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N staging of lung cancer patients with PET/MRI using a three-segment model attenuation correction algorithm: Initial experience

  • Oncology
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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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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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Correspondence to A. A. Kohan.

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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

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