspected hepatobiliary malignancy.

Zusammenfassung

Ziel Ziel der Studie war es, den potenziellen Mehrwert der 18F-FDG-PET/MRT (funktionelle Information aus der PET) gegenüber der diagnostischen Standard-MRT der Leber (ausgezeichnete Weichteilcharakterisierung) bei der Diagnose und dem Staging bei Verdacht auf primäre hepatobiliäre Malignome einschließlich des extrahepatischen Cholangiokarzinoms (ECC), des intrahepatischen cholangiozellulären Karzinoms (ICC) und des Gallenblasenkarzinoms (GBC) zu untersuchen.

Methoden Zwanzig konsekutive Patienten mit Verdacht auf hepatobiliäre Malignität wurden in diese retrospektive Studie eingeschlossen. Alle Patienten erhielten eine kombinierte Ganzkörper (GK) -18F-FDG-PET/MRT, einschließlich kontrastverstärkter MRT der Leber, kontrastverstärkter GK-MRT und GK-18F-FDG-PET. Zwei erfahrene Auswerter führten eine Stadieneinteilung der hepatobiliären Erkrankung anhand von TNM-Kriterien durch: zuerst basierend auf der MRT allein und dann basierend auf der kombinierten 18F-FDG-PET/MRT. Anschließend wurde die Auswirkung von FDG-PET/MRT auf das klinische Management im Vergleich zur MRT allein erfasst. Der histopathologische Nachweis diente als Referenzstandard.

Ergebnisse Hepatobiliäre Neoplasmen lagen bei 16/20 Patienten vor (ECC n = 3, ICC n = 8, GBC n = 5), bei 2 Patienten zeigte sich eine benigne Erkrankung, 2 wurden ausgeschlossen. Das TNM-Staging mittels 18F-FDG-PET/MRT war bei 11/18 (61,1 %) Patienten identisch mit der alleinigen MRT. Dies führte zu einer korrekten Änderung des Stadiums bei 4/18 (22,2 %), was bei 2/4 Patienten (11,1 %) zu einer Veränderung der Behandlung führte. Die 18F-FDG-PET/MRT war in 3/18 Fällen (16,7 %) falsch positiv. Beide, MRT und 18F-FDG-PET/MRT, waren in einem Fall ohne Malignität falsch positiv.

Schlussfolgerung Es wurde ein kleiner zusätzlicher Nutzen der 18F-FDG-PET/MRT gegenüber der Standard-MRT der Leber beobachtet. In einigen Fällen kann die 18F-FDG-PET/MRT jedoch zu falsch positiven Befunden führen. Insgesamt scheint die Rolle der 18F-FDG-PET/MRT bei Patienten mit Verdacht auf hepatobiliäre Malignität begrenzt.

Key words

PET/MRI - MRI - whole-body staging - cholangiocellular carcinoma - gallbladder carcinoma - diffusion-weighted imaging

Schlüsselwörter

PET/MRT - MRT - Ganzkörper-Staging - cholangiozelluläres Karzinom - Gallenblasenkarzinom - diffusionsgewichtete Bildgebung

Supplement



Publication History

Received: 19 January 2021

Accepted: 18 April 2021

Article published online:
08 June 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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