Background/Objectives:Early and accurate characterization of endometrial cancer (EC) is crucial for patient management, but current imaging modalities lack in diagnostic accuracy and ability to assess molecular profiles. The aim of this study is to evaluate hybrid [18F]FDG PET/MRI’s diagnostic accuracy in EC staging and role in predicting tumor aggressiveness, molecular characterization, and recurrence.Methods: A prospective study (ClinicalTrials.gov, ID:NCT04212910) evaluating EC patients undergoing [18F]FDG PET/MRI before surgery (2018–2024). Histology, immunohistochemistry, and patients’ follow-up (mean FU time: 3.13y) were used as the reference standard. [18F]FDG PET/MRI, PET only, and MRI only were independently reviewed to assess the diagnostic accuracy (ACC), sensitivity (SN), specificity (SP), and positive/negative predictive value (PPV, NPV). Imaging parameters were extracted from [18F]FDG PET and pcT1w, T2w, DWI, and DCE MRI. Spearman’s correlations, Fisher’s exact test, ROC-AUC analysis, Kaplan–Meier survival curves, log-rank tests and Cox proportional hazards models were applied.Results: Eighty participants with primary EC (median age 63 ± 12 years) were enrolled, with 17% showing LN involvement. [18F]FDG PET/MRI provided ACC = 98.75%, SN = 98.75%, and PPV = 100% for primary tumor detection, and ACC = 92.41%, SN = 84.62%, SP = 93.94%, PPV = 73.33%, and NPV = 96.88% for LN detection. PET/MRI parameters predicted LN involvement (AUC = 79.49%), deep myometrial invasion (79.78%), lymphovascular space invasion (82.00%), p53abn (71.47%), MMRd (74.51%), relapse (82.00%), and postoperative administration of adjuvant therapy (79.64%). Patients with a tumor cranio-caudal diameter ≥ 43 mm and MTV ≥ 13.5 cm3showed increased probabilities of recurrence (p< 0.001).Conclusions: [18F]FDG PET/MR showed exceptional accuracy in EC primary tumor and LN detection. Derived parameters demonstrated potential ability in defining features of aggressiveness, molecular alterations, and tumor recurrence.
背景/目的： 子宫内膜癌的早期准确评估对患者管理至关重要，但现有影像学方法在诊断准确性和评估分子谱方面存在不足。本研究旨在评估混合[18F]FDG PET/MR在子宫内膜癌分期中的诊断准确性，及其在预测肿瘤侵袭性、分子特征和复发中的作用。
方法： 一项前瞻性研究（ClinicalTrials.gov，ID：NCT04212910），评估在术前接受[18F]FDG PET/MR检查的子宫内膜癌患者（2018–2024年）。以组织病理学、免疫组织化学及患者随访（平均随访时间：3.13年）作为参考标准。对[18F]FDG PET/MR、单独PET及单独MRI进行独立阅片，以评估诊断准确率、敏感性、特异性、阳性预测值和阴性预测值。从[18F]FDG PET及pcT1w、T2w、DWI和DCE MRI序列中提取影像参数。采用Spearman相关性分析、Fisher精确检验、ROC-AUC分析、Kaplan-Meier生存曲线、log-rank检验和Cox比例风险模型。
结果： 共纳入80名原发性子宫内膜癌患者（中位年龄63 ± 12岁），其中17%存在淋巴结转移。[18F]FDG PET/MR对原发肿瘤检测的准确率为98.75%，敏感性为98.75%，阳性预测值为100%；对淋巴结检测的准确率为92.41%，敏感性为84.62%，特异性为93.94%，阳性预测值为73.33%，阴性预测值为96.88%。PET/MR参数可预测淋巴结转移（曲线下面积=79.49%）、深肌层浸润（79.78%）、淋巴血管间隙浸润（82.00%）、p53异常（71.47%）、错配修复缺陷（74.51%）、复发（82.00%）以及术后辅助治疗的应用（79.64%）。肿瘤头尾径≥43 mm且代谢肿瘤体积≥13.5立方厘米的患者复发概率更高（p < 0.001）。
结论： [18F]FDG PET/MR在子宫内膜癌原发肿瘤及淋巴结检测方面表现出卓越的准确性。其衍生的参数在定义肿瘤侵袭性特征、分子改变及肿瘤复发方面展现出潜在能力。
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