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PET/MRI is superior to PET/CT in detecting oesophago and gastric carcinomas: a meta-analysis

Cancer Imaging volume 25, Article number: 50 (2025) Cite this article

Abstract

Objectives

To compare the accuracy rates of the detection and staging of oesophago and gastric carcinomas between PET/MRI and PET/CT.

Methods

An extensive librarian-led literature search of PubMed, Embase, Web of Science, the Cochrane Central Library, and CNKI was performed and a meta-analysis was done.

Results

Six studies, including 123 participants, were analyzed. PET/MRI had a comparatively high sensitivity in primary lesion detection compared with PET/CT. (RR = 1.14, 95% CI 1.01–1.29, P = 0.036).PET/MRI had no significant statistical differences in all aspects of TNM staging compared with PET/CT.

Conclusions

This systematic review confirmed the advantage of PET/MRI in detecting oesophago and gastric carcinomas.Compared with PET/CT, it can reduce unnecessary radiation exposure and can be used in relevant patients without contraindications of MRI.

Introduction

Oesophago and Gastric carcinomas are the common malignant tumor of the digestive system which has a high morbidity and mortality rate[1, 2]. Early surgery or endoscopic resection is the primary treatment for oesophago and gastric carcinomas, so early diagnosis and accurate staging has a significant impact on the prognosis [3].

Traditional examination methods for digestive system tumors mainly include X-ray barium meal, CT and Endoscopic ultrasound, but their common limitations means that new imaging technologies are needed to improve the delineation of disease extent, the detection of lymph node metastases, and the assessment of treatment response.In recent years, with the update of MRI scanning technology, its application in digestive system tumors has gradually been recognized [4]. Whole-body fully integrated PET/MRI combining with the advantages of PET imaging with MRI has the advantage of superior soft tissue contrast, and it can provide crucial information such as tumour depth and nodal involvement, as well as tumor function and metabolism, which has been widely introduced in the clinical practice in recent years [5]; however, there are still few literatures focus on the application of PET/MRI in the detection and staging of digestive system tumors[6, 7].

This article searched the comparative studies comparing PET/MRI and PET/CT in the detection and staging of oesophago and gastric carcinomas. We discussed the difference in the detection rate of the primary tumor, lymph node metastasis, and the other metastasis. This article aimed to provide a better choice for patients with oesophago and gastric carcinomas in the screening, condition evaluation and treatment effect monitoring, and finally improving of the survival benefit.

Materials and methods

The protocol of this meta-analysis was registered in PROSPERO (CRD42024598923).

This systematic review was based on the Preferred.

Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statements.

Study selections

The related studies were retrieved in the following databases: PubMed, Embase, Web of Science, the Cochrane Central Library, and CNKI from inception to 1st September 2024.For all databases, the search strategy includes the use of the following terms:“PET/MRI”,“PET/CT”,“Oesophago Carcinomas”or“Gastric Carcinomas”.To prevent missed cases, we also increased manual search, manual search strategy only includes the “PET/MRI”,“Oesophago Carcinomas”or“Gastric Carcinomas”.This meta-analysis was in line with the Critical Appraisal Skills Programme Checklist.Data extraction and conformity assessment were conducted by two independent reviewers.The differences among the reviewers were resolved through group discussion.

Inclusion and exclusion criteria

Two independent reviewers assessed eligibility and reached a consensus by discussing differences with a third investigator.The evaluation was repeated twice. First of all, the title and abstract were preliminarily evaluated, and the full text was evaluated after the potentially qualified study was selected. No reviewers were blinded to the authors of these studies.

Inclusion criteria

(1) Type of study

The analysis included only comparative trials published in fully peer-reviewed journals before 1st September 2024.

(2) Language

Only English and Chinese articles were included.

(3) Type of intervention

Both two different diagnostic techniques for detection and staging of oesophago and gastric carcinomas.

(4) Type of participants

Patients who developed oesophago or gastric carcinomas were the target population for the meta-analysis.

Exclusion criteria

(1) Non-comparative trials and unpublished studies were excluded.

(2)No final pathological staging results were excluded.

(3)No relevant results(Did not contain all the PET/MRI staging details and PET/CT staging details)were found.

Data collection

We extracted the following data: first author, year of the study, country of origin, number of participants, age, radiopharmaceuticals, final pathological staging results, PETMRI/CT staging results. Two authors independently extracted and cross-checked all data. The differences were resolved through in-depth discussions with a third reviewer until we reached a consensus.

Evaluation of quality of evidence

Two independent reviewers blindly evaluated the methodological quality of the selected studies. Differences were discussed among the groups and resolved by a third evaluator. The risk of bias tool suggested by the Cochrane Handbook for Systematic Reviews of Interventions was used to adjudicate the methodological quality of RCTs [8]. The Newcastle-Ottawa Scale was used to assess the methodological quality of non-RCTs [9].

Statistical analysis

Stata software ver.12 was used to conduct statistical analysis. The Q test and I2 statistic were used to assess the heterogeneity of the detecting effects. Significant heterogeneity was defined as p < 0.1 and I2 > 50%, and the random effect model was used, otherwise, the fixed effect model was used. The relative risk and their 95% confidence interval were calculated. Publication bias was assessed qualitatively by Funnel plot, and statistically using Egger’s and Begg’s test. Sensitivity analysis was conducted by excluding a single study and recalculating the pooled estimates. P < 0.05 was considered to be significant (p values were two-sided).

Results

Characteristics of studies

As shown in the flow diagram (Fig. 1), 57 clinical studies were identified by search strategy, 3 studies were identified by manual search. And finally a total of 6 studies were finalized based on the predefined inclusion and exclusion criteria.

Fig. 1
figure 1

Flow diagram

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There were 123 patients in the 6 studies[6–7, 10,11,12,13], which all included PET/MRI and PET/CT. Among them, 5 studies compared PET/MRI staging, PET/CT staging, and pathological staging; 1 study compared PET/MRI with PET/CT staging but not compared pathological staging [13]. The study characteristics are shown in Table 1.

Table 1 The characteristics of studies
Full size table

Primary outcomes

Sensitivity in primary lesion detection.

Three of the included studies reported the primary lesion detection evaluations(Table 2). PET/MRI had a comparatively high sensitivity in primary lesion detection evaluations compared with PET/CT. (RR = 1.14, 95% CI 1.01–1.29, P = 0.036) (Fig. 2).

Table 2 The characteristics of primary lesion detection evaluations
Full size table
Fig. 2
figure 2

Forest plots of primary lesion detection evaluations

Full size image

Accuracy of TNM staging.

Five studies reported the accuracy of TNM staging. PET/MRI had no significant statistical differences in all aspects of TNM staging compared with PET/CT: T1(RR = 1.67, 95% CI 0.69–4.06, P = 0.030), T2(RR = 0.78, 95% CI 0.41–1.48, P = 0.444), T3(RR = 1.16, 95% CI 0.77–1.74, P = 0.480), T4(RR = 1.00, 95% CI 0.76–1.32, P = 1.000), N0(RR = 0.83, 95% CI 0.60–1.13, P = 0.232), N1(RR = 1.18, 95% CI 0.83–1.68, P = 0.368), N2(RR = 0.80, 95% CI 0.49–1.31, P = 0.377), N3(RR = 1.86, 95% CI 1.03–3.36, P = 0.041), M1(RR = 1.15, 95% CI 0.92–1.44, P = 0.226).(Table 3, 4; Figs. 3, 4 and 5).

Table 3 The detection evaluations of T staging
Full size table
Table 4 The detection evaluations of N and M staging
Full size table
Fig. 3
figure 3

Forest plots of detection evaluations of T staging. A: T1. B: T2. C: T3. D: T4

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Fig. 4
figure 4

Forest plots of detection evaluations of N staging. A: N0. B: N1. C: N2. D: N3

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Fig. 5
figure 5

Forest plots of detection evaluations of M1 staging

Full size image

Discussion

In recent years, as PET/MRI has been gradually used in clinical, its advantages, such as higher soft tissue contrast and no risk of radiation exposure, have been gradually recognized compared to PET/CT. Now PET/MRI has been gradually used in various diseases throughout the body detection and staging of tumors [14]. However, previous studies have shown that the application of PET/MRI in gastric cancer and esophageal cancer is limited due to motion artifact interference caused by respiratory movement or gastrointestinal motility [15]. In recent years, with the continuous updating of MRI scanning technology, such as respiratory gating technology, studies have shown that PET/MRI is better than PET/CT in detecting gastric cancer and esophageal cancer [5, 13, 16]. In this study, the detection rate of PET/MRI for primary tumors of gastric and esophageal cancer was greater than that of PET/CT(P < 0.05), which is consistent with previous studies.

In terms of tumor T staging, most previous studies believe that PET/MRI is equivalent to PET/CT [14, 17]. Some studies even believe that PET/MRI is more accurate than PET/CT. They believe that PET/MRI has better soft tissue resolution, which can more clearly display the structure of each layer of the esophagus and gastric wall as well as the relationship between the tumor and surrounding tissues, and the display of the details of the tumor itself (such as shape, edges, etc.) is also better than PET/CT, so that it can be performed more accurately T staging [18,19,20]. In this study the results of Table 3 showed that PET/MRI classified more T3 stages than PET/CT (conversely for T2 stages), this could be related to higher spatial resolution of MRI and soft-tissue definition, but the meta-analysis statistical results of Fig. 3 showed that the the difference between them were not statistically significant, so we believe that the accuracy of PET/MRI in T1-4 stages were equivalent to that of PET/CT. It is speculated that it may be related to the sample size, so larger studies are necessary to fully assess the benefit of PET/MRI in N staging of oesophago and gastric cancer.

In terms of tumor N staging, previous studies have reported that PET/MRI is more accurate than PET/CT in N staging. It is speculated that in addition to providing lymph node size and metabolic uptake, PET/MRI also has more parameters for lymph node classification and judgment of metastasis, such as DWI and ADC values [21]. In this study the results of Table 4 showed that the PET/MRI demonstrates more N3 stages than PET/CT (which classifies more N2 patients), especially in the study by Liu 2019,this could be related to lymph node morphological characteristics, or DWI or post-gadolinium contrast behaviour, that are interpreted as possible metastasis, and which are not apparent on PET/CT in case these lymph nodes are metabolically negative on PET imaging.But the meta-analysis statistical results of Fig. 4 showed that the the difference between them were not statistically significant, it is speculated that the reason may be that the judgment of lymph node metastasis by imaging examination is more complicated, not simply relying on size or metabolic uptake criteria [22], and although PET/MRI can provide more judgment parameters, there is no unified judgment standard for each parameter [23], so its judgment on lymph node metastasis needs to be further studied.

In terms of tumor M staging, the results of this study showed that both PET/MRI and PET/CT had higher accuracy in detecting distant metastasis of tumors, and the difference between them was not statistically significant. It is also due to the high accuracy provided by MRI and the high specificity provided by PET, which enable PET/MRI to detect almost all bone metastases and distant organ metastases [24], which is consistent with our study.

This study had limitations: (1) The overall sample size of this study was relatively small, and studies with larger sample sizes are needed in the future to further confirm the application value of PET/MRI in the detection and staging of gastric and esophageal cancer. (2) The different PET radiopharmaceuticals may cause deviations to the results in this study. Some classification studies have shown that the new [68 Ga]Ga-FAPI-04 contrast agent may have better gastrointestinal tumor-promoting properties than the traditional [18 F]-FDG [25, 26]. So the PET/MRI using [68 Ga]Ga-FAPI-04 in this study [11] may achieve a higher detection rate and more accurate staging of gastric and esophageal cancer, but unfortunately, there is only one article which cannot be included in the meta-analyzed, so in the next step we will also conduct comparative studies on PET/MRI or PET/CT using different PET radiopharmaceuticals. (3) At present, compared with PET/CT, PET/MRI still lacks an internationally certified standardized scanning protocol. In this analysis, PET/MRI scanning protocols were also different, and some studies [27]reported the scanning plan or sequence might influence the results in detecting primary lesions and lymph nodes, so standardized PET/MRI protocols are needed to promote the quality and consistency of PET/MRI across centers, also to help streamline examinations and limit acquisition times.

Conclusion

This systematic review confirmed the advantage of PET/MRI in detecting oesophago and gastric carcinomas.Compared with PET/CT, it can reduce unnecessary radiation exposure and can be used in relevant patients without contraindications of MRI.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

PET/CT:

Positron emission/Computed tomography

PET/MRI:

Positron emission/Magnetic resonance imaging

CNKI:

China national knowledge infrastructure

PRISMA:

The preferred reporting items for systematic reviews and meta-analyses

RCTs:

Randomized controlled trial

DWI:

Diffusion weighted imagin

ADC:

Apparent diffusion coefficient

References

  1. Sung H, Jacques F, Rebecca LS, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–49.

    Article  PubMed  Google Scholar 

  2. Kauppila JH. Mattsson F,Brusselaers N,Lagergren j.prognosis of oesophageal adenocarcinoma and squamous cell carcinoma following surgery and no surgery in a nationwide Swedish cohort study. BMJ Open. 2018;8(5):e021495.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Smyth EC, Nilsson M, Grabsch HI,Grieken NC, Lordick F. Gastric cancer. lancet. 2020;396(10251):635–48.

  4. Zeng Q, Hong YL,Cheng J, et al. Quantitative study of preoperative stating of gastric cancer using intravoxel incoherent motion diffusion weighted imaging as a potential clinical index. Eur J Radiol. 2021;141:109627.

    Article  PubMed  Google Scholar 

  5. Valkema MJ Sablonière, QG,Valkema R, et al. 18 F-FDG PET/MRI for restaging esophageal cancer after neoadjuvant chemoradiotherapy. Nucl Med Commun. 2024;45(2):128–38.

  6. Linder G, Korsavidou-Hult N, Bjerner T, Ahlström H, Hedberg J. 18F-FDG-PET/MRI in preoperative staging of oesophageal and gastroesophageal junctional cancer. Clin Radiol. 2019;74(9):718–25.

    Article  CAS  PubMed  Google Scholar 

  7. Sharkey AR, Sah BR, Withey SJ, et al. Initial experience in staging primary oesophageal/gastro-oesophageal cancer with 18F-FDG PET/MRI. Eur J Hybrid Imaging. 2021;5(1):23.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Julian PT, Higgins. Sally Green.Cochrane Handbook for Systematic Reviews of Interventions Version 6.3.2022. Available at:http://training.cochrane.org/handbook/current

  9. Wells G, Shea BJ,O'Connell D et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses.2000.Available at:http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp

  10. Lee GI, H,Kim SJ, et al. Clinical implication of PET/MR imaging in preoperative esophageal cancer staging: comparison with PET/CT, endoscopic ultrasonography, and CT. J Nucl Med. 2014;55(8):1242–7.

    Article  PubMed  Google Scholar 

  11. Qin CX, Shao FQ, Gai YK, et al. 68Ga-DOTA-FAPI-04 PET/MR in the evaluation of gastric carcinomas: comparison with 18F-FDG PET/CT. J Nucl Med. 2022;63(1):81–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Liu Y, Zheng D, Liu JJ et al. Comparing PET/MRI with PET/CT for pretreatment staging of gastric cancer. Gastroenterol Res Pract 2019:9564627.

  13. Zheng D, Liu Y, Liu JJ, et al. Improving MR sequence of 18F-FDG PET/MR for diagnosing and staging gastric cancer: a comparison study to 18F-FDG PET/CT. Cancer Imaging. 2020;20(1):39.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Singnurkar AMDCM. MPH Head-to-Head comparison of the diagnostic performance of FDG PET/CT and FDG PET/MR in patients with cancer: A systematic review and Meta-Analysis. AJR https://doiorg.publicaciones.saludcastillayleon.es/10.2214/AJR.24.31519

  15. Lee DH. Lee JM.Whole-body PET/MRI for colorectal cancer staging: is it the way forward? J Magn Reson Imaging. 2017;45(1):21–35.

    Article  PubMed  Google Scholar 

  16. Soydan L. Demir AA,Torun M,Cikrikcioglu ma.use of diffusion-Weighted magnetic resonance imaging and apparent diffusion coefficient in gastric cancer staging. Curr Med Imaging. 2020;16:1278–89.

    Article  CAS  PubMed  Google Scholar 

  17. Maksim R, Buczyńska A,Sidorkiewicz I,Krętowski AJ, Sierko E. Imaging and metabolic diagnostic methods in the stage assessment of rectal cancer. Cancers (Basel). 2024;16(14):2553.

    Article  CAS  PubMed  Google Scholar 

  18. Withey SJ, Goh V, Foley KG. State-of-the-art imaging in oesophago-gastric cancer. Br J Radiol. 2022;95(1137):20220410.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Zeng FY, Zeng F,Sugiyama N,Nogami M, Murakami TA. Case of rectal dissemination of gastric cancer diagnosed by simultaneous 18F-FDG PET/MRI.Clin. Nucl Med. 2023;48(9):e441–3.

    Google Scholar 

  20. Paspulati RM, Partovi S, Herrmann KA, Krishnamurthi S. Delaney CP,Nguyen nc.comparison of hybrid FDG PET/MRI compared with PET/CT in colorectal cancer staging and restaging: a pilot study. Abdom Imaging. 2015;40(6):1415–25.

    Article  PubMed  Google Scholar 

  21. Ge YX, Hu SD, Wang Z, et al. Feasibility and reproducibility of T2 mapping and DWI for identifying malignant lymphnodes in rectal cancer. Eur Radiol. 2021;31(5):3347–54.

    Article  PubMed  Google Scholar 

  22. Ateş SG, AydosU,Akdemir ÜÖ et al. Respiratory-gated 18F Fluorodeoxyglucose positron emission omography/magnetic resonance imaging in evaluation of primary gastric lesions and gastric lymph nodes in patients with gastric cancer.clin oncol (R Coll Radiol). 2022;34(12):810–8.

  23. Borgheresi A, Muzio FD,Agostini A, et al. Lymph nodes evaluation in rectal cancer: where do we stand and future perspective. J Clin Med. 2022;11(9):2599.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Vermersch MMuléS, Chalaye J, et al. Impact of the 18F-FDG-PET/MRI on metastatic staging in patients with hepatocellular carcinoma: initial results from 104 patients. J Clin Med. 2021;10(17):4017.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Wang YW, Luo WH,Li Y. [68Ga]Ga-FAPI-04 PET MRI/CT in the evaluation of gastric carcinomas compared with [18F]-FDG PET MRI/CT: a meta-analysis. Eur J Med Res. 2023;28(1):34.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Du T, Zhang S, Cui XM et al. Comparison of [68Ga]Ga-DOTA-FAPI-04 and [18F]FDG PET/MRI in the preoperative diagnosis of gastric cancer. Can J Gastroenterol Hepatol. 2023:6351330.

  27. Veit-Haibach P, Ahlström H,Boellaard R, et al. International EANM-SNMMI-ISMRM consensus recommendation for PET/MRI in oncology. Eur J Nucl Med Mol Imaging. 2023;50(12):3513–37.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors are particularly grateful for the excellent professional assistance from their colleagues in the Department of Radiology, Hospital of Chengdu University of Traditional Chinese.

Funding

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Authors and Affiliations

  1. Department of Radiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China

    Bo Peng, Hui Sun & Jian Hou

  2. Department of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China

    Bo Peng, Hui Sun & Jian Hou

  3. Department of Infectious Diseases, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China

    Jian-Xing Luo

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Contributions

B.P, J.H and JX.L designed the study. Screening, review, data extraction and interpretation were done by B.P, H.S, J.H and JX.LData analysis was done by B.P and H.S. B.P wrote the manuscript. All authors made contributions to the editing and revision of the manuscript. All authors read and approved the fifinal manuscript for publication.

Corresponding authors

Correspondence to Jian Hou or Jian-Xing Luo.

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Peng, B., Sun, H., Hou, J. et al. PET/MRI is superior to PET/CT in detecting oesophago and gastric carcinomas: a meta-analysis. Cancer Imaging 25, 50 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s40644-025-00871-3

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Keywords

Cancer Imaging

ISSN: 1470-7330

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