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Value of PET/MRI for assessing tumor resectability in NSCLC-intra-individual comparison with PET/CT


Messerli, Michael; de Galiza Barbosa, Felipe; Marcon, Magda; Muehlematter, Urs J; Stolzmann, Paul; Warschkow, René; Delso, Gaspar; Ter Voert, Edwin Egw; Huellner, Martin W; Frauenfelder, Thomas; Veit-Haibach, Patrick (2018). Value of PET/MRI for assessing tumor resectability in NSCLC-intra-individual comparison with PET/CT. British Journal of Radiology:Epub ahead of print.

Abstract

OBJECTIVE: The purpose of this study was to compare the diagnostic accuracy of positron emission tomography (PET)/MRI with PET/CT for determining tumor resectability of non-small cell lung cancer (NSCLC). METHODS: Sequential trimodality PET/CT/MRI was performed in 36 patients referred with the clinical question of resectability assessment in NSCLC. PET/CT and PET/MR images including T weighted sequence (T-Dixon) and respiration gated T weighted sequence (T-Propeller) were evaluated for resectability-defining factors; i.e. longest diameter of the tumor, minimal tumor distance to the carina, mediastinal invasion, invasion of the carina, pleural infiltration, pericardial infiltration, diaphragm infiltration, presence of additional nodules. RESULTS: There was no significant difference of maximal axial diameter measurements of the primary lung tumors and narrow limits of agreement in Bland-Altman analysis ranging from -11.1  mm to + 11.8  mm for T-Propeller and from -14.3  mm to + 13.8  mm for T-Dixon sequence. A high agreement of PET/MR with PET/CT for the different resectability-defining factors was observed (k from 0.769 to 1.000). There was an excellent agreement of T-Propeller sequence and CT for additional pulmonary nodule detection (k of 0.829 and 0.833), but only a moderate and good agreement using T-Dixon sequence (k of 0.484 and 0.722). CONCLUSION: In NSCLC the use of PET/MRI, including a dedicated pulmonary MR imaging protocol, provides a comparable diagnostic value for determination of tumor resectability compared to PET/CT. ADVANCES IN KNOWLEDGE: Our findings suggest that whole body PET/MRI can safely be used for the local staging of NSCLC patients. Further studies are warranted to determine whether it is feasible to integrate an imaging sequence in a whole body PET/MRI setting with the potential advantage of detection of liver or brain metastases.

Abstract

OBJECTIVE: The purpose of this study was to compare the diagnostic accuracy of positron emission tomography (PET)/MRI with PET/CT for determining tumor resectability of non-small cell lung cancer (NSCLC). METHODS: Sequential trimodality PET/CT/MRI was performed in 36 patients referred with the clinical question of resectability assessment in NSCLC. PET/CT and PET/MR images including T weighted sequence (T-Dixon) and respiration gated T weighted sequence (T-Propeller) were evaluated for resectability-defining factors; i.e. longest diameter of the tumor, minimal tumor distance to the carina, mediastinal invasion, invasion of the carina, pleural infiltration, pericardial infiltration, diaphragm infiltration, presence of additional nodules. RESULTS: There was no significant difference of maximal axial diameter measurements of the primary lung tumors and narrow limits of agreement in Bland-Altman analysis ranging from -11.1  mm to + 11.8  mm for T-Propeller and from -14.3  mm to + 13.8  mm for T-Dixon sequence. A high agreement of PET/MR with PET/CT for the different resectability-defining factors was observed (k from 0.769 to 1.000). There was an excellent agreement of T-Propeller sequence and CT for additional pulmonary nodule detection (k of 0.829 and 0.833), but only a moderate and good agreement using T-Dixon sequence (k of 0.484 and 0.722). CONCLUSION: In NSCLC the use of PET/MRI, including a dedicated pulmonary MR imaging protocol, provides a comparable diagnostic value for determination of tumor resectability compared to PET/CT. ADVANCES IN KNOWLEDGE: Our findings suggest that whole body PET/MRI can safely be used for the local staging of NSCLC patients. Further studies are warranted to determine whether it is feasible to integrate an imaging sequence in a whole body PET/MRI setting with the potential advantage of detection of liver or brain metastases.

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Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Diagnostic and Interventional Radiology
04 Faculty of Medicine > University Hospital Zurich > Clinic for Nuclear Medicine
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:11 October 2018
Deposited On:01 Nov 2018 07:02
Last Modified:01 Nov 2019 12:43
Publisher:British Institute of Radiology
ISSN:0007-1285
OA Status:Green
Free access at:PubMed ID. An embargo period may apply.
Publisher DOI:https://doi.org/10.1259/bjr.20180379
PubMed ID:30209954

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