SHORT COMMUNICATIONMagnetic resonance imaging and computed tomography in the diagnoses of brain metastases of lung cancer
Introduction
Since the diagnosis of brain metastases in patients with malignant tumors plays an important role in staging and in devising their optimal treatment plan, an accurate diagnosis of brain metastases is important. The development of computerized tomography (CT) and magnetic resonance imaging (MRI) techniques has greatly facilitated the evaluation of brain metastases in cancer patients. Double-dose (0.2 mmol/kg of gadoteridol) contrast-enhanced magnetic resonance imaging (C-E MRI) has been shown to be superior to non-enhanced MRI, conventional-dose (0.1 mmol/kg of gadoteridol) C-E MRI, and contrast-enhanced computerized tomography (C-E CT) in lesion detection [1], [2], [3], [4], [5], [6]. However, C-E CT remains the standard neuroimaging technique for the initial staging work-up of cancer, and there are few studies that have examined whether the clinical staging of lung cancer is changed when double-dose C-E MRI is used instead of C-E CT during the initial staging work-up of lung cancer. Therefore, it appears to be of value to compare C-E MRI, especially double-dose C-E MRI, with C-E CT at the time of the initial staging work-up of lung cancer patients who have no neurologic symptoms.
In this study, C-E CT and double-dose C-E MRI were performed on the same patient in the same period and compared the differences in the initial staging and survival between the two methods. This study was designed to assess the clinical usefulness of double-dose C-E MRI and C-E CT in the initial staging of lung cancer patients without neurologic symptoms.
Section snippets
Patients and methods
Among patients with lung cancer admitted to our hospitals between June 1997 and July 2000, 134 patients without neurologic symptoms were selected in whom both double-dose C-E MRI and C-E CT were performed during the initial staging work-up of their cancer. Patients characteristics were shown in Table 1. Informed consent was obtained from all the subjects. CT and MR images were evaluated by experts separately. A X-force (Toshiba Medical, Japan) was used for C-E CT. Scans were obtained at 10 mm
Detection of brain metastases by C-E CT and double-dose C-E MRI
Of the 134 patients, 12 exhibited brain metastases on C-E CT, while 19 had a brain metastasis on C-E MRI. In seven patients, a brain metastasis was not detected on C-E CT, but was detected on double-dose C-E MRI. In contrast, there were no brain metastases that were missed on double-dose C-E MRI but detected on C-E CT. Double-dose C-E MRI detected significantly more brain metastases (19) than did C-E CT (12) (P = 0.02) (Table 1).
We analyzed the background factors of patients in whom brain
Discussion
The detection of brain metastases at the time of diagnosis of lung cancer has important therapeutic implications, as a surgical or radiotherapeutic approach may be considered even in neurologically asymptomatic patients. The introduction of C-E CT and C-E MRI has greatly facilitated the evaluation of brain metastases of malignant tumors, and C-E MRI has been reported to be superior to non-enhanced MRI and C-E CT in the detectability of brain metastases of malignant tumors [1], [2], [3].
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