MRI and PET/CT of patients with bone metastases from breast carcinoma

3.0Tesla magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) was compared with combined 18F-fluorodeoxyglucose positron emission tomography and computed tomography (PET/CT) in patients with suspected bone metastases from breast cancer. A prospective clinical study was performed in 13 female breast cancer patients (mean age 61years; range 45-85 years). The spine was imaged in the sagittal plane with T1-weighted (T1), short tau inversion recovery (STIR), and T2-weighted fat-saturated (T2) sequences. The pelvis was imaged similarly in the coronal plane. Axial DWI was performed from the skull base to the mid-thigh. MRI and PET/CT were performed in all patients at a maximum interval of 10 working days and at least 14 days after chemotherapy. MRI was reviewed by two radiologists, and their consensus on potential metastases in 27 predefined locations was recorded. The predefined locations were the vertebral bodies (24), the left (1) and right (1) pelvic bones, and the sacral bone (1). The PET/CT was reviewed by a radiologists and a nuclear medicine physician. MRI detected 59 of the 60 active metastases found with our gold standard modality PET/CT. T1 had the highest sensitivity (98%) but rather low specificity (77%), but with the addition of STIR and DWI, the specificity increased to 95%. The additional metastases detected with MRI most likely represented postherapeutic residual scars without active tumour. In conclusion, 3.0Tesla MRI with T1, STIR, and DWI is useful for the clinical evaluation of bone metastases from breast cancer and compares well to PET/CT.     

Whole-body MRI and PET-CT in the management of cancer patients

Mortality rate, prognosis, and treatment outcome of cancer patients depend strongly on the detection of malignancy at an early stage and efficient monitoring of the disease. Multimodality diagnostic approaches are now widely applied for tumor detection, staging, and follow-up. However, the introduction of whole-body imaging modalities into clinical practice has substantially expanded diagnostic options. PET-CT has increased diagnostic accuracy by providing “anatometabolic” information by fusing tumor glucose-uptake measures from the PET examination and accurate delineation of anatomical structures given by spiral CT. Since PET-CT is associated with high doses of ionizing radiation, it is used in mainly tumor staging and screening within the scope of tertiary prevention. Here promising results have been reported for various tumor entities. MRI provides excellent tissue contrast, detailed morphological information and lack of ionizing radiation. MRI has been employed for the assessment of focal pathologies in specific anatomical regions. Whole-body MRI scanners using multiple receiver channels with parallel acquisition techniques now allow tumor screening from head to toe within substantially shorter examination times and without compromises in image resolution. We report our experience with these two novel techniques and discuss their benefits and drawbacks in terms of systemic tumor screening.     

Comprehensive imaging of tumor recurrence in breast cancer patients using whole-body MRI at 1.5 and 3 T compared to FDG-PET-CT

PURPOSE: To compare the diagnostic accuracy for the detection of tumor recurrence in breast cancer patients using whole-body-MRI (WB-MRI) at 1.5 or 3T compared to FDG-PET-CT. MATERIALS AND METHODS: Thirty-three female patients with breast cancer and suspicion of recurrence underwent FDG-PET-CT and WB-MRI. Coronal T1w-TSE- and STIR-sequences, HASTE-imaging of the lungs, contrast-enhanced T1w- and T2w-TSE-sequences of the liver, brain and abdomen were performed, using a WB-MRI-scanner at 1.5 (n=23) or 3T (n=10). Presence of local recurrence, lymph node involvement and distant metastatic disease was assessed using clinical and radiological follow-up as a standard of reference. RESULTS: Tumor recurrence was found in 20 of 33 patients. Overall 186 malignant foci were detected with WB-MRI and PET-CT. Both modalities revealed two recurrent tumors of the breast. PET-CT detected more lymph node metastases (n=21) than WB-MRI (n=16). WB-MRI was more precise in the detection of distant metastases (n=154 versus n=147). Sensitivity was 93% (172/186) and 91% (170/186) for WB-MRI and PET-CT, specificity was 86% (66/77) and 90% (69/77), respectively. Examination times for WB-MRI at 1.5 and 3T were 51 and 43 min, respectively, examination time for PET-CT was 103 min. CONCLUSION: WB-MRI and PET-CT are useful for the detection of tumor recurrence in the follow-up of breast cancer. WB-MRI is highly sensitive to distant metastatic disease. PET-CT is more sensitive in detecting lymph node involvement. Tumor screening with WB-MRI is feasible at 1.5 and 3T, scan time is further reduced at 3T with identical resolution.     

FDG-PET-CT and whole-body MRI for triage in patients planned for radioembolisation therapy

Purpose

The purpose was to evaluate the potential of FDG–PET–CT and whole-body MRI (WB-MRI) as diagnostic triage methods for patients planned for radioembolisation of metastatic liver disease.

Materials and methods

135 patients with multifocal liver metastases were evaluated for potential palliative therapy with radioembolisation using 90-Yttrium microspheres. All patients were examined consecutively with FDG–PET–CT and WB-MRI for exclusion of relevant extra-hepatic tumor manifestations. All patients underwent 99mTc-albumine angiography followed by scintigraphy to exclude significant hepato-pulmonary shunting.

Results

Out of the 135 patients included into the pre-therapeutic diagnostic algorithm, 56% were eligible and received radioembolisation, while 44% could not be treated. In 91% the exclusion criteria was diagnosis of significant extra-hepatic metastatic disease. In 85% exclusion diagnosis was made concordantly by both FDG–PET–CT and WB-MRI, in 9% diagnosis was provided by PET–CT, in 6% by WB-MRI alone. Patient-based sensitivity for detection of extra-hepatic disease was 94% for PET–CT and 91% for WB-MRI. False-positive diagnosis of extrahepatic disease leading to exclusion for radioembolisation therapy was made in 2% of patients, in one patient by PET–CT and in one patient by WB-MRI alone. Overall, specificity for inclusion of radioembolisation therapy by combining both modalities was 99%. In 9% of patients angiographic diagnosis made radioembolisation impossible, in 7% solely the angiographic findings were decisive.

Conclusion

Both FDG–PET–CT and WB-MRI are efficient diagnostic triage methods for patients planned for radioembolisation of liver metastases. Overall, FDG–PET–CT shows a trend to higher diagnostic accuracy compared to WB-MRI and may be used as imaging method of choice as a standalone examination. In combination, both modalities exhibited high sensitivity for the diagnosis of extra-hepatic tumor manifestations and result in high specificity.     

Detection of colorectal liver metastases: a prospective multicenter trial comparing unenhanced MRI, MnDPDP-enhanced MRI, and spiral CT

The aim of this study was to compare unenhanced MRI, MnDPDP-enhanced MRI, and spiral CT in the detection of hepatic colorectal metastases. Forty-four patients with hepatic colorectal metastases were examined with unenhanced and MnDPDP-enhanced MRI and with unenhanced and contrast-enhanced spiral CT. The MR examination protocol included baseline T1-weighted spin-echo (SE), T1-weighted gradient-recalled-echo (GRE), and T2-weighted fast-SE sequences; and T1-weighted SE and T1-weighted GRE sequences obtained 30–60 min after administration of 0.5 µmol/kg (0.5 ml/kg) mangafodipir trisodium (MnDPDP). Images were interpreted by three blinded readers. Findings at CT and MRI were compared with those at intraoperative US, which were used as term of reference. Intraoperative US detected 128 metastases. In a lesion-by-lesion analysis, the overall detection rate was 71% (91 of 128) for spiral CT, 72% (92 of 128) for unenhanced MRI, and 90% (115 of 128) for MnDPDP-enhanced MRI. MnDPDP-enhanced MRI was more sensitive than either unenhanced MRI (p<0.0001) or spiral CT (p=0.0007). In a patient-by-patient analysis, agreement with gold standard was higher for MnDPDP-enhanced MRI (33 of 44 cases) than for spiral CT (22 of 44 cases, p=0.0023) and unenhanced MRI (21 of 44 cases, p=0.0013). MnDPDP-enhanced MRI is superior to unenhanced MRI and spiral CT in the detection of hepatic colorectal metastases.     

基于CT/MRI/PET-CT进行鼻咽癌大体肿瘤区及淋巴结勾画的对照研究

目的:比较基于计算机体层成像(CT)、磁共振成像(MRI)、 18氟-脱氧葡萄糖正电子发射计算机断层显像( 18F-FDG PET-CT)3种图像勾画鼻咽癌(NPC)大体肿瘤靶区(GTV)及淋巴结的差异,并以MRI为参考研究基于PET自动勾画NPC GTV的最佳标准摄取值(SUV)。 ...     

18F-FDG PET/CT and PET/MRI fusion imaging for neuroendocrine carcinoma of the tongue: A case report

Neuroendocrine carcinoma (NEC) involving the tongue is a rare and aggressive disease that is more common in middle-aged and elderly males. We report a case of a 56-year-old male who presented to our hospital with sore throat and was found to have a mass in the left root of the tongue. ¹⁸F-FDG PET/CT revealed intense FDG uptake in the mass of the tongue base, as well as different uptake of FDG in the mid-posterior mediastinal mass, right adrenal gland, and enlarged lymph nodes in the neck and mediastinum. Gadolinium-enhanced MRI clearly showed the extent of the tongue lesion, additionally suggesting the presence of brain metastases. ¹⁸F-FDG PET/MRI fusion images of the neck were obtained on the workstation, which may have a higher diagnostic value for tongue NEC. The patient underwent a biopsy of the mass in the left root of the tongue and was pathologically diagnosed with NEC. Whole-body ¹⁸F-FDG PET/CT and regional PET/MRI fusion images have complementary roles in the diagnosis of tongue NEC, and the former is mainly applied to determine the clinical stage of the disease and to guide treatment.     

Comparison of MRI (including SS SE-EPI and SPIO-enhanced MRI) and FDG-PET/CT for the detection of colorectal liver metastases

Fluoro-18-deoxyglucose positron emission tomography computed tomography (FDG-PET/CT) and magnetic resonance imaging (MRI), including unenhanced single-shot spin-echo echo planar imaging (SS SE-EPI) and small paramagnetic iron oxide (SPIO) enhancement, were compared prospectively for detecting colorectal liver metastases. Twenty-four consecutive patients suspected for metastases underwent MRI and FDG-PET/CT. Fourteen patients (58%) had previously received chemotherapy, including seven patients whose chemotherapy was still continuing to within 1 month of the PET/CT study. The mean interval between PET/CT and MRI was 10.2 ± 5.2 days. Histopathology (n = 18) or follow-up imaging (n = 6) were used as reference. Seventy-seven metastases were detected. In nine patients, MRI and PET/CT gave concordant results. Sensitivities for unenhanced SS SE-EPI, MRI without SS SE-EPI and FDG-PET/CT were, respectively, 100% (p = 9 × 10⁻¹⁰ vs PET, p = 8 × 10⁻³ vs MRI without SS SE-EPI), 90% (p = 2 × 10⁻⁷ vs PET) and 60%. PET/CT sensitivity dropped significantly with decreasing size, from 100% in lesions larger than 20 mm (identical to MRI), over 54% in lesions between 10 and 20 mm (p = 3 × 10⁵ versus unenhanced SS SE-EPI), to 32% in lesions under 10 mm (p = 6 × 10⁻⁵ versus unenhanced SS SE-EPI). Positive predictive value of PET was 100% (identical to MRI). MRI, particularly unenhanced SS SE-EPI, has good sensitivity and positive predictive value for detecting liver metastases from colorectal carcinoma. Its sensitivity is better than that of FDG-PET/CT, especially for small lesions.     

SPECT/低剂量CT融合显像技术在肺癌骨转移诊断中的应用

目的探讨SPECT/低剂量CT融合显像在肺癌骨转移诊断中的应用价值。方法选取59例肺癌疑似骨转移患者行99m Tc-MDP全身骨显像及SPECT/低剂量CT融合显像,以随访结果或活检病理学检查结果为诊断标准,比较两种检查方式诊断骨转移的灵敏度,特异度,准确率,阴性、阳性预测值,并分析肺癌骨转移影像学表现。结果1)59例肺癌患者疑似骨转移病灶146处,经随访确诊肺癌骨转移病灶115处,其中发生于脊椎51处,占44.35%,胸廓30处,26.09%,骨盆16处,占13.91%,四肢11处,占9.56%,颅骨7处,占6.09%;2)SPECT/低剂量CT融合显像诊断肺癌骨转移灵敏度、特异度、阳性预测值、阴性预测值及准确率分别为:99.13%、93.55%、98.28%、93.55%、97.95%,均高于SPECT全身显像的97.39%、67.74%、91.80%、87.5%、91.10%,其中特异度、阳性预测值及准确率差异有统计学意义(Fisher=10.144、5.688、7.101,P<0.05);3)鳞癌:脊椎、胸廓、骨盆、四肢、颅骨转移率分别为42.86%、28.57%、14.29%、7.14%、7.14%;溶骨性、成骨性骨破坏分别为75.00%、25.00%;腺癌:脊椎、胸廓、骨盆、四肢、颅骨转移率分别为46.34%、26.83%、13.41%、7.32%、6.10%;溶骨性、成骨性骨破坏分别为68.29%、30.49%,鳞癌、腺癌骨转移部位及骨破坏类型差异无统计学意义(P>0.05)。结论SPECT/低剂量CT融合显像在鉴别诊断肺癌骨转移方面具有良好临床价值,肺腺癌骨转移发生率较高。     

MRI and 18F-fluorodeoxyglucose positron emission tomography in hemimegalencephaly

We report hemimegalencephaly in a 44-year-old woman with mental retardation, epilepsy and a mild hemiparesis. In addition to typical findings on MRI, 2-deoxy-2[¹⁸F]fluorodeoxyglucose positron-emission tomography (PET) demonstrated glucose hypometabolism of the affected hemisphere. The results of PET have been coregistered with morphological information from the MRI studies by image fusion. Received: 14 December 1999/Accepted: 15 February 2000     

Comparison of whole-body MRI with automatic moving table technique and bone scintigraphy for screening for bone metastases in patients with breast cancer

The aim of this study was presentation of a whole-body MRI technique with a moving table as a screening tool for bone metastases in patients with breast cancer. Twenty-two patients with breast carcinoma underwent both a planar whole-body bone scintigraphy and whole-body MRI at 1.5 T. The MRI images were acquired with a moving table at six different anatomical positions within a measurement time of 20 min. Coronal images were acquired using a short-tau inversion recovery sequence, accomplished by an axial T2-weighted turbo-spin-echo sequence through the head, and a T1-weighted opposed-phase sagittal 2D fast low-angle shot sequence covering the whole spine. The MRI findings indicating bone metastases were compared with findings from bone scintigraphy. Metastatic lesions were confirmed by follow-up examinations over 1 year. Twelve patients showed bone metastases. Whole-body MRI was superior to bone scintigraphy in predicting lesion origin with a sensitivity of 92% (bone scintigraphy 83%), a specificity of 90% (scintigraphy 80%) and an accuracy of 91% (scintigraphy 82%). The MRI showed additional findings such as metastases of the lung and liver. Whole-body MRI with moving table technique may be an effective method of total body screening for bone in selected patients with breast carcinoma and a high risk of distant metastases, although with the higher costs of MRI bone scintigraphy must still be considered as the first method for screening patients with breast cancer.     

椎体淋巴瘤MRI及PET临床应用价值

目的探讨椎体淋巴瘤MRI及正电子发射体层成像(PET)的影像特征及临床应用价值。资料与方法回顾性分析经病理证实的15例椎体淋巴瘤患者的MRI和PET表现,原发性骨淋巴瘤6例,继发性9例。结果MRI:原发性6例均为单一椎体压缩性骨折伴局部硬膜外和/或椎体旁软组织肿块,软组织范围超过病变椎体;继发性9例均为多椎体压缩性改变,7例伴硬膜外和/或椎体旁软组织肿块。椎体病变T1WI呈等或混杂信号,T2WI呈稍高信号。软组织肿块T1WI呈等/低信号,T2WI呈稍高信号,明显均匀强化5例,轻度均匀强化8例。PET:原发性6例均为术后PET检查,1例术后2个月显示局部复发,5例无异常;继发性9例(术前6例、术后3例)PET显示多椎体、淋巴结及脾葡萄糖代谢异常增高。结论椎体原发性淋巴瘤多为单椎体病变;继发性常为多椎体受累,两者均可伴硬膜外和/或椎体旁软组织肿块。椎体淋巴瘤MRI、PET表现无特异性,MRI能清晰显示椎管内病灶与脊髓的关系,PET对鉴别原发性与继发性淋巴瘤有重要价值。     

Unusual metastases from a medulloblastoma: Case report

Summary Calvarial and extracranial metastases by hematogenous spread of primary intracranial neoplasms have been considered a rare occurrence. This report deals with the clinicopathological and radiological findings of a child with metastatic medulloblastoma. Correlation of serial postoperative computed tomography (CT) scans and the autopsy examination indicated hematogenous calvarial and intracranial spread of the primary lesion.     

全身MRI与核素骨扫描对骨转移瘤诊断价值的对照研究

目的 评价全身MRI对骨转移瘤的诊断价值.方法 对30例经病理证实的恶性肿瘤患者在2周内分别进行伞身MRI及核素骨显像(BS),采取临床资料同常规MRI、CT等多种影像资料结合分析,辅以必要的随访复查为"金标准",分别以30例患者和270个部位为单位进行分析.使用McNemar检验比较两者对骨转移瘤诊断的敏感度、特异度.结果 30例患者中,"金标准"诊断27例患者存在骨转移,全身MRI检出25例,2例假阴性,无假阳性患者;BS检出27例阳性患者,其中2例为假阳性.以病例为单位,两者的敏感度均为92.6%(25/27),特异度分别为100%(3/3)及33.3%(1/3).ROC曲线下面积分别为0.9630及0.6296,差异无统计学意义(P>0.05).以病灶部位为单位统计显示全身MRI的敏感度、特异度分别为90.8%(108/119)、98.0%(148/151),高于骨扫描的70.6%(84/119)、90.7%(137/151)(P值均<0.01).全身MRI的ROC曲线下面积为0.9438,大于BS的0.8066(P<0.01).全身MRI同时发现3例患者存在脑转移,4例患者存在肺转移,4例患者存在肝转移.结论 全身MRI对骨转移瘤的综合诊断能力较Bs好,具有一定的临床应用价值.

Abstract：

Objective The aim of the study was to evaluate the reliability of whole-body MRI(WBMRI)in detecting osseous metastases.Methods Thirty patients verified with malignant tumor by histology were enrolled.All the patients underwent WB-MRI and bone scintigraphy(BS)with a two week interval.Clinical information,conventional MRI and CT images,and follow-up data were collected as gold standard for the diagnosis of bone metastases.The data of 30 patients and 270 segments as study unit respectively were analyzed.The sensitivity and specificity between WB-MRI and BS were compared with McNemar test.Resuits Bone metastases were confirmed in 27 of 30 patients by gold standard.Twenty-five patients with bone metastases were detected by WB-MRI and no false-positive cases.Twenty-seven patients with bone metastases were Nund by BS but having two false-positive oases.With patients as study unit,the diagnostic sensitivity of WB-MRI and BS were both 92.6%(25/27)and the specificity were 100%(3/3)and 33.3%(1/3),respectively.The area under ROC curve of WB-MRI and BS were 0.9630 and 0.6296,respectively(P>0.05).With segments as study unit,119 bone metastases segments were confirmed.The diagnostic sensitivity of WB-MRI and BS were 90.8%(108/119)and 70.6%(84/119)(P<0.01),while the specificity were 98.0%(148/151)and 90.7%(137/151),respectively(P<0.01).The area under ROC curve of WB-MRI and BS were 0.9438 and 0.8066.The former was obviously higher than the latter(P<0.01).Meauwhile.by WB-MRI,3 cases coexisting with brain metastases,4 cases with lung metastases,and 4 cases with hepatic metastases were found.Conclusion WB-MRI was a good tool for screening osseous metastases.     

MRI for the diagnosis of blunt abdominal trauma: a case report

Blunt abdominal trauma is a leading cause of trauma related mortality. Currently, the gold standard in the radiographic evaluation of intra-abdominal injury is computed tomography (CT) with iodinated contrast material. However, in the setting of renal failure or a previous anaphylactic reaction to contrast material, radiographic evaluation of the trauma patient may prove difficult. Without contrast material, the sensitivity of CT in the diagnosis of solid organ injury is diminished. We present a case report and literature review of magnetic resonance imaging in the evaluation of blunt abdominal trauma.     

PET/MRI融合显像在脑胶质瘤诊断和治疗中的研究进展

脑胶质瘤发病率较高,是颅内最常见的原发肿瘤。MRI技术在脑胶质瘤分级、手术定位和术后放疗靶区勾画中有着重要的作用。但是,越来越多的研究发现,MRI在肿瘤显像方面仍存在局限性,如准确确定肿瘤边界。PET利用组织代谢原理进行功能显像,有利于发现增殖活跃的肿瘤组织。PET与MRI图像的融合,实现了解剖与功能共同显像,为提高脑胶质瘤诊断的准确性提供了一条新途径。     

Negative scintigraphy with positive magnetic resonance imaging in bone metastases

We report three patients with known primary tumor in whom radionuclide skeletal imaging for metastatic disease was normal with or without clinical symptomatology referable to this area. Magnetic resonance imaging (MRI) of the spine demonstrated focal areas of abnormal signal intensity in the vertebral bodies of these patients. In all three patients, biopsy confirmed metastatic disease. All the patients received radiation or chemotherapy depending upon the etiology. These preliminary data suggest that MR imaging may be useful in evaluating patients with known primary tumor in whom clinical suspicion persists despite a negative radionuclide bone scan.     

Detection of residual tumor after radiofrequency ablation of liver metastasis with dual-modality PET/CT: initial results

The aim of this study was to determine the accuracy of dual-modality positron emission tomography(PET)/computed tomography (CT) in the detection of residual tumor after radiofrequency ablation (RFA) of liver metastasis of colorectal cancer. Eleven patients with 16 hepatic metastases (mean size 2.9 cm) from colorectal cancer were enrolled in this study, and 19 RFA procedures and 32 PET/CT examinations were performed. The patients had PET/CT before and after RFA using [¹⁸F]-2-fluoro-2-deoxy-D-glucose. CT images alone were read by two radiologists, PET images alone were evaluated by two nuclear physicians. Fused images were read by one physician of each speciality in consensus. The accuracy for detection of residual tumor by the different imaging modalities following RFA was assessed. Eleven patients with a mean age of 63 (range 55–71) years were evaluated. The mean follow-up period was 393 days. The overall procedure-based sensitivity for detection of residual tumor was 65% for PET and PET/CT and 44% for CT alone. The accuracies were 68% and 47%, respectively. Four patients had residual tumor after RFA, six patients total developed local recurrence. PET/CT therefore possibly proved superior to CT alone when assessing the liver for residual tumor after RFA.     

Fluorine-18 deoxyglucose positron emission tomography for the detection of bone metastases in patients with non-small cell lung cancer

Despite advances in morphological imaging, some patients with lung cancer are found to have non resectable disease at surgery or die of recurrence within a year of surgery. At present, metastatic bone involvement is usually assessed using bone scintigraphy, which has a high sensitivity but a poor specificity. We have attempted to evaluate the utility of the fluorine-18 deoxyglucose positron emission tomography (FDG PET) for the detection of bone metastasis. One hundred and ten consecutive patients with histological diagnosis of non-small cell lung cancer (NSCLC) who underwent both FDG PET and bone scintigraphy were selected for this review. In this group, there were 43 patients with metastatic disease (stage IV). Among these, 21 (19% of total group) had one or several bone metastases confirmed by biopsy (n = 8) or radiographic techniques (n = 13). Radionuclide bone scanning correctly identified 54 out of 89 cases without osseous involvement and 19 out of 21 osseous involvements. On the other hand, FDG PET correctly identified the absence of osseous involvement in 87 out of 89 patients and the presence of bone metastasis in 19 out of 21 patients. Thus using PET there were two false-negative and two false-positive cases. PET and bone scanning had, respectively, an accuracy of 96% and 66% in the evaluation of osseous involvement in patients with NSCLC. In conclusion, our data suggest that whole-body FDG PET may be useful in detecting bone metastases in patients with known NSCLC. Received 10 March and in revised form 7 May 1998