Prospective comparison of 18F-FDG PET/MRI and 18F-FDG PET/CT for thoracic staging of non-small cell lung cancer

Julian Kirchner; Lino M Sawicki; Felix Nensa; Benedikt M Schaarschmidt; Henning Reis; Marc Ingenwerth; Simon Bogner; Clemens Aigner; Christian Buchbender; Lale Umutlu; Gerald Antoch; Ken Herrmann; Philipp Heusch

doi:10.1007/s00259-018-4109-x

Prospective comparison of ¹⁸F-FDG PET/MRI and ¹⁸F-FDG PET/CT for thoracic staging of non-small cell lung cancer

Eur J Nucl Med Mol Imaging. 2019 Feb;46(2):437-445. doi: 10.1007/s00259-018-4109-x. Epub 2018 Aug 3.

Authors

Affiliations

¹ Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Moorenstrasse 5, D-40225, Dusseldorf, Germany. Julian.Kirchner@med.uni-duesseldorf.de.
² Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Moorenstrasse 5, D-40225, Dusseldorf, Germany.
³ Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147, Essen, Germany.
⁴ Institute of Pathology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK) Essen, D-45147, Essen, Germany.
⁵ Department of Medical Oncology, University Hospital Essen, West German Cancer Center, University of Duisburg-Essen, D-45122, Essen, Germany.
⁶ Department of Thoracic Surgery and Surgical Endoscopy, University Hospital Essen, Ruhrlandklinik, University of Duisburg-Essen, D-45147, Essen, Germany.
⁷ Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, D-45147, Essen, Germany.

PMID: 30074073
DOI: 10.1007/s00259-018-4109-x

Abstract

Objectives: To compare the diagnostic performance of ¹⁸F-FDG PET/MRI and ¹⁸F-FDG PET/CT for primary and locoregional lymph node staging in non-small cell lung cancer (NSCLC).

Methods: In this prospective study, a total of 84 patients (51 men, 33 women, mean age 62.5 ± 9.1 years) with histopathologically confirmed NSCLC underwent ¹⁸F-FDG PET/CT followed by ¹⁸F-FDG PET/MRI in a single injection protocol. Two readers independently assessed T and N staging in separate sessions according to the seventh edition of the American Joint Committee on Cancer staging manual for ¹⁸F-FDG PET/CT and ¹⁸F-FDG PET/MRI, respectively. Histopathology as a reference standard was available for N staging in all 84 patients and for T staging in 39 patients. Differences in staging accuracy were assessed by McNemars chi² test. The maximum standardized uptake value (SUV_max) and longitudinal diameters of primary tumors were correlated using Pearson's coefficients.

Results: T stage was categorized concordantly in ¹⁸F-FDG PET/MRI and ¹⁸F-FDG PET/CT in 38 of 39 (97.4%) patients. Herein, ¹⁸F-FDG PET/CT and ¹⁸F-FDG PET/MRI correctly determined the T stage in 92.3 and 89.7% of patients, respectively. N stage was categorized concordantly in 83 of 84 patients (98.8%). ¹⁸F-FDG PET/CT correctly determined the N stage in 78 of 84 patients (92.9%), while ¹⁸F-FDG PET/MRI correctly determined the N stage in 77 of 84 patients (91.7%). Differences between ¹⁸F-FDG PET/CT and ¹⁸F-FDG PET/MRI in T and N staging accuracy were not statistically significant (p > 0.5, each). Tumor size and SUV_max measurements derived from both imaging modalities exhibited excellent correlation (r = 0.963 and r = 0.901, respectively).

Conclusion: ¹⁸F-FDG PET/MRI and ¹⁸F-FDG PET/CT show an equivalently high diagnostic performance for T and N staging in patients suffering from NSCLC.

Keywords: NSCLC; PET/CT; PET/MRI; Thoracic staging.

Publication types

Clinical Trial
Comparative Study

MeSH terms

Carcinoma, Non-Small-Cell Lung / diagnostic imaging*
Carcinoma, Non-Small-Cell Lung / pathology*
Female
Fluorodeoxyglucose F18*
Humans
Lung Neoplasms / diagnostic imaging*
Lung Neoplasms / pathology*
Magnetic Resonance Imaging*
Male
Middle Aged
Neoplasm Staging
Positron Emission Tomography Computed Tomography*
Prospective Studies
Thorax

Substances

Fluorodeoxyglucose F18