title: Simultaneous positron emission tomography/magnetic resonance imaging for whole-body staging in patients with recurrent gynecological malignancies of the pelvis: a comparison to whole-body magnetic resonance imaging alone.
abstract: OBJECTIVE
  The objective of this study was to assess the diagnostic value of integrated positron emission tomography/magnetic resonance imaging (PET/MRI) for whole-body staging of patients with recurrent gynecological pelvic malignancies, in comparison to whole-body MRI alone.
  
  
  METHODS
  The study was approved by the local institutional ethics committee. Written informed consent was obtained before each examination. Thirty-four consecutive patients with a suspected recurrence of cervical (n = 18) or ovarian (n = 16) cancer were prospectively enrolled for an integrated PET/MRI examination, which comprised a diagnostic, contrast-enhanced whole-body MRI protocol including dedicated sagittal dynamic imaging of the pelvis. Two radiologists separately evaluated the data sets regarding lesion count, lesion detection, lesion characterization, and diagnostic confidence. Mean and median values were calculated for each rating. Statistical analyses were performed both per-patient and per-lesion bases using a Wilcoxon signed-rank test to indicate potential significant differences among PET/MRI and MRI (alone) data sets.
  
  
  RESULTS
  Malignant lesions were present in 25 of the 34 patients. Positron emission tomography/magnetic resonance imaging offered correct and superior identification of all 25 patients with cancer recurrence, compared with MRI alone (23/25). A total of 118 lesions (malignant, 89; benign, 29) were detected. Positron emission tomography/magnetic resonance imaging correctly identified 88 (98.9%) of 89 malignant lesions, whereas MRI alone allowed for correct identification of 79 (88.8%) of the 89 malignant lesions. In addition, PET/MRI provided significantly higher lesion contrast and diagnostic confidence in the detection of malignant lesions (P < 0.001) compared with MRI alone.
  
  
  CONCLUSIONS
  These first results demonstrate the high diagnostic potential of integrated PET/MRI for the assessment of recurrence of female pelvic malignancies compared with MRI alone.
authors.affiliation: From the *Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen; †Department of Diagnostic and Interventional Radiology, University Hospital Dusseldorf, University of Dusseldorf, Dusseldorf; ‡The Erwin L. Hahn Institute for Magnetic Resonance Imaging, Departments of §Obstetrics and Gynecology, and ∥Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Grueneisen
authors.forename: Karsten
authors.initials: K
authors.lastname: Beiderwellen
authors.forename: Philipp
authors.initials: P
authors.lastname: Heusch
authors.forename: Marcel
authors.initials: M
authors.lastname: Gratz
authors.forename: Antonia
authors.initials: A
authors.lastname: Schulze-Hagen
authors.forename: Martin
authors.initials: M
authors.lastname: Heubner
authors.forename: Sonja
authors.initials: S
authors.lastname: Kinner
authors.forename: Michael
authors.initials: M
authors.lastname: Forsting
authors.forename: Thomas
authors.initials: T
authors.lastname: Lauenstein
authors.forename: Verena
authors.initials: V
authors.lastname: Ruhlmann
authors.forename: Lale
authors.initials: L
authors.lastname: Umutlu
mesh_terms: D000328:Adult; D000368:Aged; D002584:Cervix Uteri / Q000000981:diagnostic imaging / Q000473:pathology; D003287:Contrast Media; D005260:Female; D019788:Fluorodeoxyglucose F18; D005833:Genital Neoplasms, Female / Q000175:diagnosis*; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D015588:Observer Variation; D010051:Ovarian Neoplasms / Q000175:diagnosis; D010053:Ovary / Q000000981:diagnostic imaging / Q000473:pathology; D049268:Positron-Emission Tomography / Q000379:methods*; D011446:Prospective Studies; D015203:Reproducibility of Results; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis; D051598:Whole Body Imaging / Q000379:methods*; D055815:Young Adult
chemical_list: D003287:Contrast Media; D019788:Fluorodeoxyglucose F18