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

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Amy R. Sharkey, Bert-ram Sah, Samuel J. Withey, Shaheel Bhuva, Radhouene Neji, Sami Jeljeli, Adrian Green, Gary J. R. Cook, Vicky Goh, 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 & 17 more 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

Original languageEnglish
Article number23
JournalEuropean Journal of Hybrid Imaging
Issue number1
Early online date13 Dec 2021
Accepted/In press3 Nov 2021
E-pub ahead of print13 Dec 2021
PublishedDec 2021

Bibliographical note

Funding Information: The authors acknowledge financial support from the Department of Health via the NIHR Comprehensive Biomedical Research Centre award to the Guy's and St Thomas' NHS Foundation Trust in partnership with King's College London/King's College Hospital NHS Foundation Trust, Wellcome EPSRC Centre for Medical Engineering at King’s College London (WT 203148/Z/16/Z) and Cancer Research UK National Cancer Imaging Translational Accelerator Award (C4278/A27066). Publisher Copyright: © 2021, The Author(s).

King's Authors


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.

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