Performing clinical 18F-FDG-PET/MRI of the mediastinum optimising a dedicated, patient-friendly protocol

Jurgen Peerlings*, Leonie Paulis, Cristina Mitea, Frans Bakers, Maaike Berbee, Roel Wierts, Stefan Voo, Joachim Wildberger, Aswin Hoffmann, Philippe Lambin, Felix Mottaghy

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Objective To construct a mediastinal-specific fluorine-18-fluorodeoxyglucose (F-18-FDG)-PET/MR protocol with high-quality MRI of minimal acquisition-time and comparable diagnostic value to F-18-FDG-PET/computed tomography (CT).

Materials and methods Fifteen healthy participants received PET/MRI and 10 patients with mediastinal tumours (eight non-small-cell lung, two oesophageal cancer) received F-18-FDG-PET/MRI immediately after F-18-FDG-PET/CT. Sequences volume interpolated breath-hold examination (T1-VIBE) and Half-Fourier acquisition single-shot turbo spin echo (T2-HASTE) were optimised by varying the parameters: breath-hold (BH, end-expiration), fat suppression (spectral adiabatic inversion recovery), and ECG-triggering (ECG, end-diastole). Image quality (IQ) of each sequence-variation was qualitatively scored by medical experts and quantitatively assessed by calculating signal-to-noise ratios, contrast relative to muscle, standardized-uptake-value, and tumour-to-blood ratios. Patient comfort was evaluated on patients' experience. Diagnostic accuracy of F-18-FDG-PET/MRI was compared to F-18-FDG-PET/CT, in reference to histopathology/cytopathology.

Results ECG-triggered T1-VIBE images showed the highest signal-to-noise ratio (P <0.01) and the largest contrast between mediastinal soft-tissues, regardless of BH or free-breathing acquisition. IQ of ECG-triggered T1-VIBE scans in BH were scored qualitatively highest with good reader agreement (kappa = 0.62). IQ of T2-HASTE was not significantly affected by BH acquisition (P > 0.9). Qualitative IQ of T1-VIBE and T2-HASTE declined after spectral adiabatic inversion recovery fat-suppression. All patients could maintain BH at end-expiration and reported no discomfort. Diagnostic performance of F-18-FDG-PET/MR was not significantly different from F-18-FDG-PET/CT with comparable staging, standardized-uptake-values, and tumour-to-blood ratios. However, T-status was more often over-staged on F-18-FDG-PET/CT, while N-status was more frequently under-staged on F-18-FDG-PET/MR.

Conclusion ECG-triggered T1-VIBE sequences acquired during short, multiple BHs are recommended for mediastinal imaging using F-18-FDG-PET/MR. With dedicated protocols, F-18-FDG-PET/MRI will be useful in thoracic oncology and aid in diagnostic evaluation and tailored treatment decision-making. Copyright (C) 2019 Wolters Kluwer Health, Inc. All rights reserved.

Original languageEnglish
Pages (from-to)815-826
Number of pages12
JournalNuclear Medicine Communications
Volume40
Issue number8
DOIs
Publication statusPublished - Aug 2019

Keywords

  • hybrid imaging
  • mediastinum
  • non-small-cell lung cancer
  • oesophageal cancer
  • PET-CT
  • PET-MRI
  • CELL LUNG-CANCER
  • ESOPHAGEAL CANCER
  • INTERNATIONAL WORKSHOP
  • PRACTICE GUIDELINES
  • COMBINED PET/MRI
  • ECHO-SEQUENCE
  • RADIAL VIBE
  • PET/CT
  • MRI
  • MOTION

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