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Qualitative and Quantitative Comparison of PET/CT and PET/MR Imaging in Clinical Practice
Open accessAbstract
UNLABELLED: The aim of this study was to prospectively compare whole-body PET/MR imaging and PET/CT, qualitatively and quantitatively, in oncologic patients and assess the confidence and degree of inter- and intraobserver agreement in anatomic lesion localization. METHODS: Fifty patients referred for staging with known cancers underwent PET/CT with low-dose CT for attenuation correction immediately followed by PET/MR imaging with 2-point Dixon attenuation correction. PET/CT scans were obtained according to standard protocols (56 ± 20 min after injection of an average 367 MBq of (18)F-FDG, 150 MBq of (68)Ga-DOTATATE, or 333.8 MBq of (18)F-fluoro-ethyl-choline; 2.5 min/bed position). PET/MR was performed with 5 min/bed position. Three dual-accredited nuclear medicine physicians/radiologists identified the lesions and assigned each to an exact anatomic location. The image quality, alignment, and confidence in anatomic localization of lesions were scored on a scale of 1-3 for PET/CT and PET/MR imaging. Quantitative analysis was performed by comparing the standardized uptake values. Intraclass correlation coefficients and the Wilcoxon signed-rank test were used to assess intra- and interobserver agreement in image quality, alignment, and confidence in lesion localization for the 2 modalities. RESULTS: Two hundred twenty-seven tracer-avid lesions were identified in 50 patients. Of these, 225 were correctly identified on PET/CT and 227 on PET/MR imaging by all 3 observers. The confidence in anatomic localization improved by 5.1% when using PET/MR imaging, compared with PET/CT. The mean percentage interobserver agreement was 96% for PET/CT and 99% for PET/MR imaging, and intraobserver agreement in lesion localization across the 2 modalities was 93%. There was 10% (5/50 patients) improvement in local staging with PET/MR imaging, compared with PET/CT. CONCLUSION: In this first study, we show the effectiveness of whole-body PET/MR imaging in oncology. There is no statistically significant difference between PET/MR imaging and PET/CT in respect of confidence and degree of inter- and intraobserver agreement in anatomic lesion localization. The PET data on both modalities were similar; however, the observed superior soft-tissue resolution of MR imaging in head and neck, pelvis, and colorectal cancers and of CT in lung and mediastinal nodal disease points to future tailored use in these locations.
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Systematically different normal organ SUVs have been reported for [18F]FDG, most likely resulting from MR-AC inaccuracies.
“However, systematically different normal organ SUVs have been reported for [18F]FDG as well, which most likely result from MR-AC inaccuracies [60,65,66].”
From Influences on PET Quantification and Interpretation (2022) · cites this paper as [66]
The SUV analysis reports 6%–18% lower SUVs in normal brain, mediastinum, liver, and soft tissue on PET/MR than on PET/CT. It attributes those differences to activity washout between scans, not primarily to MR-based attenuation-correction inaccuracies. The paper discusses attenuation-correction limitations elsewhere, but does not identify them as the likely cause of these normal-organ differences. (LLM, conf=0.88)
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Influences on PET Quantification and Interpretation
Rogasch, J. M. M., Hofheinz, F., van Heek, L., Voltin, C.-A., Boellaard, R., & Kobe, C. (2022) · Diagnostics · doi:10.3390/diagnostics12020451 · Cited by 57
“However, systematically different normal organ SUVs have been reported for [18F]FDG as well, which most likely result from MR-AC inaccuracies [60,65,66].”
Background
Metadata
- Authors
- Al-Nabhani, K. Z., Syed, R., Michopoulou, S., Alkalbani, J., Afaq, A., Panagiotidis, E., O’Meara, C., Groves, A., Ell, P., & Bomanji, J.
- Affiliations
- University College Hospital (GB)
- Venue
- Journal of Nuclear Medicine
- Publisher
- Society of Nuclear Medicine
- Published
- 2013-12-12
- Volume
- 55
- Issue
- 1
- Pages
- 88-94
- ISSN
- 0161-5505 (ISSN-L)
- 2159-662X
- OpenAlex
- W2148384441
- Cited by
- 101
- References
- 0
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 4 · 2023: 2 · 2022: 7 · 2021: 7 · 2020: 5 · 2019: 2 · 2018: 4 · 2017: 6 · 2016: 19 · 2015: 22 · 2014: 14 · 2013: 1
- FWCI
- 14.41
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Nuclear Medicine (publishedVersion)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- Cancer Research UK (16463)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Medical Imaging Techniques and Applications
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advanced MRI Techniques and Applications
- Keywords
- PET/MR, PET/CT, tumor staging, tumor localization, interobserver agreement, intraobserver agreement, standardized uptake value, 18F-FDG, 68Ga-DOTATATE, soft tissue resolution, image quality, head and neck cancer, pelvic cancer, prostate cancer
- MeSH terms
- Aged, Female, Humans, Image Processing, Computer-Assisted, Magnetic Resonance Imaging, Male, Middle Aged, Neoplasm Staging, Pilot Projects, Prospective Studies, Tomography, X-Ray Computed, Reproducibility of Results, Observer Variation, Radiopharmaceuticals, Fluorodeoxyglucose F18, Positron-Emission Tomography, Whole Body Imaging, Multimodal Imaging
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