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Non–Small Cell Lung Cancer Staging: Efficacy Comparison of Integrated PET/CT versus 3.0-T Whole-Body MR Imaging¹

¹ From the Department of Radiology and Center for Imaging Science (C.A.Y., K.M.S., K.S.L., M.J.C.), Department of Nuclear Medicine (B.T.K., J.Y.C.), and Division of Pulmonary and Critical Care Medicine, Department of Medicine (H.K., O.J.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea. From the 2007 RSNA Annual Meeting. Received October 18, 2007; revision requested January 10, 2008; revision received February 25; accepted March 7; final version accepted March 19. Supported by Samsung Medical Center Clinical Research Development Program grant #CRDP CRS 106-41-2. Address correspondence to K.S.L. (e-mail: kyungs.lee{at}samsung.com).

Purpose: To compare prospectively the diagnostic efficacies of integrated positron emission tomography (PET)/computed tomography (CT) and 3.0-T whole-body magnetic resonance (MR) imaging for determining TNM stages in non–small cell lung cancer (NSCLC).

Materials and Methods: Institutional review board approval and informed consent were obtained. The study included 165 patients (125 men, 40 women; mean age, 61 years) with NSCLC proved at pathologic examination who underwent both unenhanced PET/CT and whole-body MR imaging. Pathologic findings for T (n = 123) and N (n = 150) staging and pathologic or follow-up imaging findings (n = 154) for M staging were reference standards. The efficacies of PET/CT and whole-body MR imaging for lung cancer staging were compared by using the McNemar test.

Results: Primary tumors (n = 123 patients) were correctly staged in 101 (82%) patients at PET/CT and in 106 (86%) patients at whole-body MR imaging (P = .263). N stages (n = 150 patients) were correctly determined in 105 (70%) patients at PET/CT and in 102 (68%) patients at whole-body MR imaging (P = .880). Thirty-one (20%) of 154 patients had metastatic lesions. Accuracy for detecting metastases was 86% (133 of 154 patients) at PET/CT, and that at whole-body MR imaging was 86% (132 of 154 patients) (P > .99). Although the differences were not statistically significant, whole-body MR imaging was more useful for detecting brain and hepatic metastases, whereas PET/CT was more useful for detecting lymph node and soft-tissue metastases.

Conclusion: Both PET/CT and 3.0-T whole-body MR imaging appear to provide acceptable accuracy and comparable efficacy for NSCLC staging, but for M-stage determination, each modality has its own advantages.

© RSNA, 2008

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