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Purpose <p>The role of hepatobiliary contrast-enhanced imaging in the evaluation of liver malignancies in FDG-PET/MR remains underexplored. The aim of this study was to assess the diagnostic performance of stand-alone FDG-PET, non-contrast-enhanced (NCE) PET/MR, and contrast-enhanced (CE) PET/MR with and without hepatobiliary phase (HBP).</p> Methods <p>This prospective, single-center diagnostic accuracy study enrolled 60 patients with histologically confirmed abdominal malignancies and malignant liver lesions. Each patient underwent whole-body FDG-PET/MR, including dedicated upper abdominal imaging with NCE, CE without HBP, and CE with HBP. Three blinded radiologists independently evaluated the images in consensus. The reference standard was histopathology or follow-up imaging. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated. Fisher’s exact test and Mann–Whitney <i>U</i> test were used for statistical comparisons.</p> Results <p>A total of 134 malignant liver lesions (38 primary tumors, 96 metastases) were identified. CE FDG-PET/MR with HBP achieved the highest diagnostic accuracy (97%), sensitivity (97.8%), and specificity (95.2%). NCE FDG-PET/MR had an accuracy of 67%, sensitivity of 78%, and specificity of 44%, while stand-alone FDG-PET had the lowest accuracy (52%). The addition of HBP significantly improved specificity (75.6–95.2%, <i>p</i> = 0.013) and enabled detection of smaller lesions (median size 7&#xa0;mm vs. 19&#xa0;mm, <i>p</i> = 0.00017).</p> Conclusion <p>The inclusion of hepatobiliary contrast significantly enhances the diagnostic performance of FDG-PET/MR for liver malignancies, particularly in detecting small or poorly defined lesions. These findings support the integration of HBP into PET/MR workflows to optimize liver lesion detection and staging.</p> Clinical trial number <p>Not applicable.</p>

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To contrast or not to contrast? Evaluating the diagnostic accuracy of hepatobiliary contrast agents in liver FDG-PET/MR: a prospective study

  • 期刊论文

  • 发表日期：

    2025年5月9日

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  • Luigi Asmundo,
  • Felipe Furtado,
  • Francis Delaney,
  • Mojtahed Amirkasra,
  • Azadeh Hajati,
  • Abdar Esfahani Shadi,
  • Avinash Kambadakone,
  • Lawrence Blaszkowsky,
  • Jeffrey Clark,
  • David Ryan,
  • Onofrio Antonio Catalano

摘要

Purpose

The role of hepatobiliary contrast-enhanced imaging in the evaluation of liver malignancies in FDG-PET/MR remains underexplored. The aim of this study was to assess the diagnostic performance of stand-alone FDG-PET, non-contrast-enhanced (NCE) PET/MR, and contrast-enhanced (CE) PET/MR with and without hepatobiliary phase (HBP).

Methods

This prospective, single-center diagnostic accuracy study enrolled 60 patients with histologically confirmed abdominal malignancies and malignant liver lesions. Each patient underwent whole-body FDG-PET/MR, including dedicated upper abdominal imaging with NCE, CE without HBP, and CE with HBP. Three blinded radiologists independently evaluated the images in consensus. The reference standard was histopathology or follow-up imaging. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated. Fisher’s exact test and Mann–Whitney U test were used for statistical comparisons.

Results

A total of 134 malignant liver lesions (38 primary tumors, 96 metastases) were identified. CE FDG-PET/MR with HBP achieved the highest diagnostic accuracy (97%), sensitivity (97.8%), and specificity (95.2%). NCE FDG-PET/MR had an accuracy of 67%, sensitivity of 78%, and specificity of 44%, while stand-alone FDG-PET had the lowest accuracy (52%). The addition of HBP significantly improved specificity (75.6–95.2%, p = 0.013) and enabled detection of smaller lesions (median size 7 mm vs. 19 mm, p = 0.00017).

Conclusion

The inclusion of hepatobiliary contrast significantly enhances the diagnostic performance of FDG-PET/MR for liver malignancies, particularly in detecting small or poorly defined lesions. These findings support the integration of HBP into PET/MR workflows to optimize liver lesion detection and staging.

Clinical trial number

Not applicable.