Initial experience in staging primary oesophageal/gastro-oesophageal cancer with 18F-FDG PET/MRI

Amy R Sharkey; Bert-Ram Sah; Samuel J Withey; Shaheel Bhuva; Radhouene Neji; Sami Jeljeli; Adrian Green; Gary J R Cook; Vicky Goh; Guy’s & St Thomas’ Oesophago-Gastric Research Group

doi:10.1186/s41824-021-00117-y

Initial experience in staging primary oesophageal/gastro-oesophageal cancer with 18F-FDG PET/MRI

Eur J Hybrid Imaging. 2021 Dec 13;5(1):23. doi: 10.1186/s41824-021-00117-y.

Authors

Amy R Sharkey^{1

2}, Bert-Ram Sah³, Samuel J Withey^{4

5}, Shaheel Bhuva⁶, Radhouene Neji⁷, Sami Jeljeli⁶, Adrian Green⁴, Gary J R Cook^{4

6}, Vicky Goh^{4

5}; Guy’s & St Thomas’ Oesophago-Gastric Research Group

Collaborators

Guy’s & St Thomas’ Oesophago-Gastric Research Group:
C R Baker, F Chang, S Chicklore, M Cominos, A Coombes, A R Davies, S George, B Gill-Barman, J N Dunn, J A Gossage, N Griffin, M Hill, O Hynes, C Iezzi, A Jacques, M Kelly, U Mahadeva, N Maisey, R McEwan, J Meenan, S Ngan, K Owczarczyk, A Qureshi, A Reyhani, M Subesinghe, G Tham, J Waters, S S Zeki

Affiliations

¹ Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK. amyrose.sharkey@gstt.nhs.uk.
² Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK. amyrose.sharkey@gstt.nhs.uk.
³ Department of Diagnostic, Interventional, and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland.
⁴ Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
⁵ Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
⁶ King's College London and Guy's and St Thomas' PET Centre, St Thomas' Hospital, London, UK.
⁷ MR Research Collaborations, Siemens Healthcare, Frimley, UK.

Abstract

Background: ¹⁸F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (18F-FDG PET/MRI) may improve cancer staging by combining sensitive cancer detection with high-contrast resolution and detail. We compared the diagnostic performance of 18F-FDG PET/MRI to ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for staging oesophageal/gastro-oesophageal cancer. Following ethical approval and informed consent, participants with newly diagnosed primary oesophageal/gastro-oesophageal cancer were enrolled. Exclusions included prior/concurrent malignancy. Following 324 ± 28 MBq 18F-FDG administration and 60-min uptake, PET/CT was performed, immediately followed by integrated PET/MRI from skull base to mid-thigh. PET/CT was interpreted by two dual-accredited nuclear medicine physicians and PET/MRI by a dual-accredited nuclear medicine physician/radiologist and cancer radiologist in consensus. Per-participant staging was compared with the tumour board consensus staging using the McNemar test, with statistical significance at 5%.

Results: Out of 26 participants, 22 (20 males; mean ± SD age 68.8 ± 8.7 years) completed 18F-FDG PET/CT and PET/MRI. Compared to the tumour board, the primary tumour was staged concordantly in 55% (12/22) with PET/MRI and 36% (8/22) with PET/CT; the nodal stage was concordant in 45% (10/22) with PET/MRI and 50% (11/22) with PET/CT. There was no statistical difference in PET/CT and PET/MRI staging performance (p > 0.05, for T and N staging). The staging of distant metastases was concordant with the tumour board in 95% (21/22) with both PET/MRI and PET/CT. Of participants with distant metastatic disease, PET/MRI detected additional metastases in 30% (3/10).

Conclusion: In this preliminary study, compared to 18F-FDG PET/CT, 18F-FDG PET/MRI showed non-significant higher concordance with T-staging, but no difference with N or M-staging. Additional metastases detected by 18F-FDG PET/MRI may be of additive clinical value.

Keywords: Gastro-oesophageal cancer; Oesophageal cancer; PET/CT; PET/MR.

Abstract

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