Kombination von MRT und PET erlaubt genauere Rezidivdiagnostik des Rektumkarzinoms durch Bildfusion

 

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Zusammenfassung

Hintergrund: Es war das Ziel dieser Studie, die komplementäre diagnostische Wertigkeit der Magnetresonanztomografie (MRT) und der Positronenemissionstomografie (PET) bei Patienten mit Verdacht auf ein Rektumkarzinomrezidiv zu evaluieren. Dabei umfasste die integrierte MRT-Untersuchung sowohl hochaufgelöste, stationäre Sequenzen des Beckens wie auch eine Abklärung von Thorax und Abdomen bei kontinuierlicher Tischbewegung in gleicher Sitzung. Die Möglichkeit einer verbesserten Diagnostik mithilfe der Bildfusion von MRT und PET wurde überprüft. Patienten und Methodik: In diese retrospektive Studie wurden 31 Patienten eingeschlossen, die aufgrund eines klinischen Verdachts auf ein Rektumkarzinomrezidiv eine integrierte MRT-Untersuchung und eine ¹⁸F-FDG-PET in einem Zeitraum von maximal 30 Tagen erhalten hatten. MRT, PET und die Kombination beider Verfahren inklusive von Fusionsbildern wurden separat von 2 erfahrenen Befundern ausgewertet. Für jede detektierbare Läsion wurde die Wahrscheinlichkeit für einen malignen Befund auf einer Likert-Skala von 1 bis 5 im Konsensus eingeschätzt. Histologie und Verlaufskontrollen bildeten den Referenzstandard. Die diagnostischen Genauigkeiten wurden mit einer abgewandelten Receiver-Operator-Charakteristik (jackknife free response receiver operator characteristic; JAFROC) bestimmt. Die Sensitivitäten wurden für „sicher maligne“ und „wahrscheinlich maligne“ Läsionen berechnet. Ergebnisse: Der Referenzstandard umfasste 150 maligne Läsionen (48 Lokalbefunde, 102 Metastasen). Die JAFROC-Analyse zeigte diagnostische Genauigkeiten von 0,73 für die MRT alleine, von 0,63 für die PET alleine und 0,83 für die Kombination beider Modalitäten. Die entsprechenden Sensitivitäten betrugen 85,4, 52,1 und 95,8 % für Lokalbefunde und 61,8, 47,1 und 81,4 % für Metastasen. Schlussfolgerung: Die Kombination von lokaler MRT, der thorakoabdominellen MRT bei kontinuierlicher Tischbewegung und der FDG-PET kann mithilfe der Bildfusion die Erkennbarkeit von Läsionen bei Patienten mit einem Rektumkarzinomrezidiv verbessern.

Abstract

Purpose: It was the aim of this study to investigate the complementary diagnostic performance of a combined pelvic and thoracoabdominal magnetic resonance imaging (MRI) examination and positron emission tomography (PET) enhanced by image fusion in patients with suspected rectal cancer recurrence. Patients and Methods: Thirty-one patients with clinically suspected recurrence from rectal cancer were retrospectively included, who had received MRI (high resolution pelvic MRI combined with thoracoabdominal MRI performed during continuous table translation) and ¹⁸F-FDG-PET within 30 days. MRI alone, PET alone, and MRI and PET combined including fusion images were analysed by two observers in consensus. The likelihood of malignancy of all detectable lesions was rated on a 5-point Likert scale. The standard of reference consisted of histopathology and follow-up imaging. Confidence ratings were analysed with a jackknife free response receiver-operator characteristic paradigm (JAFROC). Further test characteristics were derived by considering “probably malignant” and “definitely malignant” lesions as positive test results. Results: The reference standard comprised 150 malignant lesions (48 local, 102 distant). JAFROC analysis revealed overall figures-of-merit of 0.73 for MRI, 0.63 for PET, and 0.83 for the combined approach (differences significant). The sensitivities of MRI, PET and the combined approach were 85.4, 52.1, and 95.8 % for local recurrence and 61.8, 47.1, and 81.4 % for distant recurrence, respectively. Conclusion: The combination of local high-resolution MRI, thoracoabdominal continuously moving table MRI and FDG-PET supported by image fusion improves lesion detection in recurrent rectal cancer.

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