Prospective comparison of 18F-FDG PET/MRI and 18F-FDG PET/CT for thoracic staging of non-small cell lung cancer
To compare the diagnostic performance of 18F-FDG PET/MRI and 18F-FDG PET/CT for primary and locoregional lymph node staging in non-small cell lung cancer (NSCLC).
In this prospective study, a total of 84 patients (51 men, 33 women, mean age 62.5 ± 9.1 years) with histopathologically confirmed NSCLC underwent 18F-FDG PET/CT followed by 18F-FDG PET/MRI in a single injection protocol. Two readers independently assessed T and N staging in separate sessions according to the seventh edition of the American Joint Committee on Cancer staging manual for 18F-FDG PET/CT and 18F-FDG PET/MRI, respectively. Histopathology as a reference standard was available for N staging in all 84 patients and for T staging in 39 patients. Differences in staging accuracy were assessed by McNemars chi2 test. The maximum standardized uptake value (SUVmax) and longitudinal diameters of primary tumors were correlated using Pearson’s coefficients.
T stage was categorized concordantly in 18F-FDG PET/MRI and 18F-FDG PET/CT in 38 of 39 (97.4%) patients. Herein, 18F-FDG PET/CT and 18F-FDG PET/MRI correctly determined the T stage in 92.3 and 89.7% of patients, respectively. N stage was categorized concordantly in 83 of 84 patients (98.8%). 18F-FDG PET/CT correctly determined the N stage in 78 of 84 patients (92.9%), while 18F-FDG PET/MRI correctly determined the N stage in 77 of 84 patients (91.7%). Differences between 18F-FDG PET/CT and 18F-FDG PET/MRI in T and N staging accuracy were not statistically significant (p > 0.5, each). Tumor size and SUVmax measurements derived from both imaging modalities exhibited excellent correlation (r = 0.963 and r = 0.901, respectively).
18F-FDG PET/MRI and 18F-FDG PET/CT show an equivalently high diagnostic performance for T and N staging in patients suffering from NSCLC.
KeywordsPET/MRI PET/CT NSCLC Thoracic staging
Compliance with ethical standards
Conflict of interest
All procedures performed were in accordance with the ethical standards of the institutional research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments.
Informed consent was obtained from all individual participants included in the study.
- 1.Govindan R, Page N, Morgensztern D, Read W, Tierney R, Vlahiotis A, et al. Changing epidemiology of small-cell lung cancer in the United States over the last 30 years: analysis of the surveillance, epidemiologic, and end results database. J Clin Oncol. 2006;24:4539–44. https://doi.org/10.1200/JCO.2005.04.4859.CrossRefPubMedGoogle Scholar
- 3.Postmus PE, Kerr KM, Oudkerk M, Senan S, Waller DA, Vansteenkiste J, et al. Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2017;28:iv1–iv21. https://doi.org/10.1093/annonc/mdx222.CrossRefPubMedGoogle Scholar
- 9.Sommer G, Wiese M, Winter L, Lenz C, Klarhofer M, Forrer F, et al. Preoperative staging of non-small-cell lung cancer: comparison of whole-body diffusion-weighted magnetic resonance imaging and 18F-fluorodeoxyglucose-positron emission tomography/computed tomography. Eur Radiol. 2012;22:2859–67. https://doi.org/10.1007/s00330-012-2542-y.CrossRefPubMedGoogle Scholar
- 13.Tournoy KG, Maddens S, Gosselin R, Van Maele G, van Meerbeeck JP, Kelles A. Integrated FDG-PET/CT does not make invasive staging of the intrathoracic lymph nodes in non-small cell lung cancer redundant: a prospective study. Thorax. 2007;62:696–701. https://doi.org/10.1136/thx.2006.072959.CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Vial MR, O'Connell OJ, Grosu HB, Hernandez M, Noor L, Casal RF, et al. Diagnostic performance of endobronchial ultrasound-guided mediastinal lymph node sampling in early stage non-small cell lung cancer: a prospective study. Respirology. 2017. https://doi.org/10.1111/resp.13162.
- 15.Nomori H, Watanabe K, Ohtsuka T, Naruke T, Suemasu K, Uno K. Evaluation of F-18 fluorodeoxyglucose (FDG) PET scanning for pulmonary nodules less than 3 cm in diameter, with special reference to the CT images. Lung Cancer. 2004;45:19–27. https://doi.org/10.1016/j.lungcan.2004.01.009.CrossRefPubMedGoogle Scholar
- 25.Ziyade S, Pinarbasili NB, Ziyade N, Akdemir OC, Sahin F, Soysal O, et al. Determination of standard number, size and weight of mediastinal lymph nodes in postmortem examinations: reflection on lung cancer surgery. J Cardiothorac Surg. 2013;8:94. https://doi.org/10.1186/1749-8090-8-94.CrossRefPubMedPubMedCentralGoogle Scholar
- 30.Sawicki LM, Grueneisen J, Buchbender C, Schaarschmidt BM, Gomez B, Ruhlmann V, et al. Evaluation of the outcome of lung nodules missed on 18F-FDG PET/MRI compared with 18F-FDG PET/CT in patients with known malignancies. J Nucl Med. 2016;57:15–20. https://doi.org/10.2967/jnumed.115.162966.CrossRefPubMedGoogle Scholar
- 31.Sawicki LM, Grueneisen J, Buchbender C, Schaarschmidt BM, Gomez B, Ruhlmann V, et al. Comparative performance of 18F-FDG PET/MRI and 18F-FDG PET/CT regarding detection and characterization of pulmonary lesions in 121 oncologic patients. J Nucl Med. 2016. https://doi.org/10.2967/jnumed.115.167486.
- 33.Sawicki LM, Grueneisen J, Buchbender C, Schaarschmidt BM, Gomez B, Ruhlmann V, et al. Comparative performance of 18F-FDG PET/MRI and 18F-FDG PET/CT in detection and characterization of pulmonary lesions in 121 oncologic patients. J Nucl Med. 2016;57:582–6. https://doi.org/10.2967/jnumed.115.167486.CrossRefPubMedGoogle Scholar
- 35.Plathow C, Aschoff P, Lichy MP, Eschmann S, Hehr T, Brink I, et al. Positron emission tomography/computed tomography and whole-body magnetic resonance imaging in staging of advanced nonsmall cell lung cancer--initial results. Investig Radiol. 2008;43:290–7. https://doi.org/10.1097/RLI.0b013e318163273a.CrossRefGoogle Scholar
- 36.Ohno Y, Koyama H, Yoshikawa T, Nishio M, Aoyama N, Onishi Y, et al. N stage disease in patients with non-small cell lung cancer: efficacy of quantitative and qualitative assessment with STIR turbo spin-echo imaging, diffusion-weighted MR imaging, and fluorodeoxyglucose PET/CT. Radiology. 2011;261:605–15. https://doi.org/10.1148/radiol.11110281.CrossRefPubMedGoogle Scholar
- 38.Schaarschmidt BM, Grueneisen J, Metzenmacher M, Gomez B, Gauler T, Roesel C, et al. Thoracic staging with 18F-FDG PET/MR in non-small cell lung cancer - does it change therapeutic decisions in comparison to 18F-FDG PET/CT? Eur Radiol. 2017;27:681–8. https://doi.org/10.1007/s00330-016-4397-0.CrossRefPubMedGoogle Scholar
- 40.Kershah S, Partovi S, Traughber BJ, Muzic RF Jr, Schluchter MD, O'Donnell JK, et al. Comparison of standardized uptake values in normal structures between PET/CT and PET/MRI in an oncology patient population. Mol Imaging Biol. 2013;15:776–85. https://doi.org/10.1007/s11307-013-0629-8.CrossRefPubMedPubMedCentralGoogle Scholar
- 41.Heusch P, Buchbender C, Beiderwellen K, Nensa F, Hartung-Knemeyer V, Lauenstein TC, et al. Standardized uptake values for [(1)(8)F] FDG in normal organ tissues: comparison of whole-body PET/CT and PET/MRI. Eur J Radiol. 2013;82:870–6. https://doi.org/10.1016/j.ejrad.2013.01.008.CrossRefPubMedGoogle Scholar