title: Value of fusion of PET and MRI in the detection of intra-pelvic recurrence of gynecological tumor: comparison with 18F-FDG contrast-enhanced PET/CT and pelvic MRI.
abstract: BACKGROUND
  To evaluate the diagnostic value of retrospective image fusion from pelvic magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose positron emission tomography (PET) in detecting intra-pelvic recurrence of gynecological tumor.
  
  
  METHODS
  Thirty patients with a suspicion of recurrence of gynecological malignancy underwent inline contrast-enhanced PET/computed tomography (CT) and pelvic contrast-enhanced MRI for restaging. Diagnostic performance about the local recurrence, pelvic lymph node and bone metastasis and peritoneal lesion of PET/low-dose non-enhanced CT (PET/ldCT), PET/full-dose contrast-enhanced CT (PET/ceCT), contrast-enhanced MRI, and retrospective image fusion from PET and MRI (fused PET/MRI) were evaluated by two experienced readers. Final diagnoses were obtained by histopathological examinations, radiological imaging and clinical follow-up for at least 6 months. McNemar test was employed for statistical analysis.
  
  
  RESULTS
  Documented positive locally recurrent disease, pelvic lymph node and bone metastases, and peritoneal dissemination were present in 53.3, 26.7, 10.0, and 16.7%, respectively. Patient-based sensitivity for detecting local recurrence, pelvic lymph node and bone metastasis and peritoneal lesion were 87.5, 87.5, 100 and 80.0%, respectively, for fused PET/MRI, 87.5, 62.5, 66.7 and 60.0%, respectively, for contrast-enhanced MRI, 62.5, 87.5, 66.7 and 80.0%, respectively, for PET/ceCT, and 50.0, 87.5, 66.7 and 60.0%, respectively, for PET/ldCT. The sensitivity of diagnosing local recurrence by fused PET/MRI was significantly better than that of PET/ldCT (p=0.041). The patient-based sensitivity, specificity and accuracy for the detection of intra-pelvic recurrence/metastasis were 91.3, 100 and 93.3% for fused PET/MRI, 82.6, 100 and 86.7% for contrast-enhanced MRI, 82.6, 100 and 86.7% for PET/ceCT and 78.3, 85.7 and 80.0% for PET/ldCT.
  
  
  CONCLUSIONS
  Fused PET/MRI combines the individual advantages of MRI and PET, and is a valuable technique for assessment of intra-pelvic recurrence of gynecological cancers.
authors.affiliation: Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, 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: Natsuko
authors.initials: N
authors.lastname: Makihara
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Ebina
authors.forename: Hideto
authors.initials: H
authors.lastname: Yamada
authors.forename: Satoru
authors.initials: S
authors.lastname: Takahashi
authors.forename: Kazuro
authors.initials: K
authors.lastname: Sugimura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D064847:Multimodal Imaging; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000000981:diagnostic imaging; D010388:Pelvis; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014565:Urogenital Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging
chemical_list: D003287:Contrast Media; D019788:Fluorodeoxyglucose F18