The Added Diagnostic Value of Complementary Gadoxetic Acid-enhanced MRI to F-DOPA-PET/CT for Liver Staging in Medullary Thyroid Carcinoma

Overview

Journal Cancer Imaging

Publisher Springer Nature

Specialties Oncology
Radiology

Date 2019 Nov 16

PMID 31727170

Citations 7

Authors

Daniel Puhr-Westerheide

Clemens C Cyran

Josef Sargsyan-Bergmann

Andrei Todica

Franz-Josef Gildehaus

Wolfgang G Kunz

Robert Stahl

Christine Spitzweg

Jens Ricke

Philipp M Kazmierczak

Affiliations

Soon will be listed here.

Abstract

Background: A high proportion of patients with advanced stages of medullary thyroid carcinoma (MTC) present with liver metastasis metastases. The aim of our study was to investigate the added diagnostic value of complementary gadoxetic acid-enhanced MRI to F-DOPA-PET/CT for liver staging in MTC.

Methods: Thirty-six patients (14 female, median age 55 years) with histologically confirmed MTC undergoing gadoxetic acid-enhanced liver MRI within 1 month of matching contrast-enhanced F-DOPA-PET/CT between 2010 and 2016 were selected for this IRB-approved retrospective study. F-DOPA-PET/CT and multiparametric MRI data sets were read consecutively and liver lesions were categorised on a 5-point Likert scale (1-definitely benign; 2-probably benign; 3-intermediate risk for metastasis; 4-probably metastasis; 5-definitely metastasis). It was noted if gadoxetic acid-enhanced MRI detected additional, F-DOPA-PET/CT-occult metastases (category 5) or if gadoxetic acid-enhanced MRI allowed for a definite classification (categories 1 and 5) of lesions for which F-DOPA-PET/CT remained inconclusive (categories 2-4). Follow-up PET/CT and MRI examinations were used as a reference standard.

Results: A total of 207 liver lesions (F-DOPA-PET/CT 149, MRI 207; 152 metastases, 37 benign cysts, 18 hemangiomas) were analysed. Fifty-eight additional lesions were detected by MRI, of which 54 were metastases (median diameter 0.5 cm [interquartile range 0.4-0.7 cm]) occult on F-DOPA-PET/CT. MRI allowed for a definite lesion classification (categories 1 and 5) in 92% (190/207) whereas F-DOPA-PET/CT allowed for a definite lesion classification in 76% (113/149). MRI lead to a change in lesion categorisation in 14% (21/149).

Conclusion: Gadoxetic acid-enhanced MRI allows for a more precise liver staging in MTC patients compared to F-DOPA-PET/CT alone, particularly for F-DOPA-negative metastases and lesions < 1 cm.

Citing Articles

Medullary Thyroid Cancer: Updates and Challenges.

Gild M, Clifton-Bligh R, Wirth L, Robinson B Endocr Rev. 2023; 44(5):934-946.

PMID: 37204852 PMC: 10656709. DOI: 10.1210/endrev/bnad013.

[In]In-CP04 as a novel cholecystokinin-2 receptor ligand with theranostic potential in patients with progressive or metastatic medullary thyroid cancer: final results of a GRAN-T-MTC Phase I clinical trial.

Lezaic L, Erba P, Decristoforo C, Zaletel K, Mikolajczak R, Maecke H Eur J Nucl Med Mol Imaging. 2022; 50(3):892-907.

PMID: 36334104 PMC: 9852173. DOI: 10.1007/s00259-022-05992-6.

Molecular Imaging and Theragnostics of Thyroid Cancers.

Giovanella L, Deandreis D, Vrachimis A, Campenni A, Petranovic Ovcaricek P Cancers (Basel). 2022; 14(5).

PMID: 35267580 PMC: 8909041. DOI: 10.3390/cancers14051272.

Imaging medullary thyroid cancer patients with detectable serum markers: state of the art and future perspectives.

Klain M, Hadoux J, Nappi C, Finessi M, Ambrosio R, Schlumberger M Endocrine. 2021; 75(2):330-337.

PMID: 34748168 DOI: 10.1007/s12020-021-02930-8.

Correlation of liver enhancement in gadoxetic acid-enhanced MRI with liver functions: a multicenter-multivendor analysis of hepatocellular carcinoma patients from SORAMIC trial.

Ocal O, Peynircioglu B, Loewe C, van Delden O, Vandecaveye V, Gebauer B Eur Radiol. 2021; 32(2):1320-1329.

PMID: 34467453 PMC: 8795026. DOI: 10.1007/s00330-021-08218-9.

References

Lorenz K, Brauckhoff M, Behrmann C, Sekulla C, Ukkat J, Brauckhoff K . Selective arterial chemoembolization for hepatic metastases from medullary thyroid carcinoma. Surgery. 2005; 138(6):986-93. DOI: 10.1016/j.surg.2005.09.020. View

Beheshti M, Pocher S, Vali R, Waldenberger P, Broinger G, Nader M . The value of 18F-DOPA PET-CT in patients with medullary thyroid carcinoma: comparison with 18F-FDG PET-CT. Eur Radiol. 2009; 19(6):1425-34. DOI: 10.1007/s00330-008-1280-7. View

Kaur H, Hindman N, Al-Refaie W, Arif-Tiwari H, Cash B, Chernyak V . ACR Appropriateness Criteria Suspected Liver Metastases. J Am Coll Radiol. 2017; 14(5S):S314-S325. DOI: 10.1016/j.jacr.2017.01.037. View

Neri E, Bali M, Ba-Ssalamah A, Boraschi P, Brancatelli G, Alves F . ESGAR consensus statement on liver MR imaging and clinical use of liver-specific contrast agents. Eur Radiol. 2015; 26(4):921-31. PMC: 4778143. DOI: 10.1007/s00330-015-3900-3. View

Giraudet A, Vanel D, Leboulleux S, Auperin A, Dromain C, Chami L . Imaging medullary thyroid carcinoma with persistent elevated calcitonin levels. J Clin Endocrinol Metab. 2007; 92(11):4185-90. DOI: 10.1210/jc.2007-1211. View

Kim B, Lee J, Lee D, Yoon J, Hur B, Suh K . Diagnostic Performance of Gadoxetic Acid-enhanced Liver MR Imaging versus Multidetector CT in the Detection of Dysplastic Nodules and Early Hepatocellular Carcinoma. Radiology. 2017; 285(1):134-146. DOI: 10.1148/radiol.2017162080. View

Parikh T, Drew S, Lee V, Wong S, Hecht E, Babb J . Focal liver lesion detection and characterization with diffusion-weighted MR imaging: comparison with standard breath-hold T2-weighted imaging. Radiology. 2008; 246(3):812-22. DOI: 10.1148/radiol.2463070432. View

Roman S, Lin R, Sosa J . Prognosis of medullary thyroid carcinoma: demographic, clinical, and pathologic predictors of survival in 1252 cases. Cancer. 2006; 107(9):2134-42. DOI: 10.1002/cncr.22244. View

Wells Jr S, Robinson B, Gagel R, Dralle H, Fagin J, Santoro M . Vandetanib in patients with locally advanced or metastatic medullary thyroid cancer: a randomized, double-blind phase III trial. J Clin Oncol. 2011; 30(2):134-41. PMC: 3675689. DOI: 10.1200/JCO.2011.35.5040. View

10.

Lincke T, Zech C . Liver metastases: Detection and staging. Eur J Radiol. 2017; 97:76-82. DOI: 10.1016/j.ejrad.2017.10.016. View

11.

Lam E, Ringel M, Kloos R, Prior T, Knopp M, Liang J . Phase II clinical trial of sorafenib in metastatic medullary thyroid cancer. J Clin Oncol. 2010; 28(14):2323-30. PMC: 2881718. DOI: 10.1200/JCO.2009.25.0068. View

12.

Tappenden P, Carroll C, Hamilton J, Kaltenthaler E, Wong R, Wadsley J . Cabozantinib and vandetanib for unresectable locally advanced or metastatic medullary thyroid cancer: a systematic review and economic model. Health Technol Assess. 2019; 23(8):1-144. PMC: 6421509. DOI: 10.3310/hta23080. View

13.

Dromain C, De Baere T, Lumbroso J, Caillet H, Laplanche A, Boige V . Detection of liver metastases from endocrine tumors: a prospective comparison of somatostatin receptor scintigraphy, computed tomography, and magnetic resonance imaging. J Clin Oncol. 2004; 23(1):70-8. DOI: 10.1200/JCO.2005.01.013. View

14.

Elisei R, Schlumberger M, Muller S, Schoffski P, Brose M, Shah M . Cabozantinib in progressive medullary thyroid cancer. J Clin Oncol. 2013; 31(29):3639-46. PMC: 4164813. DOI: 10.1200/JCO.2012.48.4659. View

15.

Grozinsky-Glasberg S, Bloom A, Lev-Cohain N, Klimov A, Besiso H, Gross D . The role of hepatic trans-arterial chemoembolization in metastatic medullary thyroid carcinoma: a specialist center experience and review of the literature. Eur J Endocrinol. 2017; 176(4):463-470. DOI: 10.1530/EJE-16-0960. View

16.

Vilgrain V, Esvan M, Ronot M, Caumont-Prim A, Aube C, Chatellier G . A meta-analysis of diffusion-weighted and gadoxetic acid-enhanced MR imaging for the detection of liver metastases. Eur Radiol. 2016; 26(12):4595-4615. DOI: 10.1007/s00330-016-4250-5. View

17.

Smit J . Treatment of advanced medullary thyroid cancer. Thyroid Res. 2013; 6 Suppl 1:S7. PMC: 3599721. DOI: 10.1186/1756-6614-6-S1-S7. View

18.

Schlumberger M, Bastholt L, Dralle H, Jarzab B, Pacini F, Smit J . 2012 European thyroid association guidelines for metastatic medullary thyroid cancer. Eur Thyroid J. 2014; 1(1):5-14. PMC: 3821456. DOI: 10.1159/000336977. View

19.

Seo H, Kim M, Lee J, Chung W, Kim Y . Gadoxetate disodium-enhanced magnetic resonance imaging versus contrast-enhanced 18F-fluorodeoxyglucose positron emission tomography/computed tomography for the detection of colorectal liver metastases. Invest Radiol. 2011; 46(9):548-55. DOI: 10.1097/RLI.0b013e31821a2163. View

20.

Roman S, Mehta P, Sosa J . Medullary thyroid cancer: early detection and novel treatments. Curr Opin Oncol. 2009; 21(1):5-10. DOI: 10.1097/CCO.0b013e32831ba0b3. View