Skip to main content

Advertisement

SpringerLink
Log in

Prospective comparison of 18F-FDG PET/MRI and 18F-FDG PET/CT for thoracic staging of non-small cell lung cancer

  • Original Article
  • Published:
European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Objectives

To compare the diagnostic performance of 18F-FDG PET/MRI and 18F-FDG PET/CT for primary and locoregional lymph node staging in non-small cell lung cancer (NSCLC).

Methods

In this prospective study, a total of 84 patients (51 men, 33 women, mean age 62.5 ± 9.1 years) with histopathologically confirmed NSCLC underwent 18F-FDG PET/CT followed by 18F-FDG PET/MRI in a single injection protocol. Two readers independently assessed T and N staging in separate sessions according to the seventh edition of the American Joint Committee on Cancer staging manual for 18F-FDG PET/CT and 18F-FDG PET/MRI, respectively. Histopathology as a reference standard was available for N staging in all 84 patients and for T staging in 39 patients. Differences in staging accuracy were assessed by McNemars chi2 test. The maximum standardized uptake value (SUVmax) and longitudinal diameters of primary tumors were correlated using Pearson’s coefficients.

Results

T stage was categorized concordantly in 18F-FDG PET/MRI and 18F-FDG PET/CT in 38 of 39 (97.4%) patients. Herein, 18F-FDG PET/CT and 18F-FDG PET/MRI correctly determined the T stage in 92.3 and 89.7% of patients, respectively. N stage was categorized concordantly in 83 of 84 patients (98.8%). 18F-FDG PET/CT correctly determined the N stage in 78 of 84 patients (92.9%), while 18F-FDG PET/MRI correctly determined the N stage in 77 of 84 patients (91.7%). Differences between 18F-FDG PET/CT and 18F-FDG PET/MRI in T and N staging accuracy were not statistically significant (p > 0.5, each). Tumor size and SUVmax measurements derived from both imaging modalities exhibited excellent correlation (r = 0.963 and r = 0.901, respectively).

Conclusion

18F-FDG PET/MRI and 18F-FDG PET/CT show an equivalently high diagnostic performance for T and N staging in patients suffering from NSCLC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Govindan R, Page N, Morgensztern D, Read W, Tierney R, Vlahiotis A, et al. Changing epidemiology of small-cell lung cancer in the United States over the last 30 years: analysis of the surveillance, epidemiologic, and end results database. J Clin Oncol. 2006;24:4539–44. https://doi.org/10.1200/JCO.2005.04.4859.

    Article  PubMed  Google Scholar 

  2. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65:87–108. https://doi.org/10.3322/caac.21262.

    Article  Google Scholar 

  3. Postmus PE, Kerr KM, Oudkerk M, Senan S, Waller DA, Vansteenkiste J, et al. Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2017;28:iv1–iv21. https://doi.org/10.1093/annonc/mdx222.

    Article  CAS  PubMed  Google Scholar 

  4. De Leyn P, Dooms C, Kuzdzal J, Lardinois D, Passlick B, Rami-Porta R, et al. Revised ESTS guidelines for preoperative mediastinal lymph node staging for non-small-cell lung cancer. Eur J Cardiothorac Surg. 2014;45:787–98. https://doi.org/10.1093/ejcts/ezu028.

    Article  PubMed  Google Scholar 

  5. Lardinois D, Weder W, Hany TF, Kamel EM, Korom S, Seifert B, et al. Staging of non-small-cell lung cancer with integrated positron-emission tomography and computed tomography. N Engl J Med. 2003;348:2500–7. https://doi.org/10.1056/NEJMoa022136.

    Article  PubMed  Google Scholar 

  6. Antoch G, Stattaus J, Nemat AT, Marnitz S, Beyer T, Kuehl H, et al. Non-small cell lung cancer: dual-modality PET/CT in preoperative staging. Radiology. 2003;229:526–33. https://doi.org/10.1148/radiol.2292021598.

    Article  PubMed  Google Scholar 

  7. Wang J, Welch K, Wang L, Kong FM. Negative predictive value of positron emission tomography and computed tomography for stage T1-2N0 non-small-cell lung cancer: a meta-analysis. Clin Lung Cancer. 2012;13:81–9. https://doi.org/10.1016/j.cllc.2011.08.002.

    Article  PubMed  Google Scholar 

  8. Ambrosini V, Fanti S, Chengazi VU, Rubello D. Diagnostic accuracy of FDG PET/CT in mediastinal lymph nodes from lung cancer. Eur J Radiol. 2014;83:1301–2. https://doi.org/10.1016/j.ejrad.2014.04.035.

    Article  PubMed  Google Scholar 

  9. Sommer G, Wiese M, Winter L, Lenz C, Klarhofer M, Forrer F, 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. 2012;22:2859–67. https://doi.org/10.1007/s00330-012-2542-y.

    Article  PubMed  Google Scholar 

  10. Roberts PF, Follette DM, von Haag D, Park JA, Valk PE, Pounds TR, et al. Factors associated with false-positive staging of lung cancer by positron emission tomography. Ann Thorac Surg. 2000;70:1154–9. discussion 9-60

    Article  CAS  Google Scholar 

  11. Konishi J, Yamazaki K, Tsukamoto E, Tamaki N, Onodera Y, Otake T, et al. Mediastinal lymph node staging by FDG-PET in patients with non-small cell lung cancer: analysis of false-positive FDG-PET findings. Respiration. 2003;70:500–6.

    Article  Google Scholar 

  12. Zhang R, Ying K, Shi L, Zhang L, Zhou L. Combined endobronchial and endoscopic ultrasound-guided fine needle aspiration for mediastinal lymph node staging of lung cancer: a meta-analysis. Eur J Cancer. 2013;49:1860–7. https://doi.org/10.1016/j.ejca.2013.02.008.

    Article  PubMed  Google Scholar 

  13. Tournoy KG, Maddens S, Gosselin R, Van Maele G, van Meerbeeck JP, Kelles A. Integrated FDG-PET/CT does not make invasive staging of the intrathoracic lymph nodes in non-small cell lung cancer redundant: a prospective study. Thorax. 2007;62:696–701. https://doi.org/10.1136/thx.2006.072959.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Vial MR, O'Connell OJ, Grosu HB, Hernandez M, Noor L, Casal RF, et al. Diagnostic performance of endobronchial ultrasound-guided mediastinal lymph node sampling in early stage non-small cell lung cancer: a prospective study. Respirology. 2017. https://doi.org/10.1111/resp.13162.

  15. Nomori H, Watanabe K, Ohtsuka T, Naruke T, Suemasu K, Uno K. Evaluation of F-18 fluorodeoxyglucose (FDG) PET scanning for pulmonary nodules less than 3 cm in diameter, with special reference to the CT images. Lung Cancer. 2004;45:19–27. https://doi.org/10.1016/j.lungcan.2004.01.009.

    Article  PubMed  Google Scholar 

  16. Cheran SK, Nielsen ND, Patz EF Jr. False-negative findings for primary lung tumors on FDG positron emission tomography: staging and prognostic implications. AJR Am J Roentgenol. 2004;182:1129–32. https://doi.org/10.2214/ajr.182.5.1821129.

    Article  PubMed  Google Scholar 

  17. Ehman EC, Johnson GB, Villanueva-Meyer JE, Cha S, Leynes AP, Larson PEZ, et al. PET/MRI: where might it replace PET/CT? J Magn Reson Imaging. 2017;46:1247–62. https://doi.org/10.1002/jmri.25711.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Spick C, Herrmann K, Czernin J. 18F-FDG PET/CT and PET/MRI perform equally well in cancer: evidence from studies on more than 2,300 patients. J Nucl Med. 2016;57:420–30. https://doi.org/10.2967/jnumed.115.158808.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Heusch P, Buchbender C, Kohler J, Nensa F, Gauler T, Gomez B, et al. Thoracic staging in lung cancer: prospective comparison of 18F-FDG PET/MR imaging and 18F-FDG PET/CT. J Nucl Med. 2014;55:373–8. https://doi.org/10.2967/jnumed.113.129825.

    Article  CAS  PubMed  Google Scholar 

  20. Kim HS, Lee KS, Ohno Y, van Beek EJ, Biederer J. PET/CT versus MRI for diagnosis, staging, and follow-up of lung cancer. J Magn Reson Imaging. 2015;42:247–60. https://doi.org/10.1002/jmri.24776.

    Article  PubMed  Google Scholar 

  21. Biederer J, Beer M, Hirsch W, Wild J, Fabel M, Puderbach M, et al. MRI of the lung (2/3). Why ... when ... how? Insights Imaging. 2012;3:355–71. https://doi.org/10.1007/s13244-011-0146-8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17:1471–4. https://doi.org/10.1245/s10434-010-0985-4.

    Article  PubMed  Google Scholar 

  23. Shim SS, Lee KS, Kim BT, Chung MJ, Lee EJ, Han J, et al. Non-small cell lung cancer: prospective comparison of integrated FDG PET/CT and CT alone for preoperative staging. Radiology. 2005;236:1011–9. https://doi.org/10.1148/radiol.2363041310.

    Article  PubMed  Google Scholar 

  24. Kim HY, Yi CA, Lee KS, Chung MJ, Kim YK, Choi BK, et al. Nodal metastasis in non-small cell lung cancer: accuracy of 3.0-T MR imaging. Radiology. 2008;246:596–604. https://doi.org/10.1148/radiol.2461061907.

    Article  PubMed  Google Scholar 

  25. Ziyade S, Pinarbasili NB, Ziyade N, Akdemir OC, Sahin F, Soysal O, et al. Determination of standard number, size and weight of mediastinal lymph nodes in postmortem examinations: reflection on lung cancer surgery. J Cardiothorac Surg. 2013;8:94. https://doi.org/10.1186/1749-8090-8-94.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Glazer GM, Gross BH, Quint LE, Francis IR, Bookstein FL, Orringer MB. Normal mediastinal lymph nodes: number and size according to American Thoracic Society mapping. AJR Am J Roentgenol. 1985;144:261–5. https://doi.org/10.2214/ajr.144.2.261.

    Article  CAS  PubMed  Google Scholar 

  27. Buchbender C, Heusner TA, Lauenstein TC, Bockisch A, Antoch G. Oncologic PET/MRI, part 1: tumors of the brain, head and neck, chest, abdomen, and pelvis. J Nucl Med. 2012;53:928–38. https://doi.org/10.2967/jnumed.112.105338.

    Article  PubMed  Google Scholar 

  28. Buchbender C, Heusner TA, Lauenstein TC, Bockisch A, Antoch G. Oncologic PET/MRI, part 2: bone tumors, soft-tissue tumors, melanoma, and lymphoma. J Nucl Med. 2012;53:1244–52. https://doi.org/10.2967/jnumed.112.109306.

    Article  PubMed  Google Scholar 

  29. Novello S, Barlesi F, Califano R, Cufer T, Ekman S, Levra MG, et al. Metastatic non-small-cell lung cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2016;27:v1–v27. https://doi.org/10.1093/annonc/mdw326.

    Article  CAS  PubMed  Google Scholar 

  30. Sawicki LM, Grueneisen J, Buchbender C, Schaarschmidt BM, Gomez B, Ruhlmann V, et al. Evaluation of the outcome of lung nodules missed on 18F-FDG PET/MRI compared with 18F-FDG PET/CT in patients with known malignancies. J Nucl Med. 2016;57:15–20. https://doi.org/10.2967/jnumed.115.162966.

    Article  CAS  PubMed  Google Scholar 

  31. Sawicki LM, Grueneisen J, Buchbender C, Schaarschmidt BM, Gomez B, Ruhlmann V, et al. Comparative performance of 18F-FDG PET/MRI and 18F-FDG PET/CT regarding detection and characterization of pulmonary lesions in 121 oncologic patients. J Nucl Med. 2016. https://doi.org/10.2967/jnumed.115.167486.

  32. Fraioli F, Screaton NJ, Janes SM, Win T, Menezes L, Kayani I, et al. Non-small-cell lung cancer resectability: diagnostic value of PET/MR. Eur J Nucl Med Mol Imaging. 2015;42:49–55. https://doi.org/10.1007/s00259-014-2873-9.

    Article  CAS  PubMed  Google Scholar 

  33. Sawicki LM, Grueneisen J, Buchbender C, Schaarschmidt BM, Gomez B, Ruhlmann V, et al. Comparative performance of 18F-FDG PET/MRI and 18F-FDG PET/CT in detection and characterization of pulmonary lesions in 121 oncologic patients. J Nucl Med. 2016;57:582–6. https://doi.org/10.2967/jnumed.115.167486.

    Article  CAS  PubMed  Google Scholar 

  34. Yi CA, Shin KM, Lee KS, Kim BT, Kim H, Kwon OJ, et al. Non-small cell lung cancer staging: efficacy comparison of integrated PET/CT versus 3.0-T whole-body MR imaging. Radiology. 2008;248:632–42. https://doi.org/10.1148/radiol.2482071822.

    Article  PubMed  Google Scholar 

  35. Plathow C, Aschoff P, Lichy MP, Eschmann S, Hehr T, Brink I, et al. Positron emission tomography/computed tomography and whole-body magnetic resonance imaging in staging of advanced nonsmall cell lung cancer--initial results. Investig Radiol. 2008;43:290–7. https://doi.org/10.1097/RLI.0b013e318163273a.

    Article  Google Scholar 

  36. Ohno Y, Koyama H, Yoshikawa T, Nishio M, Aoyama N, Onishi Y, et al. 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. 2011;261:605–15. https://doi.org/10.1148/radiol.11110281.

    Article  PubMed  Google Scholar 

  37. Huellner MW, de Galiza BF, Husmann L, Pietsch CM, Mader CE, Burger IA, et al. TNM staging of non-small cell lung cancer: comparison of PET/MR and PET/CT. J Nucl Med. 2016;57:21–6. https://doi.org/10.2967/jnumed.115.162040.

    Article  CAS  PubMed  Google Scholar 

  38. Schaarschmidt BM, Grueneisen J, Metzenmacher M, Gomez B, Gauler T, Roesel C, et al. Thoracic staging with 18F-FDG PET/MR in non-small cell lung cancer - does it change therapeutic decisions in comparison to 18F-FDG PET/CT? Eur Radiol. 2017;27:681–8. https://doi.org/10.1007/s00330-016-4397-0.

    Article  PubMed  Google Scholar 

  39. Kauczor HU, Kreitner KF. Contrast-enhanced MRI of the lung. Eur J Radiol. 2000;34:196–207.

    Article  CAS  Google Scholar 

  40. Kershah S, Partovi S, Traughber BJ, Muzic RF Jr, Schluchter MD, O'Donnell JK, et al. Comparison of standardized uptake values in normal structures between PET/CT and PET/MRI in an oncology patient population. Mol Imaging Biol. 2013;15:776–85. https://doi.org/10.1007/s11307-013-0629-8.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Heusch P, Buchbender C, Beiderwellen K, Nensa F, Hartung-Knemeyer V, Lauenstein TC, et al. Standardized uptake values for [(1)(8)F] FDG in normal organ tissues: comparison of whole-body PET/CT and PET/MRI. Eur J Radiol. 2013;82:870–6. https://doi.org/10.1016/j.ejrad.2013.01.008.

    Article  PubMed  Google Scholar 

  42. Law WP, Maggacis N, Jeavons SJ, Miles KA. Concordance of 18F-FDG PET uptake in tumor and normal tissues on PET/MRI and PET/CT. Clin Nucl Med. 2017;42:180–6. https://doi.org/10.1097/RLU.0000000000001514.

    Article  PubMed  Google Scholar 

  43. Paulus DH, Quick HH. Hybrid positron emission tomography/magnetic resonance imaging: challenges, methods, and state of the art of hardware component attenuation correction. Investig Radiol. 2016;51:624–34. https://doi.org/10.1097/RLI.0000000000000289.

    Article  Google Scholar 

Download references

Author information

Author notes

  1. Julian Kirchner and Lino M. Sawicki contributed equally to this work.

Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Moorenstrasse 5, D-40225, Dusseldorf, Germany

    Julian Kirchner, Lino M. Sawicki, Benedikt M. Schaarschmidt, Christian Buchbender, Gerald Antoch & Philipp Heusch

  2. Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147, Essen, Germany

    Felix Nensa & Lale Umutlu

  3. Institute of Pathology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK) Essen, D-45147, Essen, Germany

    Henning Reis & Marc Ingenwerth

  4. Department of Medical Oncology, University Hospital Essen, West German Cancer Center, University of Duisburg-Essen, D-45122, Essen, Germany

    Simon Bogner

  5. Department of Thoracic Surgery and Surgical Endoscopy, University Hospital Essen, Ruhrlandklinik, University of Duisburg-Essen, D-45147, Essen, Germany

    Clemens Aigner

  6. Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, D-45147, Essen, Germany

    Ken Herrmann

Authors
  1. Julian Kirchner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lino M. Sawicki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Felix Nensa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Benedikt M. Schaarschmidt
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Henning Reis
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marc Ingenwerth
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Simon Bogner
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Clemens Aigner
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Christian Buchbender
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Lale Umutlu
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Gerald Antoch
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Ken Herrmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Philipp Heusch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Julian Kirchner.

Ethics declarations

Conflict of interest

None.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kirchner, J., Sawicki, L.M., Nensa, F. et al. Prospective comparison of 18F-FDG PET/MRI and 18F-FDG PET/CT for thoracic staging of non-small cell lung cancer. Eur J Nucl Med Mol Imaging 46, 437–445 (2019). https://doi.org/10.1007/s00259-018-4109-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00259-018-4109-x

Keywords

Search

Navigation