Non–Small Cell Lung Cancer Staging: Efficacy Comparison of Integrated PET/CT versus 3.0-T Whole-Body MR Imaging

Yi, Chin A; Shin, Kyung Min; Lee, Kyung Soo; Kim, Byung‐Tae; Kim, Hojoong; Kwon, O Jung; Choi, Joon Young; Chung, Myung Jin

doi:10.1148/radiol.2482071822

Cited by 161 publications

(134 citation statements)

References 25 publications

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“…2,8,10 Abnormal focal FDG uptake accompanied by a corresponding anatomic alteration was considered to be indicative of metastasis. 8 The presence of abnormal uptake was determined qualitatively by comparing the uptake of the lesions in question with that of a mediastinal blood pool in the thorax or that of liver uptake in the abdomen, bones, or the remaining soft tissues. At brain MRI, metastases were considered present when an enhancing nodule(s) or mass was observed in the brain parenchyma on T1W images.…”

Section: Pet-ct and Dedicated Brain Mrimentioning

confidence: 99%

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Coregistered whole body magnetic resonance imaging‐positron emission tomography (MRI‐PET) versus PET‐computed tomography plus brain MRI in staging resectable lung cancer

Lee

et al. 2013

Cancer

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BACKGROUND:The objective of this study was to assess whether coregistered whole brain (WB) magnetic resonance imaging-positron emission tomography (MRI-PET) would increase the number of correctly upstaged patients compared with WB PET-computed tomography (PET-CT) plus dedicated brain MRI in patients with nonsmall cell lung cancer (NSCLC). METHODS: From January 2010 through November 2011, patients with NSCLC who had resectable disease based on conventional staging were assigned randomly either to coregistered MRI-PET or WB PET-CT plus brain MRI (ClinicalTrials.gov trial NCT01065415). The primary endpoint was correct upstaging (the identification of lesions with higher tumor, lymph node, or metastasis classification, verified with biopsy or other diagnostic test) to have the advantage of avoiding unnecessary thoracotomy, to determine appropriate treatment, and to accurately predict patient prognosis. The secondary endpoints were over staging and under staging compared with pathologic staging. RESULTS: Lung cancer was correctly upstaged in 37 of 143 patients (25.9%) in the MRI-PET group and in 26 of 120 patients (21.7%) in the PET-CT plus brain MRI group (4.2% difference; 95% confidence interval, À6.1% to 14.5%; P ¼ .426). Lung cancer was over staged in 26 of 143 patients (18.2%) in the MRI-PET group and in 7 of 120 patients (5.8%) in the PET-CT plus brain MRI group (12.4% difference; 95% confidence interval, 4.8%-20%; P ¼ .003), whereas lung cancer was under staged in 18 of 143 patients (12.6%) and in 28 of 120 patients (23.3%), respectively (À10.7% difference; 95% confidence interval, À20.1% to À1.4%; P ¼ .022). CONCLUSIONS: Although both staging tools allowed greater than 20% correct upstaging compared with conventional staging methods, coregistered MRI-PET did not appear to help identify significantly more correctly upstaged patients than PET-CT plus brain MRI in patients with NSCLC. Cancer INTRODUCTIONIn an effort to improve diagnostic accuracy and to compensate for the drawbacks of individual imaging modalities, alternative hardware-based and software-based approaches to postprocessing alignment of each imaging device involve the fusion of different imaging techniques in a single scanner.1,2 This and other similar efforts have been directed at synergistic effect of individual performance of computed tomography (CT), positron emission tomography (PET), and magnetic resonance imaging (MRI) beyond an ordinary additive effect of those individual components.One of the most important indications for whole body (WB) imaging is the detection of metastases. PET-CT is the most popular imaging device for metastasis workup. 3,4 With the development of fast MRI techniques (fast, T2-weighted [T2W] spin-echo and 3-dimensional, gradient-echo sequences) and a rolling table platform, Currently, WB MRI also is being used for metastatic workup.

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Section: Pet-ct and Dedicated Brain Mrimentioning

confidence: 99%

“…In addition, discrete lesions with abnormally high FDG uptake were regarded as metastatic if they were accompanied by corresponding morphologic alteration on MR images. 8 …”

Section: Coregistered Mri-petmentioning

confidence: 99%

Coregistered whole body magnetic resonance imaging‐positron emission tomography (MRI‐PET) versus PET‐computed tomography plus brain MRI in staging resectable lung cancer

Lee

et al. 2013

Cancer

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“…On STIR TSE, metastatic nodes have a high signal, while non-metastatic nodes present with a low signal, which influenced Ohno et al [10] to suggest that MRI should be considered as a substitute for PET-CT for the assessment of mediastinal nodes. Yi et al [12] demonstrated that high signal intensity and eccentric cortical thickening or obliterated fatty hilum on T 2 weighted triple-inversion black-blood TSE on MRI can be reliable indicators of malignancy, even in normalsized nodes.…”

Section: Mri Assessment Of N-classificationmentioning

confidence: 99%

“…Liver metastases will show as enhancing nodules on T 1 weighted images. MRI has better contrast than PET-CT in the liver, which facilitates the identification of liver lesions [12]. Similarly, a bone lesion showing enhancement on T 1 weighted images should be considered as suspicious for malignancy [12].…”

Section: Mri Assessment Of M-classificationmentioning

confidence: 99%

“…for lung cancer patients without neurological symptoms, Yi et al [12] suggested that whole body MRI including the head, without a specific brain protocol, can be helpful in detecting occult brain metastases. Other authors have shown a sensitivity of 88% for MRI for brain metastases and a sensitivity of PET-CT as only 24% [14].…”

Section: Pictorial Review: Mri In Lung Cancermentioning

confidence: 99%

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MRI in lung cancer: a pictorial essay

Hochhegger

Marchiori²,

Sedlaczek³

et al. 2011

BJR

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ABSTRACT. Imaging studies play a critical role in the diagnosis and staging of lung cancer. CT and 18-fluorodeoxyglucose positron emission tomography CT (PET/CT) are widely and routinely used for staging and assessment of treatment response. Many radiologists still use MRI only for the assessment of superior sulcus tumours, and in cases where invasion of the spinal cord canal is suspected. MRI can detect and stage lung cancer, and this method could be an excellent alternative to CT or PET/CT in the investigation of lung malignancies and other diseases. This pictorial essay discusses the use of MRI in the investigation of lung cancer. . The lung remains a challenge for MRI, but this method provides excellent tissue differentiation, and new sequences have increased the temporal resolution [3], expanding the use of MRI beyond its traditional applications. MRI can currently be used for establishing tumour node metastasis (TNM) staging, lung cancer screening and assessing lung nodules for likelihood of being benign or malignant [3]. This pictorial essay discusses the use of MRI in the diagnosis and staging of lung cancer. MRI for detection and characterisation of pulmonary nodulesMultidetector CT (MDCT) is routinely used to confirm and characterise lung lesions [1]. It is a very sensitive method for the detection of pulmonary nodules, and is considered the gold standard for detection of these lesions. The sensitivity of MRI for nodules of 5 to 11 mm is between 85% and 95% [4]. Although MDCT can depict nodules as small as 1 or 2 mm, immediate action is recommended only for lesions larger than 7 or 8 mm, depending on the lung cancer risk stratification. Followup to assess growth pattern is recommended for lesions smaller than 7 mm [5]. Koyama et al [6] reported that non-contrast enhanced pulmonary MRI can effectively detect malignant nodules as thin-section MDCT (Figure 1). The overall detection rate of nodules in each MRI sequence (82.5%) was significantly lower than that of MDCT (97.0%, p,0.05), however detection rates were not significantly different for malignant nodules (p.0.05) (Figure 2). Establishing clinical TNM stageThe overall agreement of clinical TNM (cTNM) staging established by CT compared with post-operative pathological TNM (pTNM) is not significantly better than 50%. Obviously, this comparison does not take into account cases in which the cTNM contraindicates surgery, as it does for the majority of cases. CT and PET-CT are currently the modalities recommended for assessing lung cancer if radical treatment (surgery or other therapeutic modality with curative intent) is suggested [1]. However, the capabilities of MRI have not yet been properly explored. MRI assessment of T-classificationThe T-stage of a tumour is the primary determinant of its resectability [7]. Evaluation of the primary tumour includes an assessment of its size, and the presence and extent of mediastinal or chest wall involvement. Of particular importance is the distinction between T3 and T4 tumours [7]. The definition of a T3 lesion i...

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PET-CT for assessing mediastinal lymph node involvement in patients with suspected resectable non-small cell lung cancer

Schmidt‐Hansen

Baldwin

Hasler

et al. 2014

Cochrane Database of Systematic Reviews

149

136

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Non–Small Cell Lung Cancer Staging: Efficacy Comparison of Integrated PET/CT versus 3.0-T Whole-Body MR Imaging

Abstract: Both PET/CT and 3.0-T whole-body MR imaging appear to provide acceptable accuracy and comparable efficacy for NSCLC staging, but for M-stage determination, each modality has its own advantages.

Cited by 161 publications

References 25 publications

Coregistered whole body magnetic resonance imaging‐positron emission tomography (MRI‐PET) versus PET‐computed tomography plus brain MRI in staging resectable lung cancer

Coregistered whole body magnetic resonance imaging‐positron emission tomography (MRI‐PET) versus PET‐computed tomography plus brain MRI in staging resectable lung cancer

MRI in lung cancer: a pictorial essay

PET-CT for assessing mediastinal lymph node involvement in patients with suspected resectable non-small cell lung cancer

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