title: Diagnostic impact of integrated 18F-FDG PET/MRI in cerebral staging of patients with non-small cell lung cancer.
abstract: Background Integrated positron emission tomography/magnetic resonance imaging (PET/MRI) systems are increasingly being available and used for staging examinations. Brain metastases (BM) are frequent in patients with non-small cell lung cancer (NSCLC) and decisive for treatment strategy. Purpose To assess the diagnostic value of integrated 18F-2-fluoro-2-deoxy-D glucose (18F-FDG) PET/MRI in initial staging in patients with NSCLC for BM in comparison to MRI alone. Material and Methods Eighty-three patients were prospectively enrolled for an integrated 18F-FDG PET/MRI examination. The 3 T MRI protocol included a fluid-attenuated inversion-recovery sequence (FLAIR) and a contrast-enhanced three-dimensional magnetization prepared rapid acquisition GRE sequence (MPRAGE). Two neuroradiologists evaluated the datasets in consensus regarding: (i) present lesions; (ii) size of lesions; and (iii) number of lesions detected in MRI alone, compared to the PET component when reading the 18F-FDG PET/MRI. Results Based on MRI alone, BM were detected in 15 out of the 83 patients, comprising a total of 39 metastases. Based on PET alone, six patients out of the 83 patients were rated positive for metastatic disease, revealing a total of 15 metastases. PET detected no additional BM. The size of the BM correlated positively with sensitivity of detection in PET. Conclusion The sensitivity of PET in detection of BM depends on their size. 18F-FDG PET/MRI does not lead to an improvement in diagnostic accuracy in cerebral staging of NSCLC patients, as MRI alone remains the gold standard.
authors.affiliation: 1 Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital of Essen, Essen, Germany.|2 Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Germany.
authors.forename: Cornelius
authors.initials: C
authors.lastname: Deuschl
authors.affiliation: 1 Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital of Essen, Essen, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Nensa
authors.affiliation: 1 Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital of Essen, Essen, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Grueneisen
authors.affiliation: 3 Clinic for Nuclear Medicine, University Hospital of Essen, Essen, Germany.
authors.forename: Thorsten D
authors.initials: TD
authors.lastname: Poeppel
authors.affiliation: 4 Institute of Diagnostic and Interventional Radiology, University Hospital of Duesseldorf, Duesseldorf, Germany.
authors.forename: Lino M
authors.initials: LM
authors.lastname: Sawicki
authors.affiliation: 4 Institute of Diagnostic and Interventional Radiology, University Hospital of Duesseldorf, Duesseldorf, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Heusch
authors.affiliation: 1 Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital of Essen, Essen, Germany.|5 Department of Neuroradiology, University Hospital of Gießen, Germany.
authors.forename: Carolin
authors.initials: C
authors.lastname: Gramsch
authors.affiliation: 1 Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital of Essen, Essen, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Mönninghoff
authors.affiliation: 2 Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Germany.|6 High Field and Hybrid MR Imaging, University Hospital of Essen, Essen, Germany.
authors.forename: Harald H
authors.initials: HH
authors.lastname: Quick
authors.affiliation: 1 Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital of Essen, Essen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Forsting
authors.affiliation: 1 Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital of Essen, Essen, Germany.
authors.forename: Lale
authors.initials: L
authors.lastname: Umutlu
authors.affiliation: 1 Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital of Essen, Essen, Germany.|5 Department of Neuroradiology, University Hospital of Gießen, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Schlamann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000473:pathology*; D003287:Contrast Media; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D021621:Imaging, Three-Dimensional; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: 18F-FDG-PET; Lung cancer; cerebral metastases; integrated PET/MRI; magnetic resonance imaging (MRI); staging