Skip to main content

Advertisement

SpringerLink
Log in

Thoracic staging of non-small-cell lung cancer using integrated 18F-FDG PET/MR imaging: diagnostic value of different MR sequences

  • Original Article
  • Published:
European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

To compare the accuracy of different MR sequences in simultaneous PET/MR imaging for T staging in non-small-cell lung cancer in relation to histopathology.

Methods

The study included 28 patients who underwent dedicated thoracic PET/MR imaging before tumour resection. Local tumour staging was performed separately by three readers with each of the following MR sequences together with PET: transverse T2 BLADE, transverse non-enhanced and contrast-enhanced T1 FLASH, T1 3D Dixon VIBE in transverse and coronal orientation, coronal T2 HASTE, and coronal TrueFISP. The staging results were compared with histopathology after resection as the reference standard. Differences in the accuracy of T staging among the MR sequences were evaluated using McNemar’s test. Due to multiple testing, Bonferroni correction was applied to prevent accumulation of α errors; p < 0.0024 was considered statistically significant.

Results

Compared with histopathology, T-staging accuracy was 69 % with T2 BLADE, 68 % with T2 HASTE, 59 % with contrast-enhanced T1 FLASH, 57 % with TrueFISP, 50 % with non-enhanced T1 FLASH, and 45 % and 48 % with T1 3D Dixon VIBE in transverse and coronal orientation, respectively. Staging accuracy with T2 BLADE was significantly higher than with non-enhanced T1 FLASH and with T1 3D Dixon VIBE in transverse and coronal orientations (p < 0.0024). T2 HASTE had a significantly higher T-staging accuracy than transverse T1 3D-Dixon-VIBE (p < 0.0024).

Conclusion

Transverse T2 BLADE images provide the highest accuracy for local tumour staging and should therefore be included in dedicated thoracic PET/MR protocols. As T1 3D Dixon VIBE images acquired for attenuation correction performed significantly worse, this sequence cannot be considered sufficiently accurate for local tumour staging in the thorax.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Pieterman RM, van Putten JWG, Meuzelaar JJ, Mooyaart EL, Vaalburg W, Koëter GH, et al. Preoperative staging of non-small-cell lung cancer with positron-emission tomography. N Engl J Med. 2000;343:254–61.

    Article  CAS  PubMed  Google Scholar 

  2. MacManus MP, Hicks RJ, Matthews JP, Hogg A, McKenzie AF, Wirth A, et al. High rate of detection of unsuspected distant metastases by PET in apparent stage III non-small-cell lung cancer: implications for radical radiation therapy. Int J Radiat Oncol. 2001;50:287–93.

    Article  CAS  Google Scholar 

  3. Van Tinteren H, Hoekstra OS, Smit EF, van den Bergh JH, Schreurs AJ, Stallaert RA, et al. Effectiveness of positron emission tomography in the preoperative assessment of patients with suspected non-small-cell lung cancer: the PLUS multicentre randomised trial. Lancet. 2002;359:1388–92.

    Article  PubMed  Google Scholar 

  4. Lardinois D, Weder W, Hany TF, Kamel EM, Korom S, Seifert B, et al. Staging of non-small-cell lung cancer with integrated positron-emission tomography and computed tomography. N Engl J Med. 2003;348:2500–7.

    Article  PubMed  Google Scholar 

  5. Antoch G, Stattaus J, Nemat AT, Marnitz S, Beyer T, Kuehl H, et al. Non-small cell lung cancer: dual-modality PET/CT in preoperative staging. Radiology. 2003;229:526–33.

    Article  PubMed  Google Scholar 

  6. Goeckenjan G, Sitter H, Thomas M, Branscheid D, Flentje M, Griesinger F, et al. Prevention, diagnosis, therapy, and follow-up of lung cancer. Pneumologie. 2010;65:39–59.

    Article  PubMed  Google Scholar 

  7. Hatabu H, Chen Q, Stock KW, Gefter WB, Itoh H. Fast magnetic resonance imaging of the lung. Eur J Radiol. 1999;29:114–32.

    Article  CAS  PubMed  Google Scholar 

  8. Biederer J, Schoene A, Freitag S, Reuter M, Heller M. Simulated pulmonary nodules implanted in a dedicated porcine chest phantom: sensitivity of MR imaging for detection. Radiology. 2003;227:475–83.

    Article  PubMed  Google Scholar 

  9. Both M, Schultze J, Reuter M, Bewig B, Hubner R, Bobis I, et al. Fast T1- and T2-weighted pulmonary MR-imaging in patients with bronchial carcinoma. Eur J Radiol. 2005;53:478–88.

    Article  CAS  PubMed  Google Scholar 

  10. Landwehr P, Schulte O, Lackner K. MR imaging of the chest: mediastinum and chest wall. Eur Radiol. 1999;9:1737–44.

    Article  CAS  PubMed  Google Scholar 

  11. Ohno Y, Sugimura K, Hatabu H. MR imaging of lung cancer. Eur J Radiol. 2002;44:172–81.

    Article  PubMed  Google Scholar 

  12. Schwenzer NF, Schraml C, Müller M, Brendle C, Sauter A, Spengler W, et al. Pulmonary lesion assessment: comparison of whole-body hybrid MR/PET and PET/CT imaging – pilot study. Radiology. 2012;264:551–8.

    Article  PubMed  Google Scholar 

  13. Heusch P, Buchbender C, Köhler J, Nensa F, Gauler T, Gomez B, et al. Thoracic staging in lung cancer: prospective comparison of 18F-FDG PET/MR imaging and 18F-FDG PET/CT. J Nucl Med. 2014;55:373–8.

    Article  CAS  PubMed  Google Scholar 

  14. Heusch P, Nensa F, Schaarschmidt B, Sivanesapillai R, Beiderwellen K, Gomez B, et al. Diagnostic accuracy of whole-body PET/MRI and whole-body PET/CT for TNM staging in oncology. Eur J Nucl Med Mol Imaging. 2015;42:56–65.

    Article  PubMed  Google Scholar 

  15. Regier M, Derlin T, Schwarz D, Laqmani A, Henes FO, Groth M, et al. Diffusion weighted MRI and 18F-FDG PET/CT in non-small cell lung cancer (NSCLC): does the apparent diffusion coefficient (ADC) correlate with tracer uptake (SUV)? Eur J Radiol. 2012;81:2913–8.

    Article  CAS  PubMed  Google Scholar 

  16. Heusch P, Buchbender C, Köhler J, Nensa F, Beiderwellen K, Kühl H, et al. Correlation of the apparent diffusion coefficient (ADC) with the standardized uptake value (SUV) in hybrid 18F-FDG PET/MRI in non-small cell lung cancer (NSCLC) lesions: initial results. Rofo. 2013;185:1056–62.

    Article  CAS  PubMed  Google Scholar 

  17. Schmidt H, Brendle C, Schraml C, Martirosian P, Bezrukov ID-I, Hetzel J, et al. Correlation of simultaneously acquired diffusion-weighted imaging and 2-deoxy-[18F] fluoro-2-D-glucose positron emission tomography of pulmonary lesions in a dedicated whole-body magnetic resonance/positron emission tomography system. Invest Radiol. 2013;48:247–55.

    Article  PubMed  Google Scholar 

  18. Ohno Y, Koyama H, Yoshikawa T, Matsumoto K, Aoyama N, Onishi Y, et al. Diffusion-weighted MRI versus 18F-FDG PET/CT: performance as predictors of tumor treatment response and patient survival in patients with non-small cell lung cancer receiving chemoradiotherapy. AJR Am J Roentgenol. 2012;198:75–82.

    Article  PubMed  Google Scholar 

  19. Werner MK, Parker JA, Kolodny GM, English JR, Palmer MR. Respiratory gating enhances imaging of pulmonary nodules and measurement of tracer uptake in FDG PET/CT. AJR Am J Roentgenol. 2009;193:1640–5.

    Article  PubMed  Google Scholar 

  20. Goerres GW, Kamel E, Seifert B, Burger C, Buck A, Hany TF, et al. Accuracy of image coregistration of pulmonary lesions in patients with non-small cell lung cancer using an integrated PET/CT system. J Nucl Med. 2002;43:1469–75.

    PubMed  Google Scholar 

  21. von Schulthess GK, Veit-Haibach P. Workflow considerations in PET/MR imaging. J Nucl Med. 2014;55 Suppl 2:19S–24S.

    Article  Google Scholar 

  22. Martinez-Möller A, Souvatzoglou M, Delso G, Bundschuh RA, Chefd’hotel C, Ziegler SI, et al. Tissue classification as a potential approach for attenuation correction in whole-body PET/MRI: evaluation with PET/CT data. J Nucl Med. 2009;50:520–6.

    Article  PubMed  Google Scholar 

  23. Beiderwellen K, Gomez B, Buchbender C, Hartung V, Poeppel TD, Nensa F, et al. Depiction and characterization of liver lesions in whole body [18F]-FDG PET/MRI. Eur J Radiol. 2013;82:e669–75.

    Article  PubMed  Google Scholar 

  24. Drzezga A, Souvatzoglou M, Eiber M, Beer AJ, Fürst S, Martinez-Möller A, et al. First clinical experience with integrated whole-body PET/MR: comparison to PET/CT in patients with oncologic diagnoses. J Nucl Med. 2012;53:845–55.

    Article  PubMed  Google Scholar 

  25. Appenzeller P, Mader C, Huellner MW, Schmidt D, Schmid D, Boss A, et al. PET/CT versus body coil PET/MRI: how low can you go? Insights Imaging. 2013;4:481–90.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. Stolzmann P, Veit-Haibach P, Chuck N, Rossi C, Frauenfelder T, Alkadhi H, et al. Detection rate, location, and size of pulmonary nodules in trimodality PET/CT-MR: comparison of low-dose CT and dixon-based MR imaging. Invest Radiol. 2013;48:241–6.

    Article  PubMed  Google Scholar 

  27. Huellner MW, Appenzeller P, Kuhn FP, Husmann L, Pietsch CM, Burger IA, et al. Whole-body nonenhanced PET/MR versus PET/CT in the staging and restaging of cancers: preliminary observations. Radiology. 2014;273:859–69.

    Article  PubMed  Google Scholar 

  28. Parkin M, Tyczynski JE, Bofetta P, Samet J, Shields N. Tumours of the lung. In: Travis WD, Brambilla E, Müller-Hermelink HK, Harris CC, editors. Pathology and genetics of tumours of the lung, pleura, thymus and heart. Lyon: IARC Press; 2004. p. 9–122.

    Google Scholar 

  29. Sobin LH, Gospodarowicz MK, Wittekind C (Eds) Lung. In: TNM classification of malignant tumours. New York: Wiley-Blackwell; 2011. p. 138–143,

  30. Yamashita Y, Yokoyama T, Tomiguchi S, Takahashi M, Ando M. MR imaging of focal lung lesions: elimination of flow and motion artifact by breath-hold ECG-gated and black-blood techniques on T2-weighted turbo SE and STIR sequences. J Magn Reson Imaging. 1999;9:691–8.

    Article  CAS  PubMed  Google Scholar 

  31. Puderbach M, Hintze C, Ley S, Eichinger M, Kauczor H-U, Biederer J. MR imaging of the chest: a practical approach at 1.5T. Eur J Radiol. 2007;64:345–55.

    Article  CAS  PubMed  Google Scholar 

  32. Pipe JG. Motion correction with PROPELLER MRI: application to head motion and free-breathing cardiac imaging. Magn Reson Med. 1999;42:963–9.

    Article  CAS  PubMed  Google Scholar 

  33. Schroeder T, Ruehm SG, Debatin JF, Ladd ME, Barkhausen J, Goehde SC. Detection of pulmonary nodules using a 2D HASTE MR sequence: comparison with MDCT. AJR Am J Roentgenol. 2005;185:979–84.

    Article  PubMed  Google Scholar 

  34. Lutterbey G, Leutner C, Gieseke J, Rodenburg J, Elevelt A, Sommer T, et al. Detektion fokaler lungenläsionen mit der magnetresonanz-tomographie mittels T2-gewichteter ultrashort-turbo-spin-echo-sequenz im vergleich zur spiral-computer-tomographie. Rofo. 1998;169:365–9.

    Article  CAS  PubMed  Google Scholar 

  35. Chandarana H, Heacock L, Rakheja R, DeMello LR, Bonavita J, Block TK, et al. Pulmonary nodules in patients with primary malignancy: comparison of hybrid PET/MR and PET/CT imaging. Radiology. 2013;268:874–81.

    Article  PubMed  Google Scholar 

  36. Eiber M, Martinez-Möller A, Souvatzoglou M, Holzapfel K, Pickhard A, Löffelbein D, et al. Value of a dixon-based MR/PET attenuation correction sequence for the localization and evaluation of PET-positive lesions. Eur J Nucl Med Mol Imaging. 2011;38:1691–701.

    Article  PubMed  Google Scholar 

  37. Kohan AA, Kolthammer JA, Vercher-Conejero JL, Rubbert C, Partovi S, Jones R, et al. N staging of lung cancer patients with PET/MRI using a three-segment model attenuation correction algorithm: initial experience. Eur Radiol. 2013;23:3161–9.

    Article  CAS  PubMed  Google Scholar 

  38. Jeong JH, Cho IH, Kong EJ, Chun KA. Evaluation of dixon sequence on hybrid PET/MR compared with contrast-enhanced PET/CT for PET-positive lesions. Nucl Med Mol Imaging. 2014;48:26–32.

    Article  PubMed Central  PubMed  Google Scholar 

  39. Fraioli F, Screaton NJ, Janes SM, Win T, Menezes L, Kayani I, et al. Non-small-cell lung cancer resectability: diagnostic value of PET/MR. Eur J Nucl Med Mol Imaging. 2015;42:49–55.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

Download references

Compliance with ethical standards

Conflicts of interest

None.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Acknowledgments

This publication contains parts of the MD thesis of Florian Hild and is therefore in partial fulfilment of the requirements for an MD thesis at the Medical Faculty of the Heinrich-Heine University, Dusseldorf.

Author information

Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany

    Benedikt Schaarschmidt, Christian Buchbender, Christian Rubbert, Florian Hild, Gerald Antoch & Philipp Heusch

  2. Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen, 45147, Essen, Germany

    Benedikt Schaarschmidt, Johannes Grueneisen & Axel Wetter

  3. Department of Nuclear Medicine, Medical Faculty, University of Duisburg-Essen, 45147, Essen, Germany

    Benedikt Gomez & Verena Ruhlmann

  4. Department of Medical Oncology, Medical Faculty, University of Duisburg-Essen, 45147, Essen, Germany

    Jens Köhler

  5. Institute of Pathology, Medical Faculty, University of Duisburg-Essen, 45147, Essen, Germany

    Henning Reis

  6. Erwin L. Hahn Institute for MR Imaging, University of Duisburg-Essen, Essen, Germany

    Harald H. Quick

  7. High Field and Hybrid MR Imaging, University Hospital Essen, Essen, Germany

    Harald H. Quick

Authors
  1. Benedikt Schaarschmidt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christian Buchbender
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Benedikt Gomez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christian Rubbert
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Florian Hild
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jens Köhler
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Johannes Grueneisen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Henning Reis
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Verena Ruhlmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Axel Wetter
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Harald H. Quick
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Gerald Antoch
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Philipp Heusch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Benedikt Schaarschmidt.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Online resource 1

(PDF 16 kb)

Online resource 2

(PDF 1926 kb)

Online resource 3

(PDF 1609 kb)

Online resource 4

(PDF 14 kb)

Online resource 5

(PDF 1693 kb)

Online resource 6

(PDF 14 kb)

Online resource 7

(PDF 1652 kb)

Online resource 8

(PDF 14 kb)

Online resource 9

(PDF 1750 kb)

Online resource 10

(PDF 14 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schaarschmidt, B., Buchbender, C., Gomez, B. et al. Thoracic staging of non-small-cell lung cancer using integrated 18F-FDG PET/MR imaging: diagnostic value of different MR sequences. Eur J Nucl Med Mol Imaging 42, 1257–1267 (2015). https://doi.org/10.1007/s00259-015-3050-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00259-015-3050-5

Keywords

Search

Navigation