Annals of Nuclear Medicine

, Volume 22, Issue 7, pp 595–602 | Cite as

Accuracy of whole-body FDG-PET/CT for detecting brain metastases from non-central nervous system tumors

  • Kazuhiro Kitajima
  • Yuji Nakamoto
  • Hiromi Okizuka
  • Yumiko Onishi
  • Michio Senda
  • Narufumi Suganuma
  • Kazuro Sugimura
Original Article



Positron emission tomography (PET) using 18F-fluoro-2-deoxy-d-glucose (FDG) has a limitation in detecting cerebral metastases; however, the feasibility of detection by inline PET/computed tomography (CT) system remains unknown. We evaluated the accuracy of FDG-PET/CT of body imaging protocol for the detection of cerebral metastases when compared with PET alone and CT alone.


Fifty patients underwent whole-body FDG-PET/CT scanning including the brain and contrastenhanced brain MR (magnetic resonance) scan. PET-only, CT-only, and the fused images were interpreted, and the confidence of presence of cerebral metastases was recorded using a five-point grading scale. Area under the receiver-operating characteristic (ROC) curve (Az) was calculated. Differences among the three modalities were tested with the Cochran-Q test, followed by multiple comparisons using the McNemar test with Bonferroni adjustment.


Magnetic resonance imaging revealed 70 cerebral metastatic lesions in 20 patients. Patient-based analysis showed that the sensitivity, specificity, accuracy, and Az of PET-alone interpretation were 45%, 80%, 66%, and 0.6025, respectively, those of CT-alone interpretation were 50%, 97%, 78%, and 0.7158, respectively, and those of fused-image interpretation were 50%, 93%, 76%, and 0.7242, respectively. ROC analysis revealed significant differences among the three interpretation methods (P = 0.0238) and between PET and PET/CT (P = 0.0129). The sensitivity of PET, CT, and fused-image interpretation for detecting 70 lesions was 13%, 20%, and 20%, respectively.


Even with an integrated PET/CT scanner of body imaging protocol, the sensitivity of cerebral metastases remained unsatisfactory. To assess intracranial lesions, MR scanning should still be considered.


Brain Metastasis FDG PET CT 


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  1. 1.
    Kim YS, Kondzielka D, Flicklligar JC, Lunsford LD. Stereotactic radiosurgery for patients with non-small cell lung cancer metastatic to the brain. Cancer 1997;80:2075–2083.PubMedCrossRefGoogle Scholar
  2. 2.
    Young RF. Radiosurgery for the treatment of brain metastases. Semi Surg Oncol 1998;14:70–78.CrossRefGoogle Scholar
  3. 3.
    Soffietti R, Cornu P, Delattre JY, Grant R, Graus F, Grisold W, et al. EFNS guidelines on diagnosis and treatment of brain metastases: report of an EFNS Task Force. Eur J Neurol 2006;13:674–681.PubMedCrossRefGoogle Scholar
  4. 4.
    Griffeth LK, Rich KM, Dehdashti F, Simpson JR, Fusselman MJ, McGuire AH, et al. Brain metastases from non-central nervous system tumors: evaluation with PET. Radiology 1993;186:37–44.PubMedGoogle Scholar
  5. 5.
    Larcos G, Maisey MN. FDG-PET screening for cerebral metastases in patients with suspected malignancy. Nucl Med Commun 1996;17:197–198.PubMedCrossRefGoogle Scholar
  6. 6.
    Marom EM, McAdams HP, Erasmus JJ, Goodman PC, Culhane DK, Coleman RE, et al. Staging non-small cell lung cancer with whole-body PET. Radiology 1999;212:803–809.PubMedGoogle Scholar
  7. 7.
    Rohren EM, Provenzale JM, Barboriak DP, Coleman RE. Screening for cerebral metastases with FDG PET in patients undergoing whole-body staging of non-central nervous system malignancy. Radiology 2003;226:181–187.PubMedCrossRefGoogle Scholar
  8. 8.
    Cleves M. Receiver operating characteristic (ROC) analysis. Stata Tech Bull 1999;52:19–33 [reprinted in Stata Tech Bull Reprints, vol. 9, p. 212–29].Google Scholar
  9. 9.
    Delong ER, Delong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating curves: a nonparametric approach. Biometrics 1988;44:837–845.PubMedCrossRefGoogle Scholar
  10. 10.
    Dwyer AJ. Matchmaking and McNemar in the comparison of diagnostic modalities. Radiology 1991;178:328–330.PubMedGoogle Scholar
  11. 11.
    Sze G, Milano E, Johnson C, Heier L. Detection of brain metastases: comparison of contrast-enhanced MR with unenhanced MR and enhanced CT. Am J Neuroradiol 1990;11:785–791.PubMedGoogle Scholar
  12. 12.
    Butler AR, Kricheff II. Non-contrast CT scanning: limited value in suspected brain tumor. Radiology 1978;126:689–693.PubMedGoogle Scholar
  13. 13.
    Davis JM, Davis KR, Newhouse J, Pfister RC. Expanded high iodine dose in computed cranial tomography: a preliminary report. Radiology 1979;131:373–380.PubMedGoogle Scholar
  14. 14.
    Schoder H, Yeung HWD, Gonen M, Kraus D, Larson SM. Head and neck cancer: clinical usefulness and accuracy of PET/CT image fusion. Radiology 2004;231:65–72.PubMedCrossRefGoogle Scholar

Copyright information

© The Japanese Society of Nuclear Medicine 2008

Authors and Affiliations

  • Kazuhiro Kitajima
    • 1
    • 2
    • 3
  • Yuji Nakamoto
    • 5
  • Hiromi Okizuka
    • 3
  • Yumiko Onishi
    • 3
  • Michio Senda
    • 4
  • Narufumi Suganuma
    • 6
  • Kazuro Sugimura
    • 2
  1. 1.Department of RadiologyDokkyo University School of MedicineTochigiJapan
  2. 2.Department of RadiologyKobe University Graduate School of MedicineKobeJapan
  3. 3.Clinical PET CenterInstitute of Biomedical Research and InnovationKobeJapan
  4. 4.Division of Molecular ImagingInstitute of Biomedical Research and InnovationKobeJapan
  5. 5.Department of RadiologyKyoto University Graduate school of MedicineKyotoJapan
  6. 6.Department of Environmental MedicineKochi University Medical SchoolKochiJapan

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