Objective: Incidental masses of abdominal organs are a relevant problem in radiological examinations. The aim of this study was to evaluate whether simultaneous (18)F-fluorodeoxyglucose ((18)F-FDG) PET/MRI, because of its higher soft-tissue contrast and the diversity of available pulse sequences, can reduce the number of indeterminate abdominal incidentalomas compared with (18)F-FDG PET/computed tomography (CT).
Materials and methods: In this retrospective study, we enrolled 173 patients (91 women and 82 men, mean age 55.8±14.6 years) who underwent contrast-enhanced (18)F-FDG PET/CT on the same day for oncological indications. Data sets were examined in a random order by two readers noting incidentalomas and incidental tracer uptake of the liver, kidneys, spleen, pancreas, adrenal glands, and gallbladder. Findings were categorized into three categories: most likely malignant, indeterminate, and most likely benign. In addition, the most relevant MR sequence for the final decision was recorded for each incidentaloma. The numbers of benign, indeterminate, and malignant findings on (18)F-FDG PET/CT and (18)F-FDG PET/MRI were compared. A subgroup analysis was carried out to detect potential differences with respect to lesion location (organwise) and lesion consistency (solid vs. cystic).
Results: A total of 649 upper abdominal incidentalomas were found. (18)F-FDG PET/MRI detected more incidentalomas (n=635) than contrast-enhanced (18)F-FDG PET/CT (n=407, P<0.001). Using (18)F-FDG PET/MRI, significantly fewer incidentalomas were categorized as indeterminate compared with (18)F-FDG PET/CT (n=27 vs. 91, P<0.001). This was true for cystic (P<0.001) as well as solid masses (P<0.001). Seventy incidentalomas categorized as indeterminate on contrast-enhanced (18)F-FDG PET/CT could be clarified as most likely benign by (18)F-FDG PET/MRI, whereas only six lesions rated as benign by (18)F-FDG PET/CT were classified as indeterminate in (18)F-FDG PET/MRI. (18)F-FDG PET/MRI compared with contrast-enhanced (18)F-FDG PET/CT had significantly fewer indeterminate findings in the liver (P<0.001), kidneys (P=0.012), and adrenal glands (P=0.002); differences for the spleen (P=0.5) were not significant.
Conclusion: (18)F-FDG PET/MRI identifies more incidentalomas than (18)F-FDG PET/CT, but significantly reduces the number of indeterminate incidental findings of abdominal organs.