title: Diagnostic accuracy of whole-body PET/MRI and whole-body PET/CT for TNM staging in oncology.
abstract: OBJECTIVE
  In various tumours PET/CT with [(18)F]FDG is widely accepted as the diagnostic standard of care. The purpose of this study was to compare a dedicated [(18)F]FDG PET/MRI protocol with [(18)F]FDG PET/CT for TNM staging in a cohort of oncological patients.
  
  
  METHODS
  A dedicated [(18)F]FDG PET/MRI protocol was performed in 73 consecutive patients (mean age of 59 years, range 21 - 85 years) with different histologically confirmed solid primary malignant tumours after a routine clinical FDG PET/CT scan (60 min after injection of 295 ± 45 MBq [(18)F]FDG). TNM staging according to the 7th edition of the AJCC Cancer Staging Manual was performed by two readers in separate sessions for PET/CT and PET/MRI images. Assessment of the primary tumour and nodal and distant metastases with FDG PET/CT and FDG PET/MRI was based on qualitative and quantitative analyses. Histopathology, and radiological and clinical follow-up served as the standards of reference. A McNemar test was performed to evaluate the differences in diagnostic performance between the imaging procedures.
  
  
  RESULTS
  From FDG PET/CT and FDG PET/MRI T stage was correctly determined in 22 (82 %) and 20 (74 %) of 27 patients, N stage in 55 (82 %) and 56 (84 %) of 67 patients, and M stage in 32 (76 %) and 35 (83 %) of 42 patients, respectively. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy for lymph node metastases were 65 %, 94 %, 79 %, 89 % and 87 % for PET/CT, and 63 %, 94 %, 80 %, 87 % and 85 % for PET/MRI. The respective values for the detection of distant metastases were 50 %, 82 %, 40 %, 88 % and 76 % for PET/CT, and 50 %, 91 %, 57 %, 89 % and 83 % for PET/MRI. Differences between the two imaging modalities were not statistically significant (P > 0.05).
  
  
  CONCLUSIONS
  According to our results, FDG PET/CT and FDG PET/MRI are of equal diagnostic accuracy for TNM staging in patients with solid tumours.
authors.affiliation: Medical Faculty, Department of Diagnostic and Interventional Radiology, University Duesseldorf,, Moorenstr. 5, 40225, Duesseldorf, Germany, Philipp.heusch@med.uni-duesseldorf.de.
authors.forename: Philipp
authors.initials: P
authors.lastname: Heusch
authors.forename: Felix
authors.initials: F
authors.lastname: Nensa
authors.forename: Benedikt
authors.initials: B
authors.lastname: Schaarschmidt
authors.forename: Rupika
authors.initials: R
authors.lastname: Sivanesapillai
authors.forename: Karsten
authors.initials: K
authors.lastname: Beiderwellen
authors.forename: Benedikt
authors.initials: B
authors.lastname: Gomez
authors.forename: Jens
authors.initials: J
authors.lastname: Köhler
authors.forename: Henning
authors.initials: H
authors.lastname: Reis
authors.forename: Verena
authors.initials: V
authors.lastname: Ruhlmann
authors.forename: Christian
authors.initials: C
authors.lastname: Buchbender
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008207:Lymphatic Metastasis / Q000175:diagnosis / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging / Q000592:standards*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000592:standards*; D009367:Neoplasm Staging; D009369:Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging*; D049268:Positron-Emission Tomography / Q000592:standards*; D019275:Radiopharmaceuticals; D012015:Reference Standards; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000592:standards*; D051598:Whole Body Imaging / Q000592:standards*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
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