Advertisement

European Radiology

, Volume 22, Issue 7, pp 1537–1546 | Cite as

A proposal for combined MRI and PET/CT interpretation criteria for preoperative nodal staging in non-small-cell lung cancer

  • Yoo Na Kim
  • Chin A YiEmail author
  • Kyung Soo Lee
  • O Jung Kwon
  • Ho Yun Lee
  • Byung-Tae Kim
  • Joon Young Choi
  • Seon Woo Kim
  • Man Pyo Chung
  • Joungho Han
  • Tae Sung Kim
  • Myung Jin Chung
  • Young Mog Shim
Chest

Abstract

Objectives

To determine the positive reading criteria for malignant nodes when interpreting combined MRI and PET/CT images for preoperative nodal staging in non-small-cell lung cancer (NSCLC).

Methods

Forty-nine patients with biopsy-proven NSCLC underwent both PET/CT and thoracic MRI [diffusion weighted imaging (DWI)]. Each nodal station was evaluated for the presence of metastasis by applying either inclusive (positive if either one read positive) or exclusive (positive if both read positive) criteria in the combined interpretation of PET/CT and MRI. Nodal stage was confirmed pathologically. The combined diagnostic accuracy of PET/CT and MRI was determined on per-nodal station and per-patient bases and compared with that of PET/CT alone.

Results

In 49 patients, 39 (19%) of 206 nodal stations harboured malignant cells. Out of 206 nodal stations, 186 (90%) had concordant readings, while the rest (10%) had discordant readings. Inclusive criteria of combined PET/CT and MRI helped increase sensitivity for detecting nodal metastasis (69%) compared with PET/CT alone (46%; P = 0.003), while specificity was not significantly decreased.

Conclusion

Inclusive criteria in combined MRI and PET/CT readings help improve significantly the sensitivity for detecting nodal metastasis compared with PET/CT alone and may decrease unnecessary open thoracotomy.

Key Points

Combined interpretation of MRI and PET/CT enhances the detection of nodal metastasis.

Inclusive criteria of combined MRI/PET/CT improved the sensitivity for detecting nodal metastasis.

Combined interpretation of MRI and PET/CT may reduce unnecessary open thoracotomies.

Keywords

Magnetic resonance imaging (MRI) Diffusion weighted MR imaging (DWI) PET/CT Lung cancer Non-small-cell lung cancer (NSCLC) 

Notes

Acknowledgements

This study was supported in part by the Clinical Research Development Program (CRL-110-01-1).

References

  1. 1.
    Jemal A, Chu KC, Tarone RE (2001) Recent trends in lung cancer mortality in the United States. J Natl Cancer Inst 93:277–283PubMedCrossRefGoogle Scholar
  2. 2.
    Tanaka F, Yanagihara K, Otake Y et al (2000) Surgery for non-small cell lung cancer: postoperative survival based on the revised tumor-node-metastasis classification and its time trend. Eur J Cardiothorac Surg 18:147–155PubMedCrossRefGoogle Scholar
  3. 3.
    McLoud TC, Bourgouin PM, Greenberg RW et al (1992) Bronchogenic carcinoma: analysis of staging in the mediastinum with CT by correlative lymph node mapping and sampling. Radiology 182:319–323PubMedGoogle Scholar
  4. 4.
    Seely JM, Mayo JR, Miller RR, Muller NL (1993) T1 lung cancer: prevalence of mediastinal nodal metastases and diagnostic accuracy of CT. Radiology 186:129–132PubMedGoogle Scholar
  5. 5.
    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
  6. 6.
    Gupta NC, Tamim WJ, Graeber GG, Bishop HA, Hobbs GR (2001) Mediastinal lymph node sampling following positron emission tomography with fluorodeoxyglucose imaging in lung cancer staging. Chest 120:521–527PubMedCrossRefGoogle Scholar
  7. 7.
    Shim SS, Lee KS, Kim BT et al (2005) Non-small cell lung cancer: prospective comparison of integrated FDG PET/CT and CT alone for preoperative staging. Radiology 236:1011–1019PubMedCrossRefGoogle Scholar
  8. 8.
    Toloza EM, Harpole L, McCrory DC (2003) Noninvasive staging of non-small cell lung cancer: a review of the current evidence. Chest 123:137S–146SPubMedCrossRefGoogle Scholar
  9. 9.
    Tasci E, Tezel C, Orki A, Akin O, Falay O, Kutlu CA (2010) The role of integrated positron emission tomography and computed tomography in the assessment of nodal spread in cases with non-small cell lung cancer. Interact Cardiovasc Thorac Surg 10:200–203PubMedCrossRefGoogle Scholar
  10. 10.
    Kim YK, Lee KS, Kim BT et al (2007) Mediastinal nodal staging of nonsmall cell lung cancer using integrated 18F-FDG PET/CT in a tuberculosis-endemic country: diagnostic efficacy in 674 patients. Cancer 109:1068–1077PubMedCrossRefGoogle Scholar
  11. 11.
    Bille A, Pelosi E, Skanjeti A et al (2009) Preoperative intrathoracic lymph node staging in patients with non-small-cell lung cancer: accuracy of integrated positron emission tomography and computed tomography. Eur J Cardiothorac Surg 36:440–445PubMedCrossRefGoogle Scholar
  12. 12.
    Gupta NC, Graeber GM, Bishop HA (2000) Comparative efficacy of positron emission tomography with fluorodeoxyglucose in evaluation of small (<1 cm), intermediate (1 to 3 cm), and large (>3 cm) lymph node lesions. Chest 117:773–778PubMedCrossRefGoogle Scholar
  13. 13.
    Patz EF Jr, Lowe VJ, Hoffman JM et al (1993) Focal pulmonary abnormalities: evaluation with F-18 fluorodeoxyglucose PET scanning. Radiology 188:487–490PubMedGoogle Scholar
  14. 14.
    Dewan NA, Gupta NC, Redepenning LS, Phalen JJ, Frick MP (1993) Diagnostic efficacy of PET-FDG imaging in solitary pulmonary nodules. Potential role in evaluation and management. Chest 104:997–1002PubMedCrossRefGoogle Scholar
  15. 15.
    Nakayama J, Miyasaka K, Omatsu T et al (2010) Metastases in mediastinal and hilar lymph nodes in patients with non-small cell lung cancer: quantitative assessment with diffusion-weighted magnetic resonance imaging and apparent diffusion coefficient. J Comput Assist Tomogr 34:1–8PubMedCrossRefGoogle Scholar
  16. 16.
    Ohno Y, Hatabu H, Takenaka D et al (2004) Metastases in mediastinal and hilar lymph nodes in patients with non-small cell lung cancer: quantitative and qualitative assessment with STIR turbo spin-echo MR imaging. Radiology 231:872–879PubMedCrossRefGoogle Scholar
  17. 17.
    Ohno Y, Koyama H, Nogami M et al (2007) STIR turbo SE MR imaging vs. coregistered FDG-PET/CT: quantitative and qualitative assessment of N-stage in non-small-cell lung cancer patients. J Magn Reson Imaging 26:1071–1080PubMedCrossRefGoogle Scholar
  18. 18.
    Kim HY, Yi CA, Lee KS et al (2008) Nodal metastasis in non-small cell lung cancer: accuracy of 3.0-T MR imaging. Radiology 246:596–604PubMedCrossRefGoogle Scholar
  19. 19.
    Le Bihan D, Delannoy J, Levin RL (1989) Temperature mapping with MR imaging of molecular diffusion: application to hyperthermia. Radiology 171:853–857PubMedGoogle Scholar
  20. 20.
    Padhani AR, Liu G, Koh DM et al (2009) Diffusion-weighted magnetic resonance imaging as a cancer biomarker: consensus and recommendations. Neoplasia 11:102–125PubMedGoogle Scholar
  21. 21.
    Hasegawa I, Boiselle PM, Kuwabara K, Sawafuji M, Sugiura H (2008) Mediastinal lymph nodes in patients with non-small cell lung cancer: preliminary experience with diffusion-weighted MR imaging. J Thorac Imaging 23:157–161PubMedCrossRefGoogle Scholar
  22. 22.
    Kosucu P, Tekinbas C, Erol M et al (2009) Mediastinal lymph nodes: assessment with diffusion-weighted MR imaging. J Magn Reson Imaging 30:292–297PubMedCrossRefGoogle Scholar
  23. 23.
    Nomori H, Mori T, Ikeda K et al (2008) Diffusion-weighted magnetic resonance imaging can be used in place of positron emission tomography for N staging of non-small cell lung cancer with fewer false-positive results. J Thorac Cardiovasc Surg 135:816–822PubMedCrossRefGoogle Scholar
  24. 24.
    Eiber M, Beer AJ, Holzapfel K et al (2010) Preliminary results for characterization of pelvic lymph nodes in patients with prostate cancer by diffusion-weighted MR-imaging. Invest Radiol 45:15–23PubMedCrossRefGoogle Scholar
  25. 25.
    Padhani AR, Miles KA (2010) Multiparametric imaging of tumor response to therapy. Radiology 256:348–364PubMedCrossRefGoogle Scholar
  26. 26.
    Rusch VW, Asamura H, Watanabe H, Giroux DJ, Rami-Porta R, Goldstraw P (2009) The IASLC lung cancer staging project: a proposal for a new international lymph node map in the forthcoming seventh edition of the TNM classification for lung cancer. J Thorac Oncol 4:568–577PubMedCrossRefGoogle Scholar
  27. 27.
    Akduman EI, Momtahen AJ, Balci NC, Mahajann N, Havlioglu N, Wolverson MK (2008) Comparison between malignant and benign abdominal lymph nodes on diffusion-weighted imaging. Acad Radiol 15:641–646PubMedCrossRefGoogle Scholar
  28. 28.
    Bennett BM (1972) On comparisons of sensitivity, specificity and predictive value of a number of diagnostic procedures. Biometrics 28:793–800PubMedCrossRefGoogle Scholar
  29. 29.
    Takenaka D, Ohno Y, Hatabu H et al (2002) Differentiation of metastatic versus non-metastatic mediastinal lymph nodes in patients with non-small cell lung cancer using respiratory-triggered short inversion time inversion recovery (STIR) turbo spin-echo MR imaging. Eur J Radiol 44:216–224PubMedCrossRefGoogle Scholar
  30. 30.
    Yi CA, Shin KM, Lee KS et al (2008) Non-small cell lung cancer staging: efficacy comparison of integrated PET/CT versus 3.0-T whole-body MR imaging. Radiology 248:632–642PubMedCrossRefGoogle Scholar
  31. 31.
    Sundaram M, McGuire MH, Schajowicz F (1987) Soft-tissue masses: histologic basis for decreased signal (short T2) on T2-weighted MR images. AJR Am J Roentgenol 148:1247–1250PubMedGoogle Scholar
  32. 32.
    Chakraborti KL, Jena A (1997) MR evaluation of the mediastinal lymph nodes. Indian J Chest Dis Allied Sci 39:19–25PubMedGoogle Scholar
  33. 33.
    Glazer GM, Orringer MB, Chenevert TL et al (1988) Mediastinal lymph nodes: relaxation time/pathologic correlation and implications in staging of lung cancer with MR imaging. Radiology 168:429–431PubMedGoogle Scholar
  34. 34.
    Wiener JI, Chako AC, Merten CW, Gross S, Coffey EL, Stein HL (1986) Breast and axillary tissue MR imaging: correlation of signal intensities and relaxation times with pathologic findings. Radiology 160:299–305PubMedGoogle Scholar
  35. 35.
    Bottomley PA, Hardy CJ, Argersinger RE, Allen-Moore G (1987) A review of 1H nuclear magnetic resonance relaxation in pathology: are T1 and T2 diagnostic? Med Phys 14:1–37PubMedCrossRefGoogle Scholar
  36. 36.
    Rowley HA, Grant PE, Roberts TP (1999) Diffusion MR imaging. Theory and applications. Neuroimaging Clin N Am 9:343–361PubMedGoogle Scholar
  37. 37.
    Koh DM, Collins DJ (2007) Diffusion-weighted MRI in the body: applications and challenges in oncology. AJR Am J Roentgenol 188:1622–1635PubMedCrossRefGoogle Scholar
  38. 38.
    Abdel Razek AA, Soliman NY, Elkhamary S, Alsharaway MK, Tawfik A (2006) Role of diffusion-weighted MR imaging in cervical lymphadenopathy. Eur Radiol 16:1468–1477PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2012

Authors and Affiliations

  • Yoo Na Kim
    • 1
    • 7
  • Chin A Yi
    • 1
    • 8
    Email author
  • Kyung Soo Lee
    • 1
  • O Jung Kwon
    • 2
  • Ho Yun Lee
    • 1
  • Byung-Tae Kim
    • 3
  • Joon Young Choi
    • 3
  • Seon Woo Kim
    • 4
  • Man Pyo Chung
    • 2
  • Joungho Han
    • 5
  • Tae Sung Kim
    • 1
  • Myung Jin Chung
    • 1
  • Young Mog Shim
    • 6
  1. 1.Department of Radiology and the Center for Imaging Science, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
  2. 2.Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
  3. 3.Department of Nuclear Medicine, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
  4. 4.Samsung Biomedical Research Institute, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
  5. 5.Department of Pathology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
  6. 6.Department of Thoracic Surgery, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
  7. 7.Department of RadiologySoonchunhyang University HospitalSeoulKorea
  8. 8.Department of Radiology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea

Personalised recommendations