Respiratory-gated 18F Fluorodeoxyglucose Positron Emission Tomography/Magnetic Resonance Imaging in Evaluation of Primary Gastric Lesions and Gastric Lymph Nodes in Patients with Gastric Cancer

To evaluate the added value of respiratory-gated positron emission tomography (PET) in 18F fluorodeoxyglucose (FDG) PET/magnetic resonance imaging (MRI) in the visual and semi-quantitative assessment of primary gastric lesions and gastric lymph nodes for patients with gastric cancer.In total, 102 upper abdominal respiratory-gated and whole-body 18F FDG PET/MRI of 88 patients with gastric cancer were evaluated visually and semi-quantitatively. For 41 patients who underwent surgery, histopathological and PET findings were compared. Three PET images were obtained from upper abdominal PET data: non-Q static (non-QS) PET from all counts, respiratory-gated Q static (QS) PET from counts in the end-expiration phase of breathing, shortened 4 min (S4min) PET that was reconstructed to obtain similar counts to QS PET. The semi-quantitative parameters (standardised uptake values, metabolic tumour volume, total lesion glycolysis) of primary lesions for each PET image, the sizes of primary lesions and the patient's body mass index were recorded. According to lymph node stations, the presence and numbers of positive lymph nodes and visual scores of lymph nodes for each PET image were recorded.The patients with smaller gastric lesions (≤30 mm) or higher body mass index (>30) had significantly higher standardised uptake value percentage changes in QS PET compared with non-QS PET (all P < 0.05). The third (lesser curvature), fourth (greater curvature) and sixth (infra-pyloric) lymph node stations had significantly higher visual scores in the QS PET than in the others. The fourth lymph node station had a significantly higher number of FDG-positive lymph node in the QS PET than in the non-QS and the whole-body PET images. In the fourth station, sensitivity, positive predictive value, negative predictive value and accuracy increased in the QS PET compared with the others.Respiratory-gated PET/MRI was found to be significantly superior in the evaluation of especially the fourth lymph node station, smaller gastric lesions and in the patients with a higher BMI compared with the non-respiratory-gated PET images.