Measurement Repeatability of 18F-FDG PET/CT Versus 18F-FDG PET/MRI in Solid Tumors of the Pelvis

• Published in: The Journal of nuclear medicine (1978) Vol. 60; no. 8; pp. 1080 - 1086
• Main Authors: Fraum, Tyler J, Fowler, Kathryn J, Crandall, John P, Laforest, Richard A, Salter, Amber, An, Hongyu, Jacobs, Michael A, Grigsby, Perry W, Dehdashti, Farrokh, Wahl, Richard L
• Format: Journal Article
• Language: English
• Published: New York Society of Nuclear Medicine 01.08.2019
• Subjects: Assessments; Attenuation; Body mass; Coefficient of variation; Computed tomography; Diffusion coefficient; Endometrium; Fluorine isotopes; Lean body mass; Magnetic resonance imaging; Medical imaging; Oncology; Pelvis; Positron emission; Positron emission tomography; Rectum; Reproducibility; Scanners; Solid tumors; Sport utility vehicles; Tomography; Tumors
• ISSN: 0161-5505; 1535-5667
• DOI: 10.2967/jnumed.118.218735

Knowledge of the within-subject variability of 18F-FDG PET/MRI measurements is necessary for proper interpretation of quantitative PET or MRI metrics in the context of therapeutic efficacy assessments with integrated PET/MRI scanners. The goal of this study was to determine the test–retest repeatability of these metrics on PET/MRI, with comparison to similar metrics acquired by PET/CT. Methods: This prospective study enrolled subjects with pathology-proven pelvic malignancies. Baseline imaging consisted of PET/CT immediately followed by PET/MRI, using a single 370-MBq 18F-FDG dose. Repeat imaging was performed within 7 d using an identical imaging protocol, with no oncologic therapy between sessions. PET imaging on both scanners consisted of a list-mode acquisition at a single pelvic station. The MRI consisted of 2-point Dixon imaging for attenuation correction, standard sequences for anatomic correlation, and diffusion-weighted imaging. PET data were statically reconstructed using various frame durations and minimizing uptake time differences between sessions. SUV metrics were extracted for both PET/CT and PET/MRI in each imaging session. Apparent diffusion coefficient (ADC) metrics were extracted for both PET/MRI sessions. Results: The study cohort consisted of 14 subjects (13 female, 1 male) with various pelvic cancers (11 cervical, 2 rectal, 1 endometrial). For SUVmax, the within-subject coefficient of variation (wCV) appeared higher for PET/CT (8.5%–12.8%) than PET/MRI (6.6%–8.7%) across all PET reconstructions, though with no significant repeatability differences (all P values ≥ 0.08) between modalities. For lean body mass-adjusted SUVpeak, the wCVs appeared similar for PET/CT (9.9%–11.5%) and PET/MRI (9.2%–11.3%) across all PET reconstructions, again with no significant repeatability differences (all P values ≥ 0.14) between modalities. For PET/MRI, the wCV for ADCmedian of 3.5% appeared lower than the wCVs for SUVmax (6.6%–8.7%) and SULpeak (9.2%–11.3%), though without significant repeatability differences (all P values ≥ 0.23). Conclusion: For solid tumors of the pelvis, the repeatability of the evaluated SUV and ADC metrics on 18F-FDG PET/MRI is both acceptably high and similar to previously published values for 18F-FDG PET/CT and MRI, supporting the use of 18F-FDG PET/MRI for quantitative oncologic treatment response assessments.