title: Prospective Pilot Study to Evaluate the Incremental Value of PET Information in Patients With Bladder Cancer Undergoing 18F-FDG Simultaneous PET/MRI.
abstract: OBJECTIVE
  The aim of this study was to conduct a prospective pilot study comparing the diagnostic performance of MRI alone and F-FDG simultaneous PET/MRI using a diuresis protocol in bladder cancer patients.
  
  
  METHODS
  Twenty-two bladder cancer patients underwent F-FDG PET/MRI, using intravenous furosemide and oral hydration for bladder clearance. A radiologist scored probability of tumor in 3 locations (urinary bladder, pelvic lymph nodes, nonnodal pelvis) using 1- to 3-point scale (1 = negative, 2 = equivocal, 3 = definite tumor). A nuclear medicine physician reviewed fused PET/MRI images, after which scores were reassigned based on combined findings. Follow-up pathologic and imaging data served as reference. Performances of MRI alone and PET/MRI were compared.
  
  
  RESULTS
  Of these patients, 82%, 38%, and 18% were positive for bladder, pelvic nodal, and nonnodal pelvic tumor, respectively. At a score of 3, PET/MRI exhibited greater accuracy for detection of bladder tumor (86% vs 77%), metastatic pelvic lymph nodes (95% vs 76%), and nonnodal pelvic malignancy (100% vs 91%). In the bladder, PET changed the level of suspicion in 36% of patients (50% increased suspicion, 50% decreased suspicion), with 75% of these changes deemed correct based on reference standard. For pelvic lymph nodes, PET changed suspicion in 52% (36% increase, 64% decrease), with 95% of changes deemed correct. For nonnodal pelvis, PET changed suspicion in 9% (100% increase), with 100% deemed correct.
  
  
  CONCLUSIONS
  Additional PET information helped to appropriately determine level of suspicion in multiple anatomic sites for otherwise equivocal findings on MRI alone. Although requiring larger studies, findings suggest a possible role for simultaneous PET/MRI to assist bladder cancer management.
authors: From the *Department of Radiology, †Division of Urologic Oncology, Department of Urology, and ‡Division of Hematology and Oncology, Department of Medicine, NYU Langone Medical Center, New York, NY.
authors: Andrew B
authors: AB
authors: Rosenkrantz
authors: Kent P
authors: KP
authors: Friedman
authors: Fabio
authors: F
authors: Ponzo
authors: Roy A
authors: RA
authors: Raad
authors: Kimberly
authors: K
authors: Jackson
authors: William C
authors: WC
authors: Huang
authors: Arjun V
authors: AV
authors: Balar
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000000981:diagnostic imaging* / Q000556:secondary; D004231:Diuresis; D004232:Diuretics; D005260:Female; D019788:Fluorodeoxyglucose F18; D005665:Furosemide; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D010388:Pelvis / Q000000981:diagnostic imaging; D010534:Peritoneal Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D010865:Pilot Projects; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D001749:Urinary Bladder Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology
chemical_list: D004232:Diuretics; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D005665:Furosemide