title: Comparison of retrospective PET and MRI-DWI (PET/MRI-DWI) image fusion with PET/CT and MRI-DWI in detection of cervical and endometrial cancer lymph node metastases.
abstract: OBJECTIVE
  The aim of this study was to compare the accuracy of retrospective image fusion of PET/MRI-DWI with that of PET/CT and MRI-DWI alone in detecting metastatic lymph nodes in patients with cervical and endometrial carcinoma.
  
  
  METHODS
  Twenty-seven patients with endometrial (n = 14) and cervical (n = 13) cancer who had undergone preoperative MRI-DWI and PET/CT for staging were retrospectively evaluated. The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of PET/CT, MRI-DWI, and PET/MRI-DWI image fusion were calculated on a per-patient basis and on a per-node basis. Histopathological and follow-up imaging results were used as the gold standard.
  
  
  RESULTS
  On a per-patient basis PET/MRI-DWI had the same sensitivity (87.5 %), specificity (84.2 %), diagnostic accuracy (85.1 %), PPV (70 %), and NPV (94.1 %) as PET-CT, but on a per-node basis PET/MRI-DWI showed better sensitivity (89 vs 70.2 %), specificity (91.6 vs 90.5 %), diagnostic accuracy (91.2 vs 87 %), PPV (68.7 vs 60.4 %), and NPV (97.6 vs 93.6 %) than PET-CT. Comparison of the areas under the ROC curves for the detection of metastatic lymph nodes demonstrated a non-significant difference (p = 0.055) between PET/CT and fused PET/MRI-DWI.
  
  
  CONCLUSIONS
  PET/MRI-DWI may be a valuable technique for N-staging patients with endometrial and cervical cancer, but more studies are needed to investigate its potential clinical utility.
authors.affiliation: Radiology Department, University of Eastern Piedmont, "Maggiore della Carità" Hospital, Corso Mazzini 18, 28100, Novara, Italy. a.stecco@libero.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Stecco
authors.affiliation: Radiology Department, University of Eastern Piedmont, "Maggiore della Carità" Hospital, Corso Mazzini 18, 28100, Novara, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Buemi
authors.affiliation: Radiology Department, University of Eastern Piedmont, "Maggiore della Carità" Hospital, Corso Mazzini 18, 28100, Novara, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Cassarà
authors.affiliation: Medical Physics Department, University of Eastern Piedmont, "Maggiore della Carità" Hospital, Novara, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Matheoud
authors.affiliation: Nuclear Medicine Department, University of Eastern Piedmont, "Maggiore della Carità" Hospital, Novara, Italy.
authors.forename: Gian Mauro
authors.initials: GM
authors.lastname: Sacchetti
authors.affiliation: Gynecology Department, University of Eastern Piedmont, "Maggiore della Carità" Hospital, Novara, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Arnulfo
authors.affiliation: Medical Physics Department, University of Eastern Piedmont, "Maggiore della Carità" Hospital, Novara, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Brambilla
authors.affiliation: Radiology Department, University of Eastern Piedmont, "Maggiore della Carità" Hospital, Corso Mazzini 18, 28100, Novara, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Carriero
mesh_terms: D000328:Adult; D000368:Aged; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging; D016889:Endometrial Neoplasms / Q000473:pathology*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D008875:Middle Aged; D064847:Multimodal Imaging; D009367:Neoplasm Staging; D000072078:Positron Emission Tomography Computed Tomography; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000473:pathology*
chemical_list: D003287:Contrast Media; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: DWI; Fusion Imaging; MRI; PET/CT; Uterine cancer