Objective:This study aimed to compare the diagnostic accuracy of whole-body PET/MR imaging and contrast-enhanced CT for detecting metastatic disease in patients undergoing surgical resection, using pathology as the reference standard.Materials and Methods:Nineteen patients with suspected metastatic involvement (including four who received neoadjuvant therapy before surgery) underwent both FDG PET/MR and contrast-enhanced CT scans. Imaging was reviewed for metastases at defined sites (e.g., perihepatic region, hepatic parenchyma, mesentery, bowel serosa, colon surface, and nodal basins). Findings on each modality were compared to surgical pathology results per site. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated for PET/MR and CT, with pathology as the reference standard.Results:Overall, PET/MR achieved approximately 55.5% sensitivity, 89.5% specificity, 82.5% accuracy, 57.6% positive predictive value (PPV), and 88.6% negative predictive value (NPV). In contrast, CT demonstrated 75.0% sensitivity, 72.3% specificity, 72.9% accuracy, 42% PPV, and 91.5% NPV. No significant correlations were observed between semi-quantitative PET/MR measures, such as SUV or MR ADC values, and patient survival outcomes; therefore, these metrics were excluded from further analysis. Notably, PET/MR imaging findings changed clinical management in 3/6 chemotherapy patients. PET/MR demonstrated greater sensitivity in detecting nodal metastases, 75% compared to CT (25%), and identified small bowel serosal lesions in 1 of 1 case (100% sensitivity) versus none with CT. CT showed slightly higher specificity (81%) for colon serosal involvement than PET/MR (75%).Conclusions:CT demonstrates higher sensitivity, whereas PET/MR offers greater specificity and negative predictive value. When used together, the two modalities may provide a more reliable and comprehensive assessment of metastatic disease.
目的：本研究旨在以病理学结果为金标准，比较全身PET/MR成像与增强CT在拟行手术切除患者中检测转移性疾病的诊断准确性。 材料与方法：19例疑似转移患者（其中4例术前接受新辅助治疗）均接受了FDG PET/MR和增强CT扫描。对特定部位（如肝周区域、肝实质、肠系膜、肠浆膜、结肠表面及淋巴结区域）的转移灶进行影像学评估。将每种影像学方法在各部位的检测结果与手术病理结果进行对照。以病理结果为标准，分别计算PET/MR与CT的敏感性、特异性、准确率、阳性预测值（PPV）和阴性预测值（NPV）。 结果：总体而言，PET/MR的敏感性约为55.5%，特异性为89.5%，准确率为82.5%，阳性预测值（PPV）为57.6%，阴性预测值（NPV）为88.6%。相比之下，CT的敏感性为75.0%，特异性为72.3%，准确率为72.9%，PPV为42%，NPV为91.5。半定量PET/MR指标（如SUV值或MR ADC值）与患者生存结局未观察到显著相关性，因此未纳入进一步分析。值得注意的是，PET/MR影像结果改变了3/6化疗患者的临床治疗方案。在检测淋巴结转移方面，PET/MR表现出更高的敏感性（75% vs CT的25%），并在1例小肠浆膜病灶检测中达到100%的敏感性（CT未检出）。对于结肠浆膜受累，CT的特异性（81%）略高于PET/MR（75%）。 结论：CT具有更高的敏感性，而PET/MR则提供更高的特异性和阴性预测值。两种影像学方法联合使用可为转移性疾病提供更可靠、更全面的评估。
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