title: Value of fusion of PET and MRI for staging of endometrial cancer: comparison with ¹⁸F-FDG contrast-enhanced PET/CT and dynamic contrast-enhanced pelvic MRI.
abstract: OBJECTIVE
  To investigate the diagnostic value of retrospective fusion of pelvic MRI and (18)F-fluorodeoxyglucose ((18)F-FDG) PET images for assessment of locoregional extension and nodal staging of endometrial cancer.
  
  
  METHODS
  Thirty patients with biopsy-proven endometrial cancer underwent preoperative contrast-enhanced PET/CT (PET/ceCT) and pelvic dynamic contrast-enhanced MRI for initial staging. Diagnostic performance of PET/ceCT, contrast-enhanced MRI, and retrospective image fusion from PET and MRI (fused PET/MRI) for assessing the extent of the primary tumor (T stage) and metastasis to regional LNs (N stage) was evaluated by two experienced readers. Histopathological and follow-up imaging results were used as the gold standard. The McNemar test was employed for statistical analysis.
  
  
  RESULTS
  Fused PET/MRI and MRI detected 96.7% of the primary tumors, whereas PET/ceCT detected 93.3%. Accuracy for T status was 80.0% for fused PET/MRI, and MRI proved significantly more accurate than PET/ceCT, which had an accuracy of 60.0% (p=0.041). Patient-based sensitivity, specificity and accuracy for detecting pelvic nodal metastasis were 100%, 96.3% and 96.7% for both fused PET/MRI and PET/ceCT, and 66.7%, 100% and 96.7% for MRI, respectively. These three parameters were not statistically significant (p=1).
  
  
  CONCLUSIONS
  Fused PET/MRI, which complements the individual advantages of MRI and PET, is a valuable technique for assessment of the primary tumor and nodal staging in patients with endometrial cancer.
authors.affiliation: Department of Radiology, Kobe University School of Medicine, Kobe, Japan. kitajima@med.kobe-u.ac.jp
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kitajima
authors.forename: Yuko
authors.initials: Y
authors.lastname: Suenaga
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Ueno
authors.forename: Tomonori
authors.initials: T
authors.lastname: Kanda
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Maeda
authors.forename: Satoru
authors.initials: S
authors.lastname: Takahashi
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Ebina
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Miyahara
authors.forename: Hideto
authors.initials: H
authors.lastname: Yamada
authors.forename: Kazuro
authors.initials: K
authors.lastname: Sugimura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016889:Endometrial Neoplasms / Q000473:pathology*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D009367:Neoplasm Staging; D010388:Pelvis / Q000473:pathology; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013382:Subtraction Technique; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: Endometrial cancer; Fused PET/MRI; MRI; PET/CT; Staging