DOI: 10.1007/s00259-018-3986-3Pages: 1-12

Clinical utility of simultaneous whole-body 18F-FDG PET/MRI as a single-step imaging modality in the staging of primary nasopharyngeal carcinoma

1. Linkou Chang Gung Memorial Hospital, Department of Nuclear Medicine

2. Linkou Chang Gung Memorial Hospital and Chang Gung University, Department of Diagnostic Radiology

3. Linkou Chang Gung Memorial Hospital and Chang Gung University, Department of Radiation Oncology

4. Linkou Chang Gung Memorial Hospital and Chang Gung University, Division of Medical Oncology, Department of Internal Medicine

5. Linkou Chang Gung Memorial Hospital and Chang Gung University, Department of Otorhinolaryngology

Correspondence to:
Shu-Hang Ng
Tel: +886-3-3281200
Email: shuhangng@gmail.com

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Abstract

Purpose

Both head and neck magnetic resonance imaging (MRI) and 18F–fluorodeoxyglucose (18F–FDG) positron emission tomography (PET)/computed tomography (CT) play a crucial role in the staging of primary nasopharyngeal carcinoma (NPC). In this study, we sought to prospectively investigate the clinical utility of simultaneous whole-body 18F–FDG PET/MRI for primary staging of NPC patients.

Methods

We examined 113 patients with histologically confirmed NPC who underwent pretreatment, simultaneous whole-body PET/MRI and PET/CT for primary tumor staging. The images obtained with the different imaging modalities were interpreted independently and compared with each other.

Results

PET/MRI increased the accuracy of head and neck MRI for assessment of primary tumor extent in four patients via addition of FDG uptake information to increase the conspicuity of morphologically subtle lesions. PET/MR images were more discernible than PET/CT images for mapping tumor extension, especially intracranial invasion. Regarding the N staging assessment, the sensitivity of PET/MRI (99.5%) was higher than that of head and neck MRI (94.2%) and PET/CT (90.9%). PET/MRI was particularly useful for distinguishing retropharyngeal nodal metastasis from adjacent nasopharyngeal tumors. For distant metastasis evaluation, PET/MRI exhibited a similar sensitivity (90% vs. 86.7% vs. 83.3%), but higher positive predictive value (93.1% vs. 78.8% vs. 83.3%) than whole-body MRI and PET/CT, respectively.

Conclusions

For tumor staging of NPC, simultaneous whole-body PET/MRI was more accurate than head and neck MRI and PET/CT, and may serve as a single-step staging modality.

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  • Accepted: Feb 19, 2018
  • Online: Mar 3, 2018

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