title: A proposal for combined MRI and PET/CT interpretation criteria for preoperative nodal staging in non-small-cell lung cancer.
abstract: OBJECTIVE
  To determine the positive reading criteria for malignant nodes when interpreting combined MRI and PET/CT images for preoperative nodal staging in non-small-cell lung cancer (NSCLC).
  
  
  METHODS
  Forty-nine patients with biopsy-proven NSCLC underwent both PET/CT and thoracic MRI [diffusion weighted imaging (DWI)]. Each nodal station was evaluated for the presence of metastasis by applying either inclusive (positive if either one read positive) or exclusive (positive if both read positive) criteria in the combined interpretation of PET/CT and MRI. Nodal stage was confirmed pathologically. The combined diagnostic accuracy of PET/CT and MRI was determined on per-nodal station and per-patient bases and compared with that of PET/CT alone.
  
  
  RESULTS
  In 49 patients, 39 (19%) of 206 nodal stations harboured malignant cells. Out of 206 nodal stations, 186 (90%) had concordant readings, while the rest (10%) had discordant readings. Inclusive criteria of combined PET/CT and MRI helped increase sensitivity for detecting nodal metastasis (69%) compared with PET/CT alone (46%; P = 0.003), while specificity was not significantly decreased.
  
  
  CONCLUSIONS
  Inclusive criteria in combined MRI and PET/CT readings help improve significantly the sensitivity for detecting nodal metastasis compared with PET/CT alone and may decrease unnecessary open thoracotomy.                                                     Key Points                                                  • Combined interpretation of MRI and PET/CT enhances the detection of nodal metastasis.                                                  • Inclusive criteria of combined MRI/PET/CT improved the sensitivity for detecting nodal metastasis.                                                  • Combined interpretation of MRI and PET/CT may reduce unnecessary open thoracotomies.
authors.affiliation: Department of Radiology and the Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Yoo Na
authors.initials: YN
authors.lastname: Kim
authors.forename: Chin A
authors.initials: CA
authors.lastname: Yi
authors.forename: Kyung Soo
authors.initials: KS
authors.lastname: Lee
authors.forename: O Jung
authors.initials: OJ
authors.lastname: Kwon
authors.forename: Ho Yun
authors.initials: HY
authors.lastname: Lee
authors.forename: Byung-Tae
authors.initials: BT
authors.lastname: Kim
authors.forename: Joon Young
authors.initials: JY
authors.lastname: Choi
authors.forename: Seon Woo
authors.initials: SW
authors.lastname: Kim
authors.forename: Man Pyo
authors.initials: MP
authors.lastname: Chung
authors.forename: Joungho
authors.initials: J
authors.lastname: Han
authors.forename: Tae Sung
authors.initials: TS
authors.lastname: Kim
authors.forename: Myung Jin
authors.initials: MJ
authors.lastname: Chung
authors.forename: Young Mog
authors.initials: YM
authors.lastname: Shim
mesh_terms: D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology* / Q000556:secondary* / Q000601:surgery; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011300:Preoperative Care; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013382:Subtraction Technique; D014057:Tomography, X-Ray Computed