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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

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Abstract

Objective

To investigate the diagnostic value of whole-body magnetic resonance imaging (MRI) including diffusion-weighted imaging with background signal suppression (DWIBS) for preoperative assessment of non-small-cell lung cancer (NSCLC) in comparison to 18F-fluorodeoxyglucose 18FDG) positron emission tomography/computed tomography (PET/CT).

Methods

Thirty-three patients with suspected NSCLC were enrolled. Patients were examined before surgery with PET/CT and whole-body MRI including T1-weighted turbo spin echo (TSE), T2-weighted short tau inversion recovery (STIR) and DWIBS sequences (b = 0/800). Histological or cytological specimens were taken as standard of reference.

Results

Whole-body MRI with DWIBS as well as PET/CT provided diagnostic image quality in all cases. Sensitivity for primary tumour detection: MRI 93%, PET/CT 98%. T-staging accuracy: MRI 63%, PET/CT 56%. N-staging accuracy: MRI 66%, PET/CT 71%. UICC staging accuracy: MRI 66%, PET/CT 74%. Sensitivity for metastatic involvement of individual lymph node groups: MRI 44%, PET/CT 47%. Specificity for individual non-metastatic lymph node groups: MRI 93%, PET/CT 96%. Assessment accuracy for individual lymph node groups: MRI 85%, PET/CT 88%. Observer agreement rate for UICC staging: MRI 74%, PET/CT 90%.

Conclusion

Whole-body MRI with DWIBS provides comparable results to PET/CT in staging of NSCLC, but shows no superiority. Most relevant challenges for both techniques are T-staging accuracy and sensitivity for metastatic lymph node involvement.

Key Points

Numerous radiological methods are available for the crucial staging of lung cancer

Whole-body DWIBS MRI provides comparable results to PET/CT in NSCLC staging.

No evident superiority of whole-body DWIBS over PET/CT in NSCLC staging.

Challenges for both techniques are T-staging and detection of small metastases.

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Acknowledgements

Preliminary results of this work and parts of the material enclosed have been presented at ECR 2012 as EPOS no. 4246.M. Klarhöfer is an employee of Siemens Switzerland Ltd., Healthcare Sector, Zürich, Switzerland. The authors acknowledge financial support from Guerbet Switzerland. The study sponsor played no role in matters of design, collection, analysis, interpretation of data and writing the report.

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Correspondence to Gregor Sommer.

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Sommer, G., Wiese, M., Winter, L. 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 22, 2859–2867 (2012). https://doi.org/10.1007/s00330-012-2542-y

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  • DOI: https://doi.org/10.1007/s00330-012-2542-y

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