Predictive Value of¹⁸F‐FDG PET/MRIfor Pleural Invasion in Solid and Subsolid Lung Adenocarcinomas Smaller Than 3 cm

Abstract

BackgroundPositron emission tomography (PET)/MRI combines the characteristics of metabolism imaging and high soft tissue resolution, and could provide high diagnostic efficacy for assessment of pleural invasion (PI) of lung cancer.PurposeTo investigate the application of 18F‐fluorodeoxyglucose (FDG) PET/MRI for predicting PI of lung cancer with the maximum diameter ≤3 cm.Study TypeProspective.PopulationA total of 44 patients with non‐small cell lung cancer (NSCLC), age from 39 to 79 years old, including 19 (56.82%) females.Field Strength/SequenceA 3‐T, hybrid PET/MRI including axial fast spin echo respiratory‐triggered T2 fat‐suppressed imaging (T2FS) and echo planar imaging diffusion‐weighted imaging (DWI).AssessmentThe maximum standardized uptake value (SUVmax) of all lesions was measured on PET images. Localized effusion outside the contact between the nodules and the pleura on T2FS and signal at the contact between the nodules and the pleura on DWI were evaluated by experienced physicians through visual assessment of the MRI sequences.Statistical TestsThree models (models 1–3) were developed, incorporating CT, CT and PET, PET and MRI features, and Lasso regression was used in feature selection. The receiver operating characteristic (ROC) curve for PI diagnosis was visualized for each model, and the area under the curve (AUC) was calculated. The DeLong test was used to compare the different AUCs. A P value < 0.05 was considered statistically significant.ResultsThe AUC of models 1–3 was 0.762, 0.829, and 0.915, respectively. The DeLong test showed a statistically significant difference between the AUCs of model 1 vs. model 3, while the differences between the AUCs of model 1 vs. model 2 (P = 0.253) and model 2 vs. model 3 (P = 0.075) were not statistically significant.Data conclusion18F‐FDG PET/MRI might show high predictive value for lung adenocarcinoma smaller than 3 cm with PI.Evidence Level1Technical EfficacyStage 2

Current status and prospect of PET-related imaging radiomics in lung cancer

“…Zhang et al. ( 38 ) confirmed the effectiveness of 18 F-FDG PET/MRI radiomics in forecasting pleural invasion in lung adenocarcinomas smaller than 3 cm. These studies showed that PET-related radiomics was highly effective in predicting lung cancer stage and metastasis of whole body.…”

Pleural Carcinoembryonic Antigen and Maximum Standardized Uptake Value as Predictive Indicators of Visceral Pleural Invasion in Clinical T1N0M0 Lung Adenocarcinoma

“…Elevated uptake of 18F-FDG is correlated with increased tumor invasiveness, which is also linked to VPI [ 14 , 16 ]. Zhang et al [ 17 ] observed that PET-CT, which provides both structural and functional information, is relatively intuitive and easy to interpret, making it a more suitable approach than CT imaging. Our study also revealed a significant correlation between SUVmax and VPI through multivariate analysis.…”

Editorial for “Predictive Value of 18F‐FDG PET/MRI for Pleural Invasion in Solid and Subsolid Lung Adenocarcinomas Smaller Than 3 cm”

“…Improved anatomic registration with PET secondary to simultaneous image acquisition is now a reality with the advent of simultaneous PET‐MR imaging scanners. In this article by Zhang et al, 2 the authors investigated 18 F‐FDG PET/MRI for predicting PI of lung adenocarcinoma ≤3 cm.…”

“…Following its introduction in 2011, 4 the clinical utility of hybrid PET/MRI still holds a potential area of research in which organs and/or diseases it is preferable over PET/CT. This article 2 elucidates the role of PET/MRI in pleural invasion of lung adenocarcinomas.…”