J Korean Med Sci.  2009 Dec;24(6):1132-1138. 10.3346/jkms.2009.24.6.1132.

Diagnostic Efficacy of PET/CT Plus Brain MR Imaging for Detection of Extrathoracic Metastases in Patients with Lung Adenocarcinoma

• Lee HY
• Lee KS
• Kim BT
• Cho YS
• Lee EJ
• Yi CA
• Chung MJ
• Kim TS
• Kwon OJ
• Kim H

• KMID: 1783144
• DOI: http://doi.org/10.3346/jkms.2009.24.6.1132

Abstract

We aimed to evaluate prospectively the efficacy of positron emission tomography (PET)/computed tomography (CT) plus brain magnetic resonance imaging (MRI) for detecting extrathoracic metastases in lung adenocarcinoma. Metastatic evaluations were feasible for 442 consecutive patients (M:F=238:204; mean age, 54 yr) with a lung adenocarcinoma who underwent PET/CT (CT, without IV contrast medium injection) plus contrast-enhanced brain MRI. The presence of metastases in the brain was evaluated by assessing brain MRI or PET/CT, and in other organs by PET/CT. Diagnostic efficacies for metastasis detection with PET/CT plus brain MRI and with PET/CT only were calculated on a per-patient basis and compared from each other. Of 442 patients, 88 (20%, including 50 [11.3%] with brain metastasis) had metastasis. Regarding sensitivity of overall extrathoracic metastasis detection, a significant difference was found between PET/CT and PET/CT plus brain MRI (68% vs. 84%; P=0.03). As for brain metastasis detection sensitivity, brain MRI was significantly higher than PET/CT (88% vs. 24%; P<0.001). By adding MRI to PET/CT, brain metastases were detected in additional 32 (7% of 442 patients) patients. In lung adenocarcinoma patients, significant increase in sensitivity can be achieved for detecting extrathoracic metastases by adding dedicated brain MRI to PET/CT and thus enhancing brain metastasis detection.

Keyword

PET/CT Scan; Lung Neoplasms; Neoplasm Metastasis; Brain; Magnetic Resonance Imaging; Neoplasm Staging

MeSH Terms

*Adenocarcinoma/diagnosis/pathology/radiography
Adult
Aged
Aged, 80 and over
*Carcinoma, Non-Small-Cell Lung/diagnosis/pathology/radiography
Female
Humans
*Lung Neoplasms/diagnosis/pathology/radiography
Magnetic Resonance Imaging
Male
Middle Aged
*Neoplasm Metastasis
Positron-Emission Tomography/*methods
ROC Curve
Sensitivity and Specificity
Tomography, X-Ray Computed/*methods
Young Adult

Figure

• 

  Fig. 1 A 42-yr-old woman with lung adenocarcinoma and brain metastases. Contrast-enhanced T1-weighted brain MR image (A) clearly demonstrates the presence of cerebellar metastasis (arrow). PET/CT and PET images (B, C) show decreased FDG-uptake.

• 

  Fig. 2 A 27-yr-old man with lung adenocarcinoma and multiple brain metastases. Contrast-enhanced T1-weighted brain MR image (A) shows the presence of multiple small metastases less than 5 mm in diameter (arrows). However, axial images (B, C) of PET/CT and PET images do not indicate the abnormal FDG-uptaking lesion.

Reference

1. Boring CC, Squires TS, Tong T. Cancer Statistics, 1992. CA Cancer J Clin. 1992. 42:19–38.

2. Jemal A, Thomas A, Murray T, Thun M. Cancer statistics, 2002. CA Cancer J Clin. 2002. 52:23–47.

3. The Canadian Lung Oncology Group. Investigating extrathoracic metastatic disease in patients with apparently operable lung cancer. Ann Thorac Surg. 2001. 71:425–433.

4. The American Thoracic Society and the European Respiratory Society. Pretreatment evaluation of non-small-cell lung cancer. The American Thoracic Society and the European Respiratory Society Consensus Report. Am J Respir Crit Care Med. 1997. 156:320–332.

5. Shim SS, Lee KS, Kim BT, Chung MJ, Lee EJ, Han J, Choi JY, Kwon OJ, Shim YM, Kim S. Non-small cell lung cancer: prospective comparison of integrated FDG PET/CT and CT alone for preoperative staging. Radiology. 2005. 236:1011–1019.

6. De Wever W, Vankan Y, Stroobants S, Verschakelen J. Detection of extrapulmonary lesions with integrated PET/CT in the staging of lung cancer. Eur Respir J. 2007. 29:995–1002.

7. Marom EM, McAdams HP, Erasmus JJ, Goodman PC, Culhane DK, Coleman RE, Herndon JE, Patz EF Jr. Staging non-small cell lung cancer with whole-body PET. Radiology. 1999. 212:803–809.

8. Mintz BJ, Tuhrim S, Alexander S, Yang WC, Shanzer S. Intracranial metastases in the initial staging of bronchogenic carcinoma. Chest. 2004. 86:850–853.

9. Newman SJ, Hansen HH. Proceedings: frequency, diagnosis, and treatment of brain metastases in 247 consecutive patients with bronchogenic carcinoma. Cancer. 1974. 33:492–496.

10. Mujoomdar A, Austin JH, Malhotra R, Powell CA, Pearson GD, Shiau MC, Raftopoulos H. Clinical predictors of metastatic disease to the brain from non-small cell lung carcinoma: primary tumor size, cell type, and lymph node metastases. Radiology. 2007. 242:882–888.

11. Kim YK, Lee KS, Kim BT, Choi JY, Kim H, Kwon OJ, Shim YM, Yi CA, Kim HY, Chung MJ. Mediastinal nodal staging of nonsmall cell lung cancer using integrated 18F-FDG PET/CT in a tuberculosis-endemic country: diagnostic efficacy in 674 patients. Cancer. 2007. 109:1068–1077.

12. Lee EJ, Choi JY, Lee KS, Chung HW, Lee SJ, Cho YS, Choi Y, Choe YS, Lee KH, Kwon OJ, Shim YM, Kim BT. Improving diagnostic accuracy for malignant nodes and N staging in non-small cell lung cancer using CT-corrected FDG-PET. Korean J Nucl Med. 2005. 39:231–238.

13. Hanley JA, McNeil BJ. A method comparing the areas under receiver operator characteristic curves derived from the same cases. Radiology. 1983. 148:839–843.

14. Hillers TK, Sauve MD, Guyatt GH. Analysis of published studies on the detection of extrathoracic metastases in patients presumed to have operable non-small cell lung cancer. Thorax. 1994. 49:14–19.

15. Silvestri GA, Littenberg B, Colice GL. The clinical evaluation for detecting metastatic lung cancer: a meta-analysis. Am J Respir Crit Care Med. 1995. 152:225–230.

16. Toloza EM, Harpole L, McCrory DC. Noninvasive staging of nonsmall cell lung cancer: a review of the current evidence. Chest. 2003. 123:137S–146S.

17. Jena A, Taneja S, Talwar V, Sharma JB. Magnetic resonance (MR) patterns of brain metastasis in lung cancer patients: correlation of imaging findings with symptom. J Thorac Oncol. 2008. 3:140–144.

18. Yokoi K, Kamiya N, Matsuguma H, Machida S, Hirose T, Mori K, Tominaga K. Detection of brain metastasis in potentially operable non-small cell lung cancer: a comparison of CT and MRI. Chest. 1999. 115:714–719.

19. Silvestri GA, Gould MK, Margolis ML, Tanoue LT, McCrory D, Toloza E, Detterbeck F. American College of Chest Physicians. Noninvasive staging of non-small cell lung cancer: ACCP evidencedbased clinical practice guidelines (2nd edition). Chest. 2007. 132:3 Suppl. S178–S201.

20. Sorensen JB, Hansen HH, Hansen M, Dombernowsky P. Brain metastases in adenocarcinoma of the lung: frequency, risk groups, and prognosis. J Clin Oncol. 1988. 6:1474–1480.

21. Zabel A, Milker-Zabel S, Thilmann C, Zuna I, Rhein B, Wannenmacher M, Debus J. Treatment of brain metastasis in patients with non-small cell lung cancer (NSCLC) by stereotactic linac-based radiosurgery: prognostic factors. Lung Cancer. 2002. 37:87–94.

22. Ohno Y, Koyama H, Nogami M, Takenaka D, Yoshikawa T, Yoshimura M, Kotani Y, Nishimura Y, Higashino T, Sugimura K. Whole-body MR imaging vs. FDG-PET: comparison of accuracy of M-stage diagnosis for lung cancer patients. J Magn Reson Imaging. 2007. 26:498–509.

23. Yi CA, Shin KM, Lee KS, Kim BT, Kim H, Kwon OJ, Choi JY, Chung MJ. Non-small cell lung cancer staging: efficacy comparison of integrated PET/CT versus 3.0-T whole-body MR imaging. Radiology. 2008. 248:632–642.

24. Cox JD, Yesner R. Adenocarcinoma of the lung: recent results from the veterans administration lung group. Am Rev Respir Dis. 1979. 120:1025–1029.

25. Cox JD, Scott CB, Byhardt RW, Emami B, Russell AH, Fu KK, Parliament MB, Komaki R, Gaspar LE. Addition of chemotherapy to radiation therapy alters failure patterns by cell type within non-small cell carcinoma of lung (NSCCL): analysis of radiation therapy oncology group (RTOG) trials. Int J Radiat Oncol Biol Phys. 1999. 43:505–509.

26. Robnett TJ, Machtay M, Stevenson JP, Algazy KM, Hahn SM. Factors affecting the risk of brain metastases after definitive chemoradiation for locally advanced non-small-cell lung carcinoma. J Clin Oncol. 2001. 19:1344–1349.

27. Davis PC, Hudgins PA, Peterman SB, Hoffman JC Jr. Diagnosis of cerebral metastases: double-dose delayed CT vs contrast enhanced MR imaging. AJNR Am J Neuroradiol. 1991. 12:293–300.