Abstract
Objectives
Evaluate the performance of PET/MRI at tissue interfaces with different attenuation values for detecting lymph node (LN) metastases and for accurately measuring maximum standardised uptake values (SUVmax) in lung cancer patients.
Materials and Method
Eleven patients underwent PET/CT and PET/MRI for staging, restaging or follow-up of suspected or known lung cancer. Four experienced readers determined the N stage of the patients for each imaging method in a randomised blinded way. Concerning metastases, SUVmax of FDG-avid LNs were measured in PET/CT and PET/MRI in all patients. A standard of reference was created with a fifth experienced independent reader in combination with a chart review. Results were analysed to determine interobserver agreement, SUVmax correlation between CT and MRI (three-segment model) attenuation correction and diagnostic performance of the two techniques.
Results
Overall interobserver agreement was high (κ = 0.86) for PET/CT and substantial (κ = 0.70) for PET/MRI. SUVmax showed strong positive correlation (Spearman’s correlation coefficient = 0.93, P < 0.001) between the two techniques. Diagnostic performance of PET/MRI was slightly inferior to that of PET/CT, without statistical significance (P > 0.05).
Conclusions
PET/MRI using three-segment model attenuation correction for LN staging in lung cancer shows a strong parallel to PET/CT in terms of SUVmax, interobserver agreement and diagnostic performance.
Key Points
•F18-FDG PET/MRI shows similar performance to F18-FDG PET/CT in lung cancer N staging.
•PET/MRI has substantial interobserver agreement in N staging.
•A three-segment model attenuation correction is reliable for assessing the mediastinum.
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References
De Leyn P, Lardinois D, Van Schil PE et al (2007) ESTS guidelines for preoperative lymph node staging for non-small cell lung cancer. Eur J Cardiothorac Surg Off J Eur Assoc Cardiothorac Surg 32:1–8
Sivrikoz CM, Ak I, Simsek FS, Doner E, Dundar E (2012) Is mediastinoscopy still the gold standard to evaluate mediastinal lymph nodes in patients with non-small cell lung carcinoma? Thorac Cardiovasc Surg 60:116–121
Schwenzer NF, Schraml C, Muller M et al (2012) Pulmonary lesion assessment: comparison of whole-body hybrid MR/PET and PET/CT imaging–pilot study. Radiology 264:551–558
Surti S, Kuhn A, Werner ME, Perkins AE, Kolthammer J, Karp JS (2007) Performance of Philips Gemini TF PET/CT scanner with special consideration for its time-of-flight imaging capabilities. J Nucl Med Off Publ Soc Nucl Med 48:471–480
Zaidi H, Ojha N, Morich M et al (2011) Design and performance evaluation of a whole-body Ingenuity TF PET-MRI system. Phys Med Biol 56:3091–3106
Schulz V, Torres-Espallardo I, Renisch S et al (2011) Automatic, three-segment, MR-based attenuation correction for whole-body PET/MR data. Eur J Nucl Med Mol Imaging 38:138–152
Tsim S, O'Dowd CA, Milroy R, Davidson S (2010) Staging of non-small cell lung cancer (NSCLC): a review. Respir Med 104:1767–1774
Viera AJ, Garrett JM (2005) Understanding interobserver agreement: the kappa statistic. Fam Med 37:360–363
Zou KH, Tuncali K, Silverman SG (2003) Correlation and simple linear regression. Radiology 227:617–622
Li X, Zhang H, Xing L et al (2012) Mediastinal lymph nodes staging by 18F-FDG PET/CT for early stage non-small cell lung cancer: a multicenter study. Radiother Oncol J Eur Soc Ther Radiol Oncol 102:246–250
Bini J, Izquierdo-Garcia D, Mateo J et al (2013) Preclinical evaluation of MR attenuation correction versus CT attenuation correction on a sequential whole-body MR/PET scanner. Investig Radiol. doi:10.1097/RLI.0b013e31827a49ba
Heusch P, Buchbender C, Beiderwellen K et al (2013) Standardized uptake values for [(18)F] FDG in normal organ tissues: Comparison of whole-body PET/CT and PET/MRI. Eur J Radiol. doi:10.1016/j.ejrad.2013.01.008
Kim JH, Lee JS, Song IC, Lee DS (2012) Comparison of segmentation-based attenuation correction methods for PET/MRI: evaluation of bone and liver standardized uptake value with oncologic PET/CT data. J Nucl Med Off Publ Soc Nucl Med 53:1878–1882
Schramm G, Langner J, Hofheinz F et al (2013) Quantitative accuracy of attenuation correction in the Philips Ingenuity TF whole-body PET/MR system: a direct comparison with transmission-based attenuation correction. Magma 26:115–126
Wiesmuller M, Quick HH, Navalpakkam B et al (2013) Comparison of lesion detection and quantitation of tracer uptake between PET from a simultaneously acquiring whole-body PET/MR hybrid scanner and PET from PET/CT. Eur J Nucl Med Mol Imaging 40:12–21
Delbeke D, Coleman RE, Guiberteau MJ et al (2006) Procedure guideline for tumor imaging with 18F-FDG PET/CT 1.0. J Nucl Med Off Publ Soc Nucl Med 47:885–895
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 34:1–8
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 135:816–822
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 JMRI 26:1071–1080
Ohno Y, Koyama H, Yoshikawa T et al (2011) N stage disease in patients with non-small cell lung cancer: efficacy of quantitative and qualitative assessment with STIR turbo spin-echo imaging, diffusion-weighted MR imaging, and fluorodeoxyglucose PET/CT. Radiology 261:605–615
Huang B, Law MW, Khong PL (2009) Whole-body PET/CT scanning: estimation of radiation dose and cancer risk. Radiology 251:166–174
Acknowledgements
This research was supported in part by an Ohio Third Frontier Commission grant (TECH 11-063) from the State of Ohio Department of Development.
This research was supported in part by a sponsored research agreement with Philips Healthcare.
JK was a Philips Healthcare employee during the writing of this article.
This article is based on research that was presented at ECR 2013.
KH and PF contributed equally to this work as senior authors.
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Kohan, A.A., Kolthammer, J.A., Vercher-Conejero, J.L. et al. N staging of lung cancer patients with PET/MRI using a three-segment model attenuation correction algorithm: Initial experience. Eur Radiol 23, 3161–3169 (2013). https://doi.org/10.1007/s00330-013-2914-y
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DOI: https://doi.org/10.1007/s00330-013-2914-y