Diagnostic value of [18F]FDG PET/MRI for staging in patients with ovarian cancer

Purpose To evaluate the diagnostic potential of PET/MRI with 2-[F-18]fluoro-2-deoxy-d-glucose ([F-18]FDG) in ovarian cancer. Materials and methods Participants comprised 103 patients with suspected ovarian cancer underwent pretreatment [F-18]FDG PET/MRI, contrast-enhanced CT (ceCT) and pelvic dynamic contrast-enhanced MRI (ceMRI). Diagnostic performance of [F-18]FDG PET/MRI and ceMRI for assessing the characterization and the extent of the primary tumor (T stage) and [F-18]FDG PET/MRI and ceCT for assessing nodal (N stage) and distant (M stage) metastases was evaluated by two experienced readers. Histopathological and follow-up imaging results were used as the gold standard. The McNemar test was employed for statistical analysis. Results Accuracy for the characterization of suspected ovarian cancer was significantly better for [F-18]FDG PET/MRI (92.5%) [95% confidence interval (CI) 0.84-0.95] than for ceMRI (80.6%) (95% CI 0.72-0.83) (p < 0.05). Accuracy for T status was 96.4% (95% CI 0.96-0.96) and 92.9% (95% CI 0.93-0.93) for [F-18]FDG PET/MRI and ceMRI/ceCT, respectively. Patient-based accuracies for N and M status were 100% (95% CI 0.88-1.00) and 100% (95% CI 0.88-1.00) for [F-18]FDG PET/MRI and 85.2% (95% CI 0.76-0.85) and 30.8% (95% CI 0.19-0.31) for ceCT and M staging representing significant differences (p < 0.01). Lesion-based sensitivity, specificity and accuracy for N status were 78.6% (95% CI 0.57-0.91), 95.7% (95% CI 0.93-0.97) and 93.9% (95% CI 0.89-0.97) for [F-18]FDG PET/MRI and 42.9% (95% CI 0.24-0.58), 96.6% (95% CI 0.94-0.98) and 90.8% (95% CI 0.87-0.94) for ceCT. Conclusions [F-18]FDG PET/MRI offers better sensitivity and specificity for the characterization and M staging than ceMRI and ceCT, and diagnostic value for T and N staging equivalent to ceMRI and ceCT, suggesting that [F-18]FDG PET/MRI might represent a useful diagnostic alternative to conventional imaging modalities in ovarian cancer.