Prognostic impact of combining whole-body PET/CT and brain PET/MR in patients with lung adenocarcinoma and brain metastases

  • Kung-Chu Ho
  • Cheng-Hong Toh
  • Shih-Hong Li
  • Chien-Ying Liu
  • Cheng-Ta Yang
  • Yu-Jen Lu
  • Tzu-Pei Su
  • Chih-Wei Wang
  • Tzu-Chen YenEmail author
Original Article



The role of brain FDG-PET in patients with lung cancer and brain metastases remains unclear. Here, we sought to determine the prognostic significance of whole-body PET/CT plus brain PET/MR in predicting the time to neurological progression (nTTP) and overall survival (OS) in this patient group.


Of 802 patients with non-small cell lung cancer who underwent primary staging by a single-day protocol of whole-body PET/CT plus brain PET/MR, 72 cases with adenocarcinoma and brain metastases were enrolled for a prognostic analysis of OS. On the basis of the available follow-up brain status, only 52 patients were eligible for prognostic analysis of nTTP. Metastatic brain tumors were identified on post-contrast MR imaging, and the tumor-to-brain ratio (TBR) was measured on PET images.


Multivariate analysis revealed that FDG-PET findings and eligibility for initial treatment with targeted therapy were significant independent predictors of nTTP and OS. A new index, termed the molecular imaging prognostic (MIP) score, was proposed to define three disease classes. MIP scores were significant predictors of both nTTP and OS (P < 0.001). Pre-existing prognostic indices such as Lung-molGPA scores were significant predictors of OS but did not predict nTTP.


When staging is performed with whole-body PET/CT plus brain PET/MR, our new prognostic index may be helpful to stratify the outcomes of patients with lung adenocarcinoma and brain metastases. The superior prognostic power of this index for nTTP might be used to select appropriate patients for intracranial control and thereby achieve better quality of life.


Lung adenocarcinoma Brain metastasis PET/CT PET/MR 



This study was financially supported by a grant from the Chang Gung Memorial Hospital (CMRPG3B0343), Taiwan. The authors acknowledge the statistical assistance provided by the Clinical Trial Center (MOHW107-TDU-B-212-123005), Linkou, Taiwan.


This study was financially supported by a grant from the Chang Gung Memorial Hospital (CMRPG3B0343), Taiwan.

Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest.

Ethical approval

All procedures performed in the study were in accordance with the ethical standards of the institutional and/or national research committee and the 1964 Helsinki Declaration (and its later amendments).

Informed consent

Waiver of consent for this retrospective study was approved by the Institutional Review Board.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Kung-Chu Ho
    • 1
  • Cheng-Hong Toh
    • 2
  • Shih-Hong Li
    • 3
  • Chien-Ying Liu
    • 3
  • Cheng-Ta Yang
    • 3
  • Yu-Jen Lu
    • 4
  • Tzu-Pei Su
    • 1
  • Chih-Wei Wang
    • 5
  • Tzu-Chen Yen
    • 6
    • 7
    Email author
  1. 1.Department of Nuclear MedicineChang Gung Memorial Hospital and Chang Gung UniversityKeelungTaiwan
  2. 2.Department of Medical Imaging and InterventionChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
  3. 3.Department of Thoracic MedicineChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
  4. 4.Department of NeurosurgeryChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
  5. 5.Department of Anatomic PathologyChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
  6. 6.Department of Nuclear Medicine and Center for Advanced Molecular Imaging and TranslationChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
  7. 7.Department of Nuclear MedicineXiamen Chang Gung HospitalXiamenChina

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