Hybrid PET/MRI in non-small cell lung cancer (NSCLC) and lung nodules—a literature review



The use of hybrid PET/MRI for clinical staging is growing in several cancer forms and, consequently, PET/MRI has also gained interest in the assessment of non-small cell lung cancer (NSCLC) and lung lesions. However, lung evaluation with PET/MRI is associated with challenges related to technical issues and diagnostic image quality. We, therefore, investigated the published literature on PET/MRI for clinical staging in NSCLC or lung nodule detection specifically addressing diagnostic accuracy and technical issues.


The data originates from a systematic search performed in PubMed/MEDLINE, Embase, and Cochrane Library on hybrid PET/MRI in patients with cancer for a scoping review published earlier (https://doi.org/10.1007/s00259-019-04402-8). Studies in English and German evaluating the diagnostic performance of hybrid PET/MRI for NSCLC or lung nodule detection in cancer patients were selected. Data reported in peer-reviewed journals without restrictions to year of publication were included.


A total of 3138 publications were identified from which 116 published 2012–2018 were included. Of these, nine studies addressed PET/MRI in NSCLC (4) or lung nodule detection (5). Overall, PET/MRI did not provide advantages in preoperative T- and N-staging in NSCLC compared to PET/CT. The data on M-staging were too few for conclusions to be drawn. The lung nodule detection rate of PET/MRI was comparable to that of PET/CT for FDG-avid nodules larger than 10 mm, but the sensitivity of PET/MRI for detection of non-FDG-avid nodules smaller than 5 mm was low.


PET/MRI did not provide advantages in T- and N-staging of NSCLC compared to PET/CT. PET/MRI had a comparable sensitivity for detection of FDG-avid lung nodules and nodules over 10 mm, but PET/CT yielded a higher detection rate in non FDG-avid lung nodules under 5 mm. With PET/MRI, the overall detection rate for lung nodules in various cancer types remains inferior to that of PET/CT due to the lower diagnostic performance of MRI than CT in the lungs.

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Research librarian L. Østengaard, PhD, University Library of Southern Denmark and Head of Department, and Associate Professor J.S. Madsen, Biochemistry and Immunology, Institute of Regional Health Research, University of Southern Denmark are acknowledged for help with the literature search.

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Dahlsgaard-Wallenius, S.E., Hildebrandt, M.G., Johansen, A. et al. Hybrid PET/MRI in non-small cell lung cancer (NSCLC) and lung nodules—a literature review. Eur J Nucl Med Mol Imaging 48, 584–591 (2021). https://doi.org/10.1007/s00259-020-04955-z

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  • PET/CT
  • 18F-FDG
  • Lung lesions