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Background <p>Distinguishing postoperative inflammatory alterations from residual or recurrent neoplastic tissue remains a significant diagnostic obstacle when relying solely on conventional imaging techniques. 18F-FDG PET/CT provides metabolic insight but is prone to false-positive results attributable to inflammatory processes during the early postoperative phase. MRI delivers superior soft tissue resolution yet lacks functional or metabolic assessment capabilities. The integration of metabolic data from <sup>18</sup>F-FDG PET with MRI’s detailed anatomical imaging enhance diagnostic precision.</p> Aim <p>This research aimed to assess the diagnostic utility of MRI in characterizing postoperative changes, compared to 18F-FDG PET/CT. Additionally it evaluated the impact of integrating MRI &amp; PET/CT data for improved characterization of postoperative changes.</p> Methods <p>This prospective investigation involved 50 patients (30 females, 20 males; mean age 52.3 ± 9.9&#xa0;years) who underwent <sup>18</sup>F-FDG PET/CECT and MRI at least six weeks following tumor resection. Imaging datasets from PET and MRI were analyzed. Interpretations were correlated with histopathology and/or follow-up data. Sensitivity, specificity, positive and negative predictive values, and overall accuracy were determined for <sup>18</sup>F-FDG PET/CECT, MRI, and combined data from PET/CT &amp; MRI.</p> Results <p>Confirmatory histopathology and/or follow-up demonstrated tumor tissue in 24 (48%) patients and postoperative inflammatory changes in 26 (52%) patients. For detection of residual/recurrent tumor tissue, <sup>18</sup>F-FDG PET/CECT achieved a sensitivity of 83.3%, specificity of 76.9%, PPV of 76.9%, NPV of 83.3%, and accuracy of 80% (AUC = 0.801). MRI alone exhibited 100% sensitivity, 69.2% specificity, 75% PPV, 100% NPV, and 84% accuracy (AUC = 0.846). The combined data from PET/CT and MRI significantly improved diagnostic performance with 100% specificity, 100% PPV, 86.7% NPV, and 92% accuracy (AUC = 0.917). An ADC cutoff value 1.5 × 10⁻<sup>3</sup> mm<sup>2</sup>/s yielded superior diagnostic efficacy (AUC = 0.84) compared to SUVmax cutoff 5.5 (AUC = 0.67).</p> Conclusions <p>Fusion of data from 18F-FDG PET/CT and MRI markedly enhances diagnostic accuracy in differentiating postoperative inflammatory changes from tumor recurrence relative to 18F-FDG PET/CECT or MRI independently. This represents a valuable diagnostic tool in the post-surgical management of oncologic patients.</p>

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Multimodality imaging in characterization of postoperative changes after tumor resection: role of PET/CT, Fused MRI

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月27日

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  • Heba Abdelhalim,
  • Mohamed Houseni,
  • Muhammad Ahmed Magdy Abdelhamid,
  • Hesham A. E. Temraz,
  • Yahya Fayed,
  • Eman Helmy Hebesh,
  • Dalia Ibrahim Aggour

摘要

Background

Distinguishing postoperative inflammatory alterations from residual or recurrent neoplastic tissue remains a significant diagnostic obstacle when relying solely on conventional imaging techniques. 18F-FDG PET/CT provides metabolic insight but is prone to false-positive results attributable to inflammatory processes during the early postoperative phase. MRI delivers superior soft tissue resolution yet lacks functional or metabolic assessment capabilities. The integration of metabolic data from 18F-FDG PET with MRI’s detailed anatomical imaging enhance diagnostic precision.

Aim

This research aimed to assess the diagnostic utility of MRI in characterizing postoperative changes, compared to 18F-FDG PET/CT. Additionally it evaluated the impact of integrating MRI & PET/CT data for improved characterization of postoperative changes.

Methods

This prospective investigation involved 50 patients (30 females, 20 males; mean age 52.3 ± 9.9 years) who underwent 18F-FDG PET/CECT and MRI at least six weeks following tumor resection. Imaging datasets from PET and MRI were analyzed. Interpretations were correlated with histopathology and/or follow-up data. Sensitivity, specificity, positive and negative predictive values, and overall accuracy were determined for 18F-FDG PET/CECT, MRI, and combined data from PET/CT & MRI.

Results

Confirmatory histopathology and/or follow-up demonstrated tumor tissue in 24 (48%) patients and postoperative inflammatory changes in 26 (52%) patients. For detection of residual/recurrent tumor tissue, 18F-FDG PET/CECT achieved a sensitivity of 83.3%, specificity of 76.9%, PPV of 76.9%, NPV of 83.3%, and accuracy of 80% (AUC = 0.801). MRI alone exhibited 100% sensitivity, 69.2% specificity, 75% PPV, 100% NPV, and 84% accuracy (AUC = 0.846). The combined data from PET/CT and MRI significantly improved diagnostic performance with 100% specificity, 100% PPV, 86.7% NPV, and 92% accuracy (AUC = 0.917). An ADC cutoff value 1.5 × 10⁻3 mm2/s yielded superior diagnostic efficacy (AUC = 0.84) compared to SUVmax cutoff 5.5 (AUC = 0.67).

Conclusions

Fusion of data from 18F-FDG PET/CT and MRI markedly enhances diagnostic accuracy in differentiating postoperative inflammatory changes from tumor recurrence relative to 18F-FDG PET/CECT or MRI independently. This represents a valuable diagnostic tool in the post-surgical management of oncologic patients.