Elsevier

Lung Cancer

Volume 46, Issue 3, December 2004, Pages 357-360
Lung Cancer

SHORT COMMUNICATION
Magnetic resonance imaging and computed tomography in the diagnoses of brain metastases of lung cancer

https://doi.org/10.1016/j.lungcan.2004.05.011Get rights and content

Abstract

We evaluated the usefulness of double-dose (0.2 mmol/kg of gadoteridol) contrast-enhanced magnetic resonance imaging (C-E MRI) in detecting brain metastases of lung cancer. We prospectively enrolled 134 patients with lung cancer who had no neurologic symptoms and who underwent a staging work-up. Patients were assigned to receive both contrast-enhanced computerized tomography (C-E CT) and double-dose C-E MRI. Double-dose C-E MRI detected brain metastases in 19 patients, while C-E CT detected brain metastasis in only 12 of the 19 (P = 0.02). The 3-month survival rate for patients in double-dose C-E MRI group was found to be 2.06 times that of patients in a C-E CT group (P = 0.029), although the survival rate fell to 1.45 (P = 0.387) at 6 months. The results imply that double-dose C-E MRI changed the clinical stage of lung cancer patients. We concluded that double-dose C-E MRI improves the rate of detection of brain metastases during the initial staging 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].

References (8)

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