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Integrated imaging of non-small cell lung cancer recurrence: CT and PET-CT findings, possible pitfalls and risk of recurrence criteria

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Abstract

Objectives

To review the role of imaging in the diagnosis of recurrent disease in previously treated non-small cell lung cancer (NSCLC) and discuss the imaging pitfalls.

Methods

A comprehensive review of published literature on CT and PET imaging of NSCLC recurrence was performed. Diagnostic and prognostic values are discussed. Representative imaging examples are illustrated.

Results

Up to 30% of NSCLC recurrences present as loco-regional, involving treated hemithorax and ipsilateral lymph nodes, while 70% present as metachronous distant metastases. CT and PET-CT play an important role in the early detection of recurrence; indications for imaging vary depending on pathological features.

Conclusion

Imaging plays a central role in the identification of recurrence and may predict prognosis.

Key Points

  • Lung cancer recurs after surgery in 30% to 75% of patients.

  • CT and PET-CT are crucial in identification of loco-regional recurrence.

  • Knowledge of potential pitfalls is essential, especially for parenchymal or nodal recurrence.

  • CT can diagnose metastases but further examinations (PET-CT, MRI) are often needed.

  • Morphological and functional imaging criteria may help in predicting recurrence.

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Authors and Affiliations

  1. Department of Bioimaging and Radiological Sciences, Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168, Rome, Italy

    Andrea Caulo, Fabio Maggi, Lucia Leccisotti & Lorenzo Bonomo

  2. Clinical Research Imaging Centre, Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK

    Andrea Caulo, Saeed Mirsadraee & Edwin J. R. van Beek

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  1. Andrea Caulo
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  2. Saeed Mirsadraee
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Correspondence to Andrea Caulo.

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Caulo, A., Mirsadraee, S., Maggi, F. et al. Integrated imaging of non-small cell lung cancer recurrence: CT and PET-CT findings, possible pitfalls and risk of recurrence criteria. Eur Radiol 22, 588–606 (2012). https://doi.org/10.1007/s00330-011-2299-8

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