O estado da arte da PET/RM para o câncer retal: o valor agregado à imagem convencional

Zampieri, Poliana Fonseca; Hernandes, Daniel Barros Garcia; Albenda, David Alberto Gutiérrez; Horvat, Natally; Catalano, Onofrio Antonio; Buchpiguel, Carlos Alberto; Queiroz, Marcelo Araújo

doi:10.1590/0100-3984.2025.0060

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Review Article • Radiol Bras 58 • 2025 • https://doi.org/10.1590/0100-3984.2025.0060 linkcopiar

O estado da arte da PET/RM para o câncer retal: o valor agregado à imagem convencional

Autoria SCIMAGO INSTITUTIONS RANKINGS

Os exames de imagem desempenham um papel fundamental na avaliação de pacientes com câncer retal, e a tomografia por emissão de pósitrons/ressonância magnética (PET/RM) tem demonstrado superioridade em cenários clínicos específicos. Esta revisão descreve a potencial contribuição da PET/RM com ¹⁸F-fluorodesoxiglicose (¹⁸F-FDG) em relação à imagem padrão - tomografia computadorizada (TC), RM ou PET/TC - na avaliação de pacientes com câncer retal em cenários como estadiamento primário, avaliação da resposta terapêutica e detecção de recidiva. Discutimos os protocolos e o fluxo de trabalho clínico da PET/RM com ¹⁸F-FDG, além de destacar a potencial superioridade clínica da PET/RM sobre outras modalidades de imagem.

Unitermos:
Tomografia por emissão de pósitrons; Ressonância magnética; Neoplasias retais.

Autoria

person Poliana Fonseca Zampieri

schoolDepartment of Radiology and Oncology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP, BrazilUniversidade de São PauloBrazilSão Paulo, SP, BrazilDepartment of Radiology and Oncology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil

0000-0002-5364-6337

person Daniel Barros Garcia Hernandes

0009-0000-1417-1124

person David Alberto Gutiérrez Albenda

0000-0002-5879-5382

person Natally Horvat

schoolDepartment of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USAMemorial Sloan Kettering Cancer CenterUSANew York, NY, USADepartment of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

0000-0001-8849-5789

person Onofrio Antonio Catalano

schoolDepartment of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USAHarvard Medical SchoolUSABoston, MA, USADepartment of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

0000-0001-7733-4138

person Carlos Alberto Buchpiguel

0000-0003-0956-2790

person Marcelo Araújo Queiroz

0000-0003-0052-0682

Correspondence: Dra. Poliana Fonseca Zampieri. Departamento de Radiologia e Oncologia - HC-FMUSP. Rua Doutor Ovidio Pires de Campos, 872, Cerqueira César. São Paulo, SP, Brazil, 05403-911. Email:
poliana.zampieri@hc.fm.usp.br

Editor-Responsável:

Dr. Valdair Francisco Muglia

SCIMAGO INSTITUTIONS RANKINGS

Department of Radiology and Oncology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP, BrazilUniversidade de São PauloBrazilSão Paulo, SP, BrazilDepartment of Radiology and Oncology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil

Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USAMemorial Sloan Kettering Cancer CenterUSANew York, NY, USADepartment of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USAHarvard Medical SchoolUSABoston, MA, USADepartment of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

Figuras

Figuras (7)

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Figure 1 Clinical workflow in ¹⁸F-FDG PET/MRI for rectal cancer staging.

Thumbnail

Figure 2 A 56-year-old male at primary staging of rectal cancer. The primary tumor and its extensions are better seen in the MRI component (A). DWI (B) aids in the detection of viable tumors but is not strictly necessary in primary staging. The PET component (C) shows a very high ¹⁸F-FDG uptake, and PET parameters can be quantified, helping identify high-risk patients .

Thumbnail

Figure 3 A 56-year-old male at primary staging of rectal cancer. A: MRI detects a lesion with an extensive mucinous component (red arrow) and some nonmucinous components (yellow arrow). B: PET/MRI clearly shows the difference between the mucinous and nonmucinous components by highlighting ¹⁸F-FDG avidity.

Thumbnail

Figure 4 A 48-year-old female at primary staging (A) and treatment response assessment following neoadjuvant CRT (B). PET/MRI after neoadjuvant CRT showed a partial metabolic response with residual ¹⁸F-FDG uptake suggestive of a viable tumor. The patient underwent surgery that confirmed the staging as ypT3ypN0.

Thumbnail

Figure 5 A 57-year-old male at primary staging (A) and treatment response assessment following neoadjuvant CRT (B). At primary staging, PET/MRI detected a hypermetabolic primary rectal tumor staged as T3N0 (A). PET/MRI after neoadjuvant CRT showed a complete metabolic response, although a partial morphology response (tumor regression grade 3) was depicted by MRI (B).

Thumbnail

Figure 6 Restaging in a 57-year-old male with rectal cancer and rising CEA levels. PET/CT (B) depicts ¹⁸F-FDG uptake without a clear morphological change on CT (A). However, local recurrence was detected on MRI (C) and PET/MRI (D).

Thumbnail

Figure 7 Clinical impact of PET/MRI on primary staging of rectal cancer (A), treatment response assessment (B), and detection of recurrence (C). nCRT, neoadjuvant CRT; RT, radiotherapy; mrTRG, magnetic resonance tumor regression grade.

imageFigure 1 Clinical workflow in ¹⁸F-FDG PET/MRI for rectal cancer staging. open_in_new

imageFigure 2 A 56-year-old male at primary staging of rectal cancer. The primary tumor and its extensions are better seen in the MRI component (A). DWI (B) aids in the detection of viable tumors but is not strictly necessary in primary staging. The PET component (C) shows a very high ¹⁸F-FDG uptake, and PET parameters can be quantified, helping identify high-risk patients . open_in_new

imageFigure 3 A 56-year-old male at primary staging of rectal cancer. A: MRI detects a lesion with an extensive mucinous component (red arrow) and some nonmucinous components (yellow arrow). B: PET/MRI clearly shows the difference between the mucinous and nonmucinous components by highlighting ¹⁸F-FDG avidity. open_in_new

imageFigure 4 A 48-year-old female at primary staging (A) and treatment response assessment following neoadjuvant CRT (B). PET/MRI after neoadjuvant CRT showed a partial metabolic response with residual ¹⁸F-FDG uptake suggestive of a viable tumor. The patient underwent surgery that confirmed the staging as ypT3ypN0. open_in_new

imageFigure 5 A 57-year-old male at primary staging (A) and treatment response assessment following neoadjuvant CRT (B). At primary staging, PET/MRI detected a hypermetabolic primary rectal tumor staged as T3N0 (A). PET/MRI after neoadjuvant CRT showed a complete metabolic response, although a partial morphology response (tumor regression grade 3) was depicted by MRI (B). open_in_new

imageFigure 6 Restaging in a 57-year-old male with rectal cancer and rising CEA levels. PET/CT (B) depicts ¹⁸F-FDG uptake without a clear morphological change on CT (A). However, local recurrence was detected on MRI (C) and PET/MRI (D). open_in_new

imageFigure 7 Clinical impact of PET/MRI on primary staging of rectal cancer (A), treatment response assessment (B), and detection of recurrence (C). nCRT, neoadjuvant CRT; RT, radiotherapy; mrTRG, magnetic resonance tumor regression grade. open_in_new

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