Thoracic Staging in Lung Cancer: Prospective Comparison of <sup>18</sup>F-FDG PET/MR Imaging and <sup>18</sup>F-FDG PET/CT

Heusch, Philipp; Buchbender, Christian; Köhler, Jens; Nensa, Felix; Gauler, Thomas; Gomez, Benedikt; Reis, Henning; Stamatis, Georgios; Kühl, Hilmar; Hartung, Verena; Heusner, Till A.

doi:10.2967/jnumed.113.129825

Cited by 111 publications

(85 citation statements)

References 28 publications

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“…Fraioli et al demonstrated that PET/MR is accurate in the assessment of NSCLC resectability, detecting the correct T stage and N stage in 74% of patients (6). Another study by Heusch et al showed that PET/MR and PET/ CT was 100% accurate in the T staging in a small cohort of 16 NSCLC patients, clearly exceeding previous results of larger studies with PET/CT (9). An assessment of the M stage was not part of this study.…”

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confidence: 56%

TNM Staging of Non–Small Cell Lung Cancer: Comparison of PET/MR and PET/CT

et al. 2015

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The purpose of this study was to compare the diagnostic accuracy of whole-body unenhanced PET/MR with that of PET/CT in determining the stage of non-small cell lung cancer. Methods: This study was approved by the institutional review board and by national government authorities. Forty-two consecutive patients referred for the initial staging of non-small cell lung cancer underwent whole-body imaging with a sequential trimodality PET/CT/MR system. PET/MR and PET/CT datasets were evaluated separately, and a TNM stage was assigned on the basis of the image analysis. Nodal stations in the chest were identified according to the mapping system of the American Thoracic Society. The standard of reference was histopathology for the tumor stage in 20 subjects, for the nodal stage in 22 patients, and for extrathoracic metastases in 5 subjects. All other lesions were confirmed by at least 1 different imaging method. A Wilcoxon signed-ranks test was used for comparing PET/MR with PET/CT. Results: PET/MR did not provide additional information compared with PET/CT. The diagnostic accuracy of both imaging modalities was equal (T staging, P 5 0.177; N staging, P 5 0.114; M staging, P 5 0.465), however, with advantages for PET/CT by trend. In the subgroup with histopathologic confirmation of T and N stages, the situation was similar (T staging, P 5 0.705; N staging, P 5 0.334). Conclusion: This study indicates that PET/MR using a fast MR protocol does not improve the diagnostic accuracy of the staging of non-small cell lung cancer.

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confidence: 56%

TNM Staging of Non–Small Cell Lung Cancer: Comparison of PET/MR and PET/CT

et al. 2015

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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%

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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“…FDG PET/CT showed high diagnostic accuracy in NSCLC although limited specificity in false-positive lymph node. PET/MRI showed high diagnostic accuracy for lymph node metastasis of NSCLC when comparing with PET/CT (concordance rate of 91 %) [58]. Another study reported that diagnostic [59].…”

Section: Lung Cancermentioning

confidence: 96%

FDG Whole-Body PET/MRI in Oncology: a Systematic Review

Kwon

Becker

Goo

et al. 2016

Nucl Med Mol Imaging

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The recent advance in hybrid imaging techniques enables offering simultaneous positron emission tomography (PET)/magnetic resonance imaging (MRI) in various clinical fields. 18F-fluorodeoxyglucose (FDG) PET has been widely used for diagnosis and evaluation of oncologic patients. The growing evidence from research and clinical experiences demonstrated that PET/MRI with FDG can provide comparable or superior diagnostic performance more than conventional radiological imaging such as computed tomography (CT), MRI or PET/CT in various cancers. Combined analysis using structural information and functional/molecular information of tumors can draw additional diagnostic information based on PET/MRI. Further studies including determination of the diagnostic efficacy, optimizing the examination protocol, and analysis of the hybrid imaging results is necessary for extending the FDG PET/MRI application in clinical oncology.

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Thoracic Staging in Lung Cancer: Prospective Comparison of ¹⁸F-FDG PET/MR Imaging and ¹⁸F-FDG PET/CT

Cited by 111 publications

References 28 publications

TNM Staging of Non–Small Cell Lung Cancer: Comparison of PET/MR and PET/CT

TNM Staging of Non–Small Cell Lung Cancer: Comparison of PET/MR and PET/CT

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

FDG Whole-Body PET/MRI in Oncology: a Systematic Review

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Thoracic Staging in Lung Cancer: Prospective Comparison of 18F-FDG PET/MR Imaging and 18F-FDG PET/CT

Cited by 111 publications

References 28 publications

TNM Staging of Non–Small Cell Lung Cancer: Comparison of PET/MR and PET/CT

TNM Staging of Non–Small Cell Lung Cancer: Comparison of PET/MR and PET/CT

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

FDG Whole-Body PET/MRI in Oncology: a Systematic Review

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Thoracic Staging in Lung Cancer: Prospective Comparison of ¹⁸F-FDG PET/MR Imaging and ¹⁸F-FDG PET/CT

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