title: Brain metastasis in lung cancer. Comparison of cerebral MRI and 18F-FDG-PET/CT for diagnosis in the initial staging.
abstract: FDG-PET/CT is increasingly used in staging of lung cancer as single "one stop shop" method. AIM, PATIENTS, METHODS: We prospectively included 104 neurological asymptomatic patients (65 years, 26% women) with primary diagnosis of lung cancer. In all patients PET/CT including cerebral imaging and cerebral MRI were performed.
  
  
  RESULTS
  Diagnosis of brain metastases (BM) was made by PET/CT in 8 patients only (7.7%), by MRI in 22 (21.2%). In 80 patients both PET/CT and MRI showed no BM. In 6 patients (5.8%) BM were detectable on PET/CT as well as on MRI. Exclusive diagnosis of BM by MRI with negative finding on PET/CT was present in 16 patients (15.4%). 2 patients (1.9%) had findings typical for BM on PET/CT but were negative on MRI. With MRI overall 100 BM were detected, with PET/CT only 17 BM (p < 0.01). For the diagnosis of BM PET/CT showed a sensitivity of 27.3%, specificity of 97.6%, positive predictive value of 75% and negative predictive value of 83.3%. BM diameter on PET/CT and MRI were consistent in 43%, in 57% BM were measured larger on MRI.
  
  
  CONCLUSIONS
  Compared to the gold standard of MRI for cerebral staging a considerable number of patients are falsely diagnosed as free from BM by PET/CT. MRI is more accurate than PET/CT for detecting multiple and smaller BM.
  
  
  CONCLUSIONS
  In patients with a curative option MRI should be performed additionally to PET/CT for definitive exclusion of brain metastases.
authors.affiliation: Medical Clinic II, Medical Faculty, University of Ulm, Germany. stkrueger@ukaachen.de
authors.forename: S
authors.initials: S
authors.lastname: Krüger
authors.forename: F M
authors.initials: FM
authors.lastname: Mottaghy
authors.forename: A K
authors.initials: AK
authors.lastname: Buck
authors.forename: S
authors.initials: S
authors.lastname: Maschke
authors.forename: H
authors.initials: H
authors.lastname: Kley
authors.forename: D
authors.initials: D
authors.lastname: Frechen
authors.forename: T
authors.initials: T
authors.lastname: Wibmer
authors.forename: S N
authors.initials: SN
authors.lastname: Reske
authors.forename: S
authors.initials: S
authors.lastname: Pauls
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000556:secondary*; D002277:Carcinoma / Q000175:diagnosis / Q000453:epidemiology / Q000556:secondary; D005260:Female; D019788:Fluorodeoxyglucose F18; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000453:epidemiology*; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography / Q000706:statistics & numerical data*; D015995:Prevalence; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18