Pulmonary Nodules in Patients with Primary Malignancy: Comparison of Hybrid PET/MR and PET/CT Imaging

Chandarana, Hersh; Heacock, Laura; Rakheja, Rajan; DeMello, Linda; Bonavita, Jacopo; Block, Tobias; Geppert, Christian; Babb, James S.; Friedman, Kent

doi:10.1148/radiol.13130620

Cited by 138 publications

(109 citation statements)

References 21 publications

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“…In concordance with prior studies, our study found a strong positive correlation between SUV measurements (15,16,21). Additionally, we confirmed the propensity for slightly higher SUVs on PET/MRI than on PET/CT (15,16,22,23).…”

Section: Discussionsupporting

confidence: 92%

“…The reasons for the inferiority of PET/MRI are found in the methodologic shortcomings of MRI at depicting small lung nodules, which accounted for most lesions in our study. (15,16). The clinical impact of this finding, however, remains controversial as most small pulmonary nodules are known to be noncancerous even in patients with a proven malignancy (20).…”

Section: Discussionmentioning

confidence: 99%

“…Not only is the comparison of morphologic imaging datasets (MRI vs. CT) of great interest but also the comparison of PET from PET/MRI versus PET from PET/CT, considering the differences in PET acquisition and attenuation correction techniques between the two. Existing evidence in this field is based on one study by Chandarana et al and another by Rauscher et al, the former with 32 patients and the latter with 40 (15,16).…”

mentioning

confidence: 99%

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Comparative Performance of ¹⁸F-FDG PET/MRI and ¹⁸F-FDG PET/CT in Detection and Characterization of Pulmonary Lesions in 121 Oncologic Patients

et al. 2016

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Our objective was to compare 18 F-FDG PET/MRI (performed using a contrast-enhanced T1-weighted fat-suppressed volume-interpolated breath-hold examination [VIBE]) with 18 F-FDG PET/CT for detecting and characterizing lung lesions in oncologic patients. Methods: In 121 oncologic patients with 241 lung lesions, PET/MRI was performed after PET/CT in a single-injection protocol (260 ± 58 MBq of 18 F-FDG). The detection rates were computed for MRI, the PET component of PET/CT, and the PET component of PET/MRI in relation to the CT component of PET/CT. Wilcoxon testing was used to assess differences in lesion contrast (4-point scale) and size between morphologic datasets and differences in image quality (4-point scale), SUV mean , SUV max , and characterization (benign/malignant) between PET/MRI and PET/CT. Correlation was determined using the Pearson coefficient (r) for SUV and size and the Spearman rank coefficient (ρ) for contrast. Results: The detection rates for MRI, the PET component of PET/CT, and the PET component of PET/MRI were 66.8%, 42.7%, and 42.3%, respectively. There was a strong correlation in size (r 5 0.98) and SUV (r 5 0.91) and a moderate correlation in contrast (ρ 5 0.48). Image quality was better for PET/CT than for PET/MRI (P , 0.001). Lesion measurements were smaller for MRI than for CT (P , 0.001). SUV max and SUV mean were significantly higher for PET/MRI than for PET/CT (P , 0.001 each). There was no significant difference in lesion contrast (P 5 0.11) or characterization (P 5 0.076). Conclusion: In the detection and characterization of lung lesions 10 mm or larger, 18 F-FDG PET/MRI and 18 F-FDG PET/CT perform comparably. Lesion size, SUV and characterization correlate strongly between the two modalities. However, the overall detection rate of PET/MRI remains inferior to that of PET/CT because of the limited ability of MRI to detect lesions smaller than 10 mm. Thus, thoracic staging with PET/MRI bears a risk of missing small lung metastases. Pul monary lesion detection and characterization play a key role in cancer staging, as the presence of lung metastases influences therapy regimens and patient survival (1-3). CT, offering high spatial resolution of pulmonary tissue, has been regarded as the reference standard for lung lesion detection (4,5). However, because morphologic CT-based criteria have a relatively low specificity for malignant versus benign character, there has been a need for a more robust diagnostic standard. Over the last decade, 18 F-FDG PET/CT has proven successful not only in detecting pulmonary lesions but also in discriminating benign from malignant findings, taking advantage of the accurate anatomic information from CT and the functional characterization from PET in a onestop-shop examination (6-8). Yet, a major drawback of 18 F-FDG PET/CT is the low sensitivity of the PET component in pulmonary lesions smaller than 10 mm, because of motion artifacts, partialvolume effects, and the limited spatial resolution of PET (9). MRI has played only a minor role in radiologic asses...

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Comparative Performance of ¹⁸F-FDG PET/MRI and ¹⁸F-FDG PET/CT in Detection and Characterization of Pulmonary Lesions in 121 Oncologic Patients

et al. 2016

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“…Her ne kadar MR görüntüleme akciğer lezyonlarının değerlendirilmesinde kısıtlı bir yöntem olarak kabul edilse de, standart tüm vücut PET/MR görüntülemenin akciğer nodüllerinin saptanmasında düşük doz BT ile benzer performans gösterdiği bildirilmiştir (Şekil 3) (65). PET/MR görüntülemenin FDG tutulumu gösteren 5 mm'den büyük boyuttaki akciğer nodüllerinde yüksek duyarlılığa sahip olduğu; FDG tutulumu göstermeyen daha küçük nodüllerde ise duyarlılığının düşük olduğu belirtilmiştir (66). Diğer taraftan FDG tutulumu göstermeyen ve MR görüntülemede saptanamayıp sadece BT görüntülerinde izlenen nodüllerin çok büyük bir kısmının (%96.4) takipte kaybolduğu ya da stabil seyrettiği, dolayısıyla benign karakterde olduğu gösterilmiştir (67).…”

Section: Pet Görüntüleme Teknolojisinde Gelişmelerunclassified

Role of Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Imaging in Diagnosis and Staging of Lung Cancer

Akdemir¹,

Aydos²

2018

Nts

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GirişAkciğer kanseri, en sık görülen kanser türlerinden biri olup, tedavi olanaklarındaki iyileşmelere rağmen kansere bağlı ölüm nedenleri arasında birinci sırada yer alır (1). Tüm akciğer kanserlerinin yaklaşık %85'ini küçük hücreli dışı akciğer kanseri (KHDAK), kalan kısmını da küçük hücreli akciğer kanseri (KHAK) oluşturur (2).KHAK hastalarının çoğunda tanı anında uzak metastaz bulunması ve bu hastaların cerrahi tedavi olasılıklarının düşük olması; buna karşılık KHDAK hastalarında cerrahi tedavi olasılığının daha yüksek olması nedeniyle bu sınıflama özellikle tedavi yaklaşımı bakımından önem taşır. Akciğer kanseri tanısı alan hastalarda uygun tedavi seçeneğini belirlemek ve hasta prognozunu Flor-18 ile işaretli florodeoksiglikoz (FDG) ile yapılan pozitron emisyon tomografisi/bilgisayarlı tomografi (PET/ BT) akciğerde kuşkulu parankimal nodülü olan veya akciğer kanseri tanısı alan hastaların klinik yönetiminde kullanılan güçlü bir tanı aracıdır. Bu yazıda FDG PET/BT görüntülemenin kuşkulu akciğer nodüllerinin değerlendirilmesinde ve yeni tanı akciğer kanserinde evrelemesindeki yerinden, sayısal PET değişkenlerinin hasta prognozu ile ilişkisinden, hibrid PET/manyetik rezonans sistemi gibi teknik gelişmelerden ve akciğer kanserinin patofizyolojisi ile ilişkili FDG dışındaki diğer PET radyofarmasötiklerinin kullanımından bahsedilmektedir. Anahtar Kelimeler: Akciğer kanseri, küçük hücreli-dışı akciğer kanseri, küçük hücreli akciğer kanseri, FDG, PET/BT görüntüleme Positron emission tomography/computed tomography (PET/ CT) using fluorine-18 labelled fluorodeoxyglucose (FDG) is a powerful tool for managing patients with suspected lung nodules and lung cancer. In this review, we discuss the utility of FDG PET/CT imaging in evaluation of suspected pulmonary nodules and initial staging of patients with newly diagnosed lung cancer, prognostic value of quantitative PET parameters, technical developments in PET imaging such as hybrid PET/ magnetic resonance systems, and the use of other PET radiopharmaceuticals related to lung cancer pathophysiology.

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“…None deals with thyroid cancer directly, allowing us to consider the new publication under discussion by Vrachimis et al the first to study this neoplastic entity specifically. However, the utility of PET/MRI and PET/CT to detect and characterize small pulmonary nodules more generally has been previously investigated in three papers, with the data tipping the scales in favour of PET/CT [8][9][10]. The remaining 13 publications report some evidence that PET/ MRI is superior to PET/CT for characterizing primary tumours, e.g.…”

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confidence: 99%

PET/MRI and PET/CT: is there room for both at the top of the food chain?

Kuwert

Ritt

2015

Eur J Nucl Med Mol Imaging

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In this issue of the journal, Vrachimis and colleagues demonstrate that positron emission tomography combined with Xray computed tomography (PET/CT) outperforms PET combined with magnetic resonance imaging (PET/MRI) in restaging radioiodine-negative patients with biochemical relapse of differentiated thyroid carcinoma [1]. This comes as a surprise, at least to the uninitiated: In a world predominantly driven by material considerations, common sense would presume that diagnostic accuracy correlates with costs, and PET/ MRI indeed Boutperforms^PET considerably with regard to its demands on resources spent on acquisition and operation.A closer look at the data proffered by Vrachimis et al. reveals that the poorer performance of PET/MRI compared to PET/CT for this indication resides in its shortcomings in the ability to diagnose pulmonary metastases, a frequent occurrence in progressive thyroid carcinoma. MRI aficionados will argue that this problem may be overcome by using MRI sequences dedicated to lung imaging. This contingent may ultimately be correct, but such arguments are purely speculative at the moment, as empirical proof for the case of PET/MRI is lacking.A comprehensive review on the evidence reporting the use of PET/MRI in a clinical setting is beyond the scope of this editorial. However, a short appraisal of the hitherto published literature comparing the utility of PET/MRI and PET/CT can be attempted: At the time of this writing, 166 papers featuring the keyword combination BPET/MR PET/CT^currently reside in the Web of Science (ISI) Internet library. Of these, roughly 22 are original articles comparing the diagnostic performance of these two hybrid imaging modalities in oncology. Six report data from mixed groups of patients [2][3][4][5][6][7], with five finding an equivalence of diagnostic performance of the two hybrid imaging technologies and one a slight superiority of PET/MRI over PET/CT with regard to influence on further clinical management. None deals with thyroid cancer directly, allowing us to consider the new publication under discussion by Vrachimis et al. the first to study this neoplastic entity specifically. However, the utility of PET/MRI and PET/CT to detect and characterize small pulmonary nodules more generally has been previously investigated in three papers, with the data tipping the scales in favour of PET/CT [8][9][10]. The remaining 13 publications report some evidence that PET/ MRI is superior to PET/CT for characterizing primary tumours, e.g. primary bone tumours [11][12][13] or oesophageal carcinoma [14], but do not demonstrate significant advantages of whole-body MRI over whole-body PET/CT for N or M staging [15][16][17][18][19][20][21][22][23][24].The introduction of PET/MRI was heralded as a technological breakthrough, and many expected a subsequent clinical revolution, with the newer modality vying to supersede PET/CT atop the diagnostic food chain just as the Burmese python is supplanting the American alligator in the Florida Everglades. However, none of the above-mention...

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Pulmonary Nodules in Patients with Primary Malignancy: Comparison of Hybrid PET/MR and PET/CT Imaging

Abstract: Radial VIBE and PET data acquired simultaneously with PET/MR imaging have high sensitivity in the detection of FDG-avid nodules and nodules 0.5 cm in diameter or larger, with low sensitivity for small non-FDG-avid nodules.

Cited by 138 publications

References 21 publications

Comparative Performance of ¹⁸F-FDG PET/MRI and ¹⁸F-FDG PET/CT in Detection and Characterization of Pulmonary Lesions in 121 Oncologic Patients

Comparative Performance of ¹⁸F-FDG PET/MRI and ¹⁸F-FDG PET/CT in Detection and Characterization of Pulmonary Lesions in 121 Oncologic Patients

Role of Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Imaging in Diagnosis and Staging of Lung Cancer

PET/MRI and PET/CT: is there room for both at the top of the food chain?

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Pulmonary Nodules in Patients with Primary Malignancy: Comparison of Hybrid PET/MR and PET/CT Imaging

Abstract: Radial VIBE and PET data acquired simultaneously with PET/MR imaging have high sensitivity in the detection of FDG-avid nodules and nodules 0.5 cm in diameter or larger, with low sensitivity for small non-FDG-avid nodules.

Cited by 138 publications

References 21 publications

Comparative Performance of 18F-FDG PET/MRI and 18F-FDG PET/CT in Detection and Characterization of Pulmonary Lesions in 121 Oncologic Patients

Comparative Performance of 18F-FDG PET/MRI and 18F-FDG PET/CT in Detection and Characterization of Pulmonary Lesions in 121 Oncologic Patients

Role of Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Imaging in Diagnosis and Staging of Lung Cancer

PET/MRI and PET/CT: is there room for both at the top of the food chain?

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Comparative Performance of ¹⁸F-FDG PET/MRI and ¹⁸F-FDG PET/CT in Detection and Characterization of Pulmonary Lesions in 121 Oncologic Patients

Comparative Performance of ¹⁸F-FDG PET/MRI and ¹⁸F-FDG PET/CT in Detection and Characterization of Pulmonary Lesions in 121 Oncologic Patients