Accuracy of whole-body FDG-PET/CT for detecting brain metastases from non-central nervous system tumors

Ann Nucl Med. 2008 Aug;22(7):595-602. doi: 10.1007/s12149-008-0145-0. Epub 2008 Aug 29.


Objective: Positron emission tomography (PET) using (18)F-fluoro-2-deoxy-D -glucose (FDG) has a limitation in detecting cerebral metastases; however, the feasibility of detection by inline PET/computed tomography (CT) system remains unknown. We evaluated the accuracy of FDG-PET/CT of body imaging protocol for the detection of cerebral metastases when compared with PET alone and CT alone.

Methods: Fifty patients underwent whole-body FDG-PET/CT scanning including the brain and contrast enhanced brain MR (magnetic resonance) scan. PET-only, CT-only, and the fused images were interpreted, and the confidence of presence of cerebral metastases was recorded using a five-point grading scale. Area under the receiver-operating characteristic (ROC) curve (Az) was calculated. Differences among the three modalities were tested with the Cochran-Q test, followed by multiple comparisons using the McNemar test with Bonferroni adjustment.

Results: Magnetic resonance imaging revealed 70 cerebral metastatic lesions in 20 patients. Patient-based analysis showed that the sensitivity, specificity, accuracy, and Az of PET-alone interpretation were 45%, 80%, 66%, and 0.6025, respectively, those of CT-alone interpretation were 50%, 97%, 78%, and 0.7158, respectively, and those of fused-image interpretation were 50%, 93%, 76%, and 0.7242, respectively. ROC analysis revealed significant differences among the three interpretation methods (P = 0.0238) and between PET and PET/CT (P = 0.0129). The sensitivity of PET, CT, and fused-image interpretation for detecting 70 lesions was 13%, 20%, and 20%, respectively.

Conclusions: Even with an integrated PET/CT scanner of body imaging protocol, the sensitivity of cerebral metastases remained unsatisfactory. To assess intracranial lesions, MR scanning should still be considered.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Brain Neoplasms / diagnostic imaging*
  • Brain Neoplasms / secondary
  • Female
  • Fluorodeoxyglucose F18 / pharmacokinetics
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Positron-Emission Tomography* / methods
  • ROC Curve
  • Radiopharmaceuticals / pharmacokinetics
  • Reproducibility of Results
  • Tomography, X-Ray Computed* / methods
  • Whole Body Imaging


  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18