Multiparametric Dual-Time-Point [F]FDG PET/MRI for Lymph Node Staging in Patients with Untreated FIGO I/II Cervical Carcinoma.
Matthias Weissinger, Stefan Kommoss, Johann Jacoby, Stephan Ursprung, Ferdinand Seith, Sascha Hoffmann, Konstantin Nikolaou, Sara Yvonne Brucker, Christian La Fougère, Helmut Dittmann
Author Information
Matthias Weissinger: Department of Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tuebingen, 72076 Tuebingen, Germany. ORCID
Stefan Kommoss: Department of Women's Health, University Hospital Tuebingen, 72076 Tuebingen, Germany.
Johann Jacoby: Institute for Clinical Epidemiology and Applied Biometry, University Hospital Tuebingen, 72076 Tuebingen, Germany. ORCID
Stephan Ursprung: Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany. ORCID
Ferdinand Seith: Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany. ORCID
Sascha Hoffmann: Department of Women's Health, University Hospital Tuebingen, 72076 Tuebingen, Germany. ORCID
Konstantin Nikolaou: Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany. ORCID
Sara Yvonne Brucker: Department of Women's Health, University Hospital Tuebingen, 72076 Tuebingen, Germany. ORCID
Christian La Fougère: Department of Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tuebingen, 72076 Tuebingen, Germany.
Helmut Dittmann: Department of Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tuebingen, 72076 Tuebingen, Germany. ORCID
[F]FDG PET/MRI was shown to have limited sensitivity for N-staging in FIGO I/IICervical Carcinoma. Therefore, this prospective study aimed to investigate the additional value of multiparametric dual-time-point PET/MRI and to assess potential influencing factors for lymph node metastasis (LNM) detection. A total of 63 patients underwent whole-body dual-time-point [F]FDG PET/MRI 60 + 90 min p.i., and 251 LN were evaluated visually, quantified multiparametrically, and correlated with histology. Grading of the primary tumor (G2/G3) had a significant impact on visual detection (sens: 8.3%/31%). The best single parameter for LNM detection was SUVavg, however, with a significant loss of discriminatory power in G2 vs. G3 tumors (AUC: 0.673/0.901). The independent predictors SUVavg, ∆SUVpeak, LN sphericity, ADC, and histologic grade were included in the logistic-regression-based malignancy score (MS) for multiparametric analysis. Application of MS enhanced AUCs, especially in G2 tumors (AUC: G2:0.769; G3:0.877) and improved the accuracy for single LNM from 34.5% to 55.5% compared with the best univariate parameter SUVavg. Compared with visual analysis, the use of the malignancy score increased the overall sensitivity from 31.0% to 79.3% (Youden optimum) with a moderate decrease in specificity from 98.3% to 75.6%. These findings indicate that multiparametric evaluation of dual-time-point PET/MRI has the potential to improve accuracy compared with visual interpretation and enables sufficient N-staging also in G2 Cervical Carcinoma.
