title: Accuracy of whole-body FDG-PET/CT for detecting brain metastases from non-central nervous system tumors.
abstract: OBJECTIVE
  Positron emission tomography (PET) using (18)F-fluoro-2-deoxy-D -glucose (FDG) has a limitation in detecting cerebral metastases; however, the feasibility of detection by inline PET/computed tomography (CT) system remains unknown. We evaluated the accuracy of FDG-PET/CT of body imaging protocol for the detection of cerebral metastases when compared with PET alone and CT alone.
  
  
  METHODS
  Fifty patients underwent whole-body FDG-PET/CT scanning including the brain and contrast enhanced brain MR (magnetic resonance) scan. PET-only, CT-only, and the fused images were interpreted, and the confidence of presence of cerebral metastases was recorded using a five-point grading scale. Area under the receiver-operating characteristic (ROC) curve (Az) was calculated. Differences among the three modalities were tested with the Cochran-Q test, followed by multiple comparisons using the McNemar test with Bonferroni adjustment.
  
  
  RESULTS
  Magnetic resonance imaging revealed 70 cerebral metastatic lesions in 20 patients. Patient-based analysis showed that the sensitivity, specificity, accuracy, and Az of PET-alone interpretation were 45%, 80%, 66%, and 0.6025, respectively, those of CT-alone interpretation were 50%, 97%, 78%, and 0.7158, respectively, and those of fused-image interpretation were 50%, 93%, 76%, and 0.7242, respectively. ROC analysis revealed significant differences among the three interpretation methods (P = 0.0238) and between PET and PET/CT (P = 0.0129). The sensitivity of PET, CT, and fused-image interpretation for detecting 70 lesions was 13%, 20%, and 20%, respectively.
  
  
  CONCLUSIONS
  Even with an integrated PET/CT scanner of body imaging protocol, the sensitivity of cerebral metastases remained unsatisfactory. To assess intracranial lesions, MR scanning should still be considered.
authors.affiliation: Department of Radiology, Dokkyo University School of Medicine, 880 Kita-kobayashi, Mibu, Shimotuga-gun, Tochigi 321-0293, Japan. kazu10041976@yahoo.co.jp
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kitajima
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nakamoto
authors.forename: Hiromi
authors.initials: H
authors.lastname: Okizuka
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Onishi
authors.forename: Michio
authors.initials: M
authors.lastname: Senda
authors.forename: Narufumi
authors.initials: N
authors.lastname: Suganuma
authors.forename: Kazuro
authors.initials: K
authors.lastname: Sugimura