IN a new 5-year follow-up study exploring diagnostic tools for adenocarcinoma of the esophagogastric junction (AEG), PET combined with MRI (PET/MRI) has shown strong potential for predicting long-term survival. PET/MRI, a hybrid modality that integrates metabolic and anatomical imaging, was evaluated as a prognostic tool in a retrospective analysis of 22 AEG patients who underwent neo-adjuvant chemotherapy (NT). The study builds on earlier work assessing PET/MRI for tumor resectability and now shifts focus to survival outcomes.
Patients underwent PET/MRI scans prior to chemotherapy and again within 17 to 21 days of starting NT. Researchers analyzed changes in key imaging parameters including standard uptake value (∆SUVmax) and apparent diffusion coefficients (∆ADCb0 and ∆ADCb50), correlating these with survival and recurrence data. Sensitivity, specificity, and overall predictive power were determined using receiver operating characteristic (ROC) analysis.
Of the 22 patients initially included, 8 were alive at the time of analysis. The study found the strongest survival prediction when combining all three parameters—∆SUVmax, ∆ADCb0, and ∆ADCb50—yielding an area under the curve (AUC) of 0.81 with sensitivity of 78.6% and specificity of 85.7% (p = 0.002). The most robust individual predictor was post-NT SUVmax alone, also with an AUC of 0.81, sensitivity of 85.7%, and specificity of 87.5% (p = 0.002).
While early treatment response measured by RECIST criteria showed no significant correlation with survival (p = 0.15), changes in PET/MRI values offered a clearer prognostic signal. These findings support the use of PET/MRI not only for initial staging and treatment planning but also as a critical tool for identifying patients likely to benefit from more aggressive or alternative therapeutic approaches.
As oncologists and radiologists seek more precise tools for managing AEG, this study underscores the emerging role of multimodal imaging in guiding personalized cancer care.
Reference:
Schæbel GH et al. The prognostic value of positron emission tomography/magnetic resonance imaging in predicting survival in patients with adenocarcinoma of the esophagogastric junction. Ann Nucl Med. 2025. doi: 10.1007/s12149-025-02058-z.
