[18F]FDG PET/MRI combined with chest HRCT in early cancer detection: a retrospective study of 3020 asymptomatic subjects

Liling Peng; Yi Liao; Rui Zhou; Yan Zhong; Han Jiang; Jing Wang; Yu Fu; Le Xue; Xiaohui Zhang; Mingxiang Sun; Gang Feng; Zhaoting Meng; Sisi Peng; Xuexin He; Gaojun Teng; Xin Gao; Hong Zhang; Mei Tian

doi:10.1007/s00259-023-06273-6

[¹⁸F]FDG PET/MRI combined with chest HRCT in early cancer detection: a retrospective study of 3020 asymptomatic subjects

Eur J Nucl Med Mol Imaging. 2023 Oct;50(12):3723-3734. doi: 10.1007/s00259-023-06273-6. Epub 2023 Jul 4.

Authors

Liling Peng¹, Yi Liao^{2

3

4}, Rui Zhou^{2

3

4}, Yan Zhong^{2

3

4}, Han Jiang^{2

3

4}, Jing Wang^{2

3

4}, Yu Fu⁵, Le Xue^{2

3

4

6}, Xiaohui Zhang^{2

3

4}, Mingxiang Sun¹, Gang Feng¹, Zhaoting Meng¹, Sisi Peng¹, Xuexin He⁷, Gaojun Teng⁸, Xin Gao⁹, Hong Zhang^{10

11

12

13

14}, Mei Tian^{15

16

17

18}

Affiliations

¹ Shanghai Universal Medical Imaging Diagnostic Center, Shanghai, China.
² Department of Nuclear Medicine and PET-CT Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, Hangzhou, China.
³ Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China.
⁴ Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.
⁵ College of Information Science & Electronic Engineering, Zhejiang University, Hangzhou, China.
⁶ Human Phenome Institute, Fudan University, Shanghai, China.
⁷ Department of Oncology, Huashan Hospital, Fudan University, Shanghai, China.
⁸ Radiology Department, Zhongda Hospital Southeast University, Nanjing, Jiangsu, China.
⁹ Shanghai Universal Medical Imaging Diagnostic Center, Shanghai, China. george.ssmu@163.com.
¹⁰ Department of Nuclear Medicine and PET-CT Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, Hangzhou, China. hzhang21@zju.edu.cn.
¹¹ Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China. hzhang21@zju.edu.cn.
¹² Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China. hzhang21@zju.edu.cn.
¹³ Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Zhejiang, Hangzhou, China. hzhang21@zju.edu.cn.
¹⁴ The College of Biomedical Engineering and Instrument Science, Zhejiang University, Zhejiang, Hangzhou, China. hzhang21@zju.edu.cn.
¹⁵ Department of Nuclear Medicine and PET-CT Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, Hangzhou, China. tianmei@fudan.edu.cn.
¹⁶ Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China. tianmei@fudan.edu.cn.
¹⁷ Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China. tianmei@fudan.edu.cn.
¹⁸ Human Phenome Institute, Fudan University, Shanghai, China. tianmei@fudan.edu.cn.

Abstract

Purpose: PET/MRI has become an important medical imaging approach in clinical practice. In this study, we retrospectively investigated the detectability of fluorine-18 (¹⁸F)-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging ([¹⁸F]FDG PET/MRI) combined with chest computerized tomography (CT) for early cancer in a large cohort of asymptomatic subjects.

Methods: This study included a total of 3020 asymptomatic subjects who underwent whole-body [¹⁸F]FDG PET/MRI and chest HRCT examinations. All subjects received a 2-4-year follow-up for cancer development. Cancer detection rate, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the [¹⁸F]FDG PET/MRI with or without chest HRCT were calculated and analyzed.

Results: Sixty-one subjects were pathologically diagnosed with cancers, among which 59 were correctly detected by [¹⁸F]FDG PET/MRI combined with chest HRCT. Of the 59 patients (32 with lung cancer, 9 with breast cancer, 6 with thyroid cancer, 5 with colon cancer, 3 with renal cancer, 1 with prostate cancer, 1 with gastric cancer, 1 with endometrial cancer, and 1 with lymphoma), 54 (91.5%) were at stage 0 or stage I (according to the 8th edition of the tumor-node-metastasis [TNM] staging system), 33 (55.9%) were detected by PET/MRI alone (27 with non-lung cancers and 6 with lung cancer). Cancer detection rate, sensitivity, specificity, PPV, and NPV for PET/MRI combined with chest CT were 2.0%, 96.7%, 99.6%, 83.1%, and 99.9%, respectively. For PET/MRI alone, the metrics were 1.1%, 54.1%, 99.6%, 73.3%, and 99.1%, respectively, and for PET/MRI in non-lung cancers, the metrics were 0.9%, 93.1%, 99.6%, 69.2%, and 99.9%, respectively.

Conclusions: [¹⁸F]FDG PET/MRI holds great promise for the early detection of non-lung cancers, while it seems insufficient for detecting early-stage lung cancers. Chest HRCT can be complementary to whole-body PET/MRI for early cancer detection.

Trial registration: ChiCTR2200060041. Registered 16 May 2022. Public site: https://www.chictr.org.cn/index.html.

Keywords: Early detection of cancer; Glucose metabolism; Positron emission tomography/magnetic resonance imaging (PET/MRI).

MeSH terms

Breast Neoplasms* / pathology
Female
Fluorodeoxyglucose F18
Humans
Lung Neoplasms* / pathology
Magnetic Resonance Imaging
Male
Neoplasm Staging
Positron-Emission Tomography
Radiopharmaceuticals
Retrospective Studies
Sensitivity and Specificity

Substances

Fluorodeoxyglucose F18
Radiopharmaceuticals

Grants and funding

81725009/National Outstanding Youth Science Fund Project of National Natural Science Foundation of China