Published online before print September 25, 2003, 10.1148/radiol.2292021598
Non–Small Cell Lung Cancer: Dual-Modality PET/CT in Preoperative Staging1
Gerald Antoch, MD,
Jörg Stattaus, MD,
Andre T. Nemat, MD,
Simone Marnitz, MD,
Thomas Beyer, PhD,
Hilmar Kuehl, MD,
Andreas Bockisch, MD, PhD,
Jörg F. Debatin, MD, MBA and
Lutz S. Freudenberg, MD
1 From the Departments of Diagnostic and Interventional Radiology (G.A., J.S., T.B., H.K., J.F.D.), Radiation Therapy (S.M.), and Nuclear Medicine (T.B., A.B., L.S.F.), University Hospital Essen, Hufelandstrasse 55, 45122 Essen, Germany; and Department of Thoracic Surgery, Ruhrlandclinic, Essen, Germany (A.T.N.). Received November 28, 2002; revision requested February 6, 2003; revision received March 4; accepted April 14. Address correspondence to G.A. (e-mail: gerald.antoch@uni-essen.de).
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Figure 1a. Transverse (a) CT, (b) PET, and (c) PET/CT images obtained in 56-year-old man with NSCLC of right upper lung lobe. (a) Accurate differentiation of tumor tissue from atelectasis is not possible with CT. (b) With PET, tumor (arrow) size can be evaluated sufficiently; however, involvement of the pleura is not assessable. (c) On PET/CT image, the tumor can be accurately differentiated from pulmonary atelectasis, and involvement of the visceral pleura is suspected. This patient was deemed to have T2 cancer on the basis of PET/CT image findings. This T stage was later verified at histopathologic analysis.
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Figure 1b. Transverse (a) CT, (b) PET, and (c) PET/CT images obtained in 56-year-old man with NSCLC of right upper lung lobe. (a) Accurate differentiation of tumor tissue from atelectasis is not possible with CT. (b) With PET, tumor (arrow) size can be evaluated sufficiently; however, involvement of the pleura is not assessable. (c) On PET/CT image, the tumor can be accurately differentiated from pulmonary atelectasis, and involvement of the visceral pleura is suspected. This patient was deemed to have T2 cancer on the basis of PET/CT image findings. This T stage was later verified at histopathologic analysis.
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Figure 1c. Transverse (a) CT, (b) PET, and (c) PET/CT images obtained in 56-year-old man with NSCLC of right upper lung lobe. (a) Accurate differentiation of tumor tissue from atelectasis is not possible with CT. (b) With PET, tumor (arrow) size can be evaluated sufficiently; however, involvement of the pleura is not assessable. (c) On PET/CT image, the tumor can be accurately differentiated from pulmonary atelectasis, and involvement of the visceral pleura is suspected. This patient was deemed to have T2 cancer on the basis of PET/CT image findings. This T stage was later verified at histopathologic analysis.
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Figure 2a. Transverse images obtained in 53-year-old man with NSCLC of left lower lung lobe. (a) CT image shows pathologically enlarged lymph node (arrow) inferior to the carina, but (b) PET and (c) fused PET/CT images do not depict focally increased glucose metabolism. The false-positive CT finding was corrected on the basis of PET and combined PET/CT findings. Histopathologic analysis did not reveal mediastinal lymph node involvement.
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Figure 2b. Transverse images obtained in 53-year-old man with NSCLC of left lower lung lobe. (a) CT image shows pathologically enlarged lymph node (arrow) inferior to the carina, but (b) PET and (c) fused PET/CT images do not depict focally increased glucose metabolism. The false-positive CT finding was corrected on the basis of PET and combined PET/CT findings. Histopathologic analysis did not reveal mediastinal lymph node involvement.
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Figure 2c. Transverse images obtained in 53-year-old man with NSCLC of left lower lung lobe. (a) CT image shows pathologically enlarged lymph node (arrow) inferior to the carina, but (b) PET and (c) fused PET/CT images do not depict focally increased glucose metabolism. The false-positive CT finding was corrected on the basis of PET and combined PET/CT findings. Histopathologic analysis did not reveal mediastinal lymph node involvement.
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Figure 3a. Transverse images obtained in 68-year-old man with NSCLC of right upper lung lobe. (a) CT, (b) PET, and (c) PET/CT images depict a lymph node metastasis (arrow), which was not suspected on the basis of clinical examination findings and not sampled at mediastinoscopy. Follow-up findings in this patient confirmed the diagnosis.
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Figure 3b. Transverse images obtained in 68-year-old man with NSCLC of right upper lung lobe. (a) CT, (b) PET, and (c) PET/CT images depict a lymph node metastasis (arrow), which was not suspected on the basis of clinical examination findings and not sampled at mediastinoscopy. Follow-up findings in this patient confirmed the diagnosis.
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Figure 3c. Transverse images obtained in 68-year-old man with NSCLC of right upper lung lobe. (a) CT, (b) PET, and (c) PET/CT images depict a lymph node metastasis (arrow), which was not suspected on the basis of clinical examination findings and not sampled at mediastinoscopy. Follow-up findings in this patient confirmed the diagnosis.
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Figure 4a. Transverse images obtained in 58-year-old man with NSCLC of right upper lung lobe. (a) At CT, only mild sclerosis (arrow) of the right pubic bone is seen, but both (b) PET and (c) PET/CT depict focally increased glucose metabolism indicative of bone metastasis. PET/CT findings were verified at histopathologic analysis.
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Figure 4b. Transverse images obtained in 58-year-old man with NSCLC of right upper lung lobe. (a) At CT, only mild sclerosis (arrow) of the right pubic bone is seen, but both (b) PET and (c) PET/CT depict focally increased glucose metabolism indicative of bone metastasis. PET/CT findings were verified at histopathologic analysis.
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Figure 4c. Transverse images obtained in 58-year-old man with NSCLC of right upper lung lobe. (a) At CT, only mild sclerosis (arrow) of the right pubic bone is seen, but both (b) PET and (c) PET/CT depict focally increased glucose metabolism indicative of bone metastasis. PET/CT findings were verified at histopathologic analysis.
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Figure 5a. Transverse (a) CT, (b) PET, and (c) PET/CT images obtained in 58-year-old man with NSCLC of right middle lung lobe. (a) At CT, a pulmonary metastasis (arrow) was detected in the right upper lobe, and the diagnosis was verified at radiologic follow-up. (b) PET scan was negative for pulmonary metastases. (c) Diagnosis of the pulmonary metastasis depicted on PET/CT images was based on the CT data.
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Figure 5b. Transverse (a) CT, (b) PET, and (c) PET/CT images obtained in 58-year-old man with NSCLC of right middle lung lobe. (a) At CT, a pulmonary metastasis (arrow) was detected in the right upper lobe, and the diagnosis was verified at radiologic follow-up. (b) PET scan was negative for pulmonary metastases. (c) Diagnosis of the pulmonary metastasis depicted on PET/CT images was based on the CT data.
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Figure 5c. Transverse (a) CT, (b) PET, and (c) PET/CT images obtained in 58-year-old man with NSCLC of right middle lung lobe. (a) At CT, a pulmonary metastasis (arrow) was detected in the right upper lobe, and the diagnosis was verified at radiologic follow-up. (b) PET scan was negative for pulmonary metastases. (c) Diagnosis of the pulmonary metastasis depicted on PET/CT images was based on the CT data.
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Copyright © 2003 by the Radiological Society of North America.
