title: Non-small-cell lung cancer resectability: diagnostic value of PET/MR.
abstract: OBJECTIVE
  To assess the diagnostic performance of PET/MR in patients with non-small-cell lung cancer.
  
  
  METHODS
  Fifty consecutive consenting patients who underwent routine (18)F-FDG PET/CT for potentially radically treatable lung cancer following a staging CT scan were recruited for PET/MR imaging on the same day. Two experienced readers, unaware of the results with the other modalities, interpreted the PET/MR images independently. Discordances were resolved in consensus. PET/MR TNM staging was compared to surgical staging from thoracotomy as the reference standard in 33 patients. In the remaining 17 nonsurgical patients, TNM was determined based on histology from biopsy, imaging results (CT and PET/CT) and follow-up. ROC curve analysis was used to assess accuracy, sensitivity and specificity of the PET/MR in assessing the surgical resectability of primary tumour. The kappa statistic was used to assess interobserver agreement in the PET/MR TNM staging. Two different readers, without knowledge of the PET/MR findings, subsequently separately reviewed the PET/CT images for TNM staging. The generalized kappa statistic was used to determine intermodality agreement between PET/CT and PET/MR for TNM staging.
  
  
  RESULTS
  ROC curve analysis showed that PET/MR had a specificity of 92.3 % and a sensitivity of 97.3 % in the determination of resectability with an AUC of 0.95. Interobserver agreement in PET/MR reading ranged from substantial to perfect between the two readers (Cohen's kappa 0.646 - 1) for T stage, N stage and M stage. Intermodality agreement between PET/CT and PET/MR ranged from substantial to almost perfect for T stage, N stage and M stage (Cohen's kappa 0.627 - 0.823).
  
  
  CONCLUSIONS
  In lung cancer patients PET/MR appears to be a robust technique for preoperative staging.
authors.affiliation: Department of Nuclear Medicine and Radiology, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, NW1 2BU, UK, fraioli.francesco@gmail.com.
authors.forename: Francesco
authors.initials: F
authors.lastname: Fraioli
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Screaton
authors.forename: Samuel M
authors.initials: SM
authors.lastname: Janes
authors.forename: Thida
authors.initials: T
authors.lastname: Win
authors.forename: Leon
authors.initials: L
authors.lastname: Menezes
authors.forename: Irfan
authors.initials: I
authors.lastname: Kayani
authors.forename: Rizwan
authors.initials: R
authors.lastname: Syed
authors.forename: Fulvio
authors.initials: F
authors.lastname: Zaccagna
authors.forename: Celia
authors.initials: C
authors.lastname: O'Meara
authors.forename: Anna
authors.initials: A
authors.lastname: Barnes
authors.forename: Jamshed B
authors.initials: JB
authors.lastname: Bomanji
authors.forename: Shonit
authors.initials: S
authors.lastname: Punwani
authors.forename: Ashley M
authors.initials: AM
authors.lastname: Groves
mesh_terms: D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009367:Neoplasm Staging; D015588:Observer Variation; D049268:Positron-Emission Tomography; D057234:Preoperative Period; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18