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European Radiology

, Volume 17, Issue 1, pp 23–32 | Cite as

Additional value of PET-CT in the staging of lung cancer: comparison with CT alone, PET alone and visual correlation of PET and CT

  • W. De WeverEmail author
  • S. Ceyssens
  • L. Mortelmans
  • S. Stroobants
  • G. Marchal
  • J. Bogaert
  • J. A. Verschakelen
Chest

Abstract

Integrated positron emission tomography (PET) and computed tomography (CT) is a new imaging modality offering anatomic and metabolic information. The purpose was to evaluate retrospectively the accuracy of integrated PET-CT in the staging of a suggestive lung lesion, comparing this with the accuracy of CT alone, PET alone and visually correlated PET-CT. Fifty patients undergoing integrated PET-CT for staging of a suggestive lung lesion were studied. Their tumor, node, metastasis (TNM) statuses were determined with CT, PET, visually correlated PET-CT and integrated PET-CT. These TNM stages were compared with the surgical TNM status. Integrated PET-CT was the most accurate imaging technique in the assessment of the TNM status. Integrated PET-CT predicted correctly the T status, N status, M status and TNM status in, respectively, 86%, 80%, 98%, 70% versus 68%, 66%,88%, 46% with CT, 46%, 70%, 96%, 30% with PET and 72%, 68%, 96%, 54% with visually correlated PET-CT. T status and N status were overstaged, respectively, in 8% and 16% with integrated PET-CT, in 20% and 28% with CT, in 16% and 20% with PET, in 12% and 20% with visually correlated PET-CT and understaged in 6% and 4% with integrated PET-CT, versus 12% and 6% with CT, 38% and 10% with PET and 12% with visually correlated PET-CT. Integrated PET-CT improves the staging of lung cancer through a better anatomic localization and characterization of lesions and is superior to CT alone and PET alone. If this technique is not available, visual correlation of PET and CT can be a valuable alternative.

Keywords

Integrated PET-CT Visually correlated PET-CT Lung cancer Staging 

References

  1. 1.
    Ettinger DS (2004) Overview and state of the art in the management of lung cancer. Oncology(Williston Park) 18(Suppl 4):3–9Google Scholar
  2. 2.
    AJCC Cancer Staging Manual, 6th edn (2002) Greene FL, Page DL, Fleming ID, Fritz A, Balch CM, Haller DG, Morrow M (eds). Springer, Heidelberg New York, pp 165–177Google Scholar
  3. 3.
    Hany TF, Steinert HC, Goerres GW, Buck A, von Schulthess GK (2002) PET diagnostic accuracy: improvement with in-line PET-CT system: initial results. Radiology 225:575–581PubMedCrossRefGoogle Scholar
  4. 4.
    Scott WJ, Gobar LS, Terry JD, Dewan NA, Sunderland JJ (1996) Mediastinal lymph node staging of non-small-cell lung cancer: a prospective comparison of computed tomography and positron emission tomography. J Thorac Cardiovasc Surg 111:642–648PubMedCrossRefGoogle Scholar
  5. 5.
    Weder W, Schmid RA, Bruchhaus H, Hillinger S, von Schulthess GK, Steinert HC (1998) Detection of extrathoracic metastases by positron emission tomography in lung cancer. Ann Thorac Surg 66:886–893PubMedCrossRefGoogle Scholar
  6. 6.
    Wahl RL, Quint LE, Greenough RL, Meyer CR, White RI, Orringer MB (1994) Staging of mediastinal non-small cell lung cancer with FDG PET, CT, and fusion images: preliminary prospective evaluation. Radiology 191:371–377PubMedGoogle Scholar
  7. 7.
    Abouzied MM, Crawford ES, Nabi HA (2005) 18F-FDG imaging: pitfalls and artifacts. J Nucl Med Technol 33:145–155; quiz 162–163PubMedGoogle Scholar
  8. 8.
    Steinert HC (2005) PET in lung cancer. Chang Gung Med J 28:296–305, MayPubMedGoogle Scholar
  9. 9.
    Verschakelen JA, De Wever W, Bogaert J, Stroobants S (2004) Imaging: staging of lung cancer. Eur Respir Mon 30:214–240CrossRefGoogle Scholar
  10. 10.
    Vansteenkiste JF, Stroobants SG, Dupont PJ, De Leyn PR, De Wever WF, Verbeken EK, Nuyts JL, Maes FP, Bogaert JG (1998) FDG-PET scan in potentially operable non-small cell lung cancer: do anatometabolic PET-CT fusion images improve the localisation of regional lymph node metastases? The Leuven Lung Cancer Group. Eur J Nucl Med 25:1495–1501PubMedCrossRefGoogle Scholar
  11. 11.
    Townsend DW, Beyer T, Blodgett TM (2003) PET/CT scanners: a hardware approach to image fusion. Semin Nucl Med 33:193–204PubMedCrossRefGoogle Scholar
  12. 12.
    Antoch G, Stattaus J, Nemat AT, Marnitz S, Beyer T, Kuehl H, Bockisch A, Debatin JF, Freudenberg LS (2003) Non-small cell lung cancer: dual-modality PET/CT in preoperative staging. Radiology 229:526–533PubMedCrossRefGoogle Scholar
  13. 13.
    Aquino SL, Asmuth JC, Alpert NM, Halpern EF, Fischman AJ (2003) Improved radiologic staging of lung cancer with 2-[18F]-fluoro-2-deoxy-D-glucose-positron emission tomography and computed tomography registration. J Comput Assist Tomogr 27:479–484PubMedCrossRefGoogle Scholar
  14. 14.
    Cerfolio RJ, Ojha B, Bryant AS, Raghuveer V, Mountz JM, Bartolucci AA (2004) The accuracy of integrated PET-CT compared with dedicated PET alone for the staging of patients with nonsmall cell lung cancer. Ann Thorac Surg 78:1017–1023PubMedCrossRefGoogle Scholar
  15. 15.
    Goerres GW, Burger C, Kamel E, Seifert B, Kaim AH, Buck A, Buehler TC, von Schulthess GK (2003) Respiration-induced attenuation artifact at PET/CT: technical considerations. Radiology 226:906–910PubMedCrossRefGoogle Scholar
  16. 16.
    Goerres GW, Kamel E, Heidelberg TN, Schwitter MR, Burger C, von Schulthess GK. (2002) PET-CT image co-registration in the thorax: influence of respiration. Eur J Nucl Med Mol Imaging 29:351–360PubMedCrossRefGoogle Scholar
  17. 17.
    Mountain CF (1997) Revisions in the international system for staging lung cancer. Chest 111:1710–1717PubMedGoogle Scholar
  18. 18.
    Verschakelen JA, De Wever W, Bogaert J (2004) Role of computed tomography in lung cancer staging. Curr Opin Pulm Med 10:248–255PubMedCrossRefGoogle Scholar
  19. 19.
    Shim SS, Lee KS, Kim BT, Chung MJ, Lee EJ, Han J, Choi JY, Kwon OJ, Shim YM, Kim S (2005) Non-small cell lung cancer: prospective comparison of integrated FDG PET-CT and CT alone for preoperative staging. Radiology 236:1011–1019PubMedCrossRefGoogle Scholar
  20. 20.
    Lardinois D, Weder W, Hany TF, Kamel EM, Korom S, Seifert B, von Schultness GK, Steinert HC (2003) Staging of non-small-cell lung cancer with integrated positron-emission tomography and computed tomography. N Engl J Med 348:2500–2507PubMedCrossRefGoogle Scholar
  21. 21.
    Bar-Shalom R, Yefremov N, Guralnik L, Gaitini D, Frenkel A, Kuten A, Altman H, Keidar Z, Israel O (2003) Clinical performance of PET/CT in evaluation of cancer: additional value for diagnostic imaging and patient management. J Nucl Med 44:1200–1209PubMedGoogle Scholar
  22. 22.
    Scott WJ, Gobar LS, Terry JD, Dewan NA, Sunderland JJ (1996) Mediastinal lymph node staging of non-small-cell lung cancer: a prospective comparison of computed tomography and positron emission tomography. J Thorac Cardiovasc Surg 111:642–648PubMedCrossRefGoogle Scholar
  23. 23.
    Magnani P, Carretta A, Rizzo G, Fazio F, Vanzulli A, Lucignani G, Zannini P, Messa C, Landoni C, Gilardi MC, Del Maschio A (1999) FDG/PET and spiral CT image fusion for medistinal lymph node assessment of non-small cell lung cancer patients. J Cardiovasc Surg (Torino) 40:741–748Google Scholar
  24. 24.
    Keidar Z, Haim N, Guralnik L, Wollner M, Bar-Shalom R, Ben-Nun A, Israel O (2004) PET/CT using F-FDG in suspected lung cancer recurrence: diagnostic value and impact on patient management. J Nucl Med 45:1640–1646PubMedGoogle Scholar
  25. 25.
    Kamel E, Hany TF, Burger C et al (2002) CT vs 68Ge attenuation correction in a combined PET/CT system: evaluation of the effect of lowering the CT tube current. Eur J Nucl Med Mol Imaging 29:346–350PubMedCrossRefGoogle Scholar
  26. 26.
    Juergens KU, Weckesse M, Stegger L, Franzius C, Beetz M, Schober O, Heindel W, Wormanns D (2006) Tumor staging using whole-body high resolution 16-channel PET-CT: does additional low-dos chest CT in inspiration improve the detection of solitary pulmonary nodules? Eur Radiol 16:1131–1137PubMedCrossRefGoogle Scholar
  27. 27.
    Antoch G, Freudenberg LS, Beyer T, Bockisch A, Debatin JF (2004) To enhance or not to enhance? 18F-FDG and CT contrast agents in dual-modality 18F-FDG PET/CT. J Nucl Med 45(Suppl 1):56S–65SPubMedGoogle Scholar
  28. 28.
    Yau YY, Chan WS, Tam YM, Vernon P, Wong S, Coel M, Chu SK (2005) Application of intravenous contrast in PET/CT: does it really introduce significant attenuation correction error? J Nucl Med 46:283–291PubMedGoogle Scholar
  29. 29.
    Dizendorf E, Hany TF, Buck A, Von Schulthess GK, Burger C (2003) Cause and magnitude of the error induced by oral CT contrast agent in CT-based attenuation correction of PET emission studies. J Nucl Med 44:732–738PubMedGoogle Scholar
  30. 30.
    Schrevens L, Lorent N, Dooms C, Vansteenkiste J (2004) The role of PET scan in diagnosis, staging, and management of non-small cell lung cancer. Oncologist 9:633–643PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • W. De Wever
    • 1
    Email author
  • S. Ceyssens
    • 2
  • L. Mortelmans
    • 2
  • S. Stroobants
    • 2
  • G. Marchal
    • 1
  • J. Bogaert
    • 1
  • J. A. Verschakelen
    • 1
  1. 1.Department of RadiologyUniversity Hospitals GasthuisbergLeuvenBelgium
  2. 2.Department of Nuclear MedicineUniversity Hospitals GasthuisbergLeuvenBelgium

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