title: Integrated PET/MRI for whole-body staging of patients with primary cervical cancer: preliminary results.
abstract: OBJECTIVE
  To assess the diagnostic value of integrated PET/MRI for whole-body staging of cervical cancer patients, as well as to investigate a potential association between PET/MRI derived functional parameters and prognostic factors of cervical cancer.
  
  
  METHODS
  The present study was approved by the local institutional review board. Twenty-seven patients with histopathologically confirmed cervical cancer were prospectively enrolled in our study. All patients underwent a whole-body PET/MRI examination after written informed consent was obtained. Two radiologists separately evaluated the PET/MRI data sets regarding the determination of local tumor extent of primary cervical cancer lesions, as well as detection of nodal and distant metastases. Furthermore, SUV and ADC values of primary tumor lesions were analyzed and correlated with dedicated prognostic factors of cervical cancer. Results based on histopathology and cross-sectional imaging follow-up served as the reference standard.
  
  
  RESULTS
  PET/MRI enabled the detection of all 27 primary tumor lesions of the uterine cervix and allowed for the correct determination of the T-stage in 23 (85 %) out of the 27 patients. Furthermore, the calculated sensitivity, specificity and diagnostic accuracy for the detection of nodal positive patients (n = 11) were 91 %, 94 % and 93 %, respectively. PET/MRI correctly identified regional metastatic disease (N1-stage) in 8/10 (80 %) patients and non-regional lymph node metastases in 5/5 (100 %) patients. In addition, quantitative analysis of PET and MRI derived functional parameters (SUV; ADC values) revealed a significant correlation with pathological grade and tumor size (p < 0.05).
  
  
  CONCLUSIONS
  The present study demonstrates the high potential of integrated PET/MRI for the assessment of primary tumor and the detection of lymph node metastases in patients with cervical cancer. Providing additional prognostic information, PET/MRI may serve as a valuable diagnostic tool for cervical cancer patients in a pretreatment setting.
authors.affiliation: Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany. johannes.grueneisen@uk-essen.de.
authors.forename: Johannes
authors.initials: J
authors.lastname: Grueneisen
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Dusseldorf, University of Dusseldorf, D-40225, Dusseldorf, Germany.
authors.forename: Benedikt Michael
authors.initials: BM
authors.lastname: Schaarschmidt
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital Essen, University of Duisburg-Essen, D-45147, Essen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Heubner
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital Essen, University of Duisburg-Essen, D-45147, Essen, Germany.
authors.forename: Bahriye
authors.initials: B
authors.lastname: Aktas
authors.affiliation: Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.
authors.forename: Sonja
authors.initials: S
authors.lastname: Kinner
authors.affiliation: Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Forsting
authors.affiliation: Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lauenstein
authors.affiliation: Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, D-45147, Essen, Germany.
authors.forename: Verena
authors.initials: V
authors.lastname: Ruhlmann
authors.affiliation: Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.
authors.forename: Lale
authors.initials: L
authors.lastname: Umutlu
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D064847:Multimodal Imaging; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011379:Prognosis; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology*; D051598:Whole Body Imaging
keywords: Apparent diffusion coefficient; Cervical cancer; PET/MRI; Primary tumor staging; Standardized uptake value