Utility of 18F-FDG PET/CT Combined With Dedicated Brain PET/MRI in Determination Of Brain Metastasis From Lung Cancer
Keywords:
Brain metastasis, 18F-FDG, lung cancer, PET/CT, PET/MRIAbstract
Background and Purpose: Diagnosing brain metastasis is important in managing lung cancer. We compared 18F-FDG PET/CT combined with dedicated brain PET/MRI and 18F-FDG PET/CT alone in diagnosing brain metastasis from lung cancer and investigated the quantitative parameters affecting the positivity of PET scans. Methods: This study included 89 patients (age: 43–88 years; 58% men) with pathologically confirmed lung cancer who underwent whole-body 18F-FDG PET/CT and dedicated brain PET/MRI with gadolinium contrast enhancement. Imaging data acquired between October 2020 and February 2021 were retrospectively collected, and MRI findings were used as the reference standard for diagnosing brain metastasis. The detection of brain metastasis was compared between 18F-FDG PET/CT alone and 18F-FDG PET/CT combined with dedicated brain PET/MRI. Quantitative parameters were analyzed to determine factors affecting the positivity of the PET scan results. Correlations between these quantitative parameters were also examined. Results: Per-patient and per-lesion detection of brain metastasis on PET/CT alone versus that combined with dedicated brain PET/MRI with gadolinium contrast enhancement showed ratios of 0.64 and 0.17, respectively. Quantitative parameters with the highest areas under the curve from receiver operating characteristics analysis were the maximum tumor-to-background ratio and the size of the metastasis. The optimum maximum tumor-to-background ratio cut-off, with the highest area under the curve, for PET positivity was 1.83. The minimum and mean lesion sizes for detection on PET were 0.3 cm and 1.45 cm, respectively. Conclusions: PET/MRI can augment the detection of brain metastasis from lung cancer compared with PET/CT alone. High FDG background activity in the brain parenchyma may hinder the positivity of PET results. Therefore, MRI is important for detecting brain metastasis.
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Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-249. doi:10.3322/caac.21660
Investigating extrathoracic metastatic disease in patients with apparently operable lung cancer. The Canadian Lung Oncology Group. Ann Thorac Surg. 2001;71(2):425-434.
Vogelbaum MA, Brown PD, Messersmith H, et al. Treatment for Brain Metastases: ASCO-SNO-ASTRO Guideline [published correction appears in J Clin Oncol. 2022 Apr 20;40(12):1392. doi: 10.1200/JCO.22.00593]. J Clin Oncol. 2022;40(5):492-516. doi:10.1200/JCO.21.02314
National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology. Non-Small Cell Lung Cancer Version7.2021. https://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf. Accessed November 10, 2021.
Ernani V, Stinchcombe TE. Management of Brain Metastases in Non-Small-Cell Lung Cancer [published correction appears in JCO Oncol Pract. 2020 Mar;16(3):149. doi: 10.1200/JOP.20.00042]. J Oncol Pract. 2019;15(11):563-570. doi:10.1200/JOP.19.00357
van Tinteren H, Hoekstra OS, Smit EF, et al. Effectiveness of positron emission tomography in the preoperative assessment of patients with suspected non-small-cell lung cancer: the PLUS multicentre randomised trial. Lancet. 2002;359(9315):1388-1393. doi:10.1016/s0140-6736(02)08352-6
Gambhir SS, Hoh CK, Phelps ME, Madar I, Maddahi J. Decision tree sensitivity analysis for cost-effectiveness of FDG-PET in the staging and management of non-small-cell lung carcinoma. J Nucl Med. 1996;37(9):1428-1436.
Chao F, Zhang H. PET/CT in the staging of the non-small-cell lung cancer. J Biomed Biotechnol. 2012;2012:783739. doi:10.1155/2012/783739
Brink I, Schumacher T, Mix M, et al. Impact of [18F]FDG-PET on the primary staging of small-cell lung cancer. Eur J Nucl Med Mol Imaging. 2004;31(12):1614-1620. doi:10.1007/s00259-004-1606-x
Steinert HC. PET and PET-CT of lung cancer. Methods Mol Biol. 2011;727:33-51. doi:10.1007/978-1-61779-062-1_3
Deuschl C, Nensa F, Grueneisen J, et al. Diagnostic impact of integrated 18F-FDG PET/MRI in cerebral staging of patients with non-small cell lung cancer. Acta Radiol. 2017;58(8):991-996. doi:10.1177/0284185116681041
De Wever W, Stroobants S, Coolen J, Verschakelen JA. Integrated PET/CT in the staging of nonsmall cell lung cancer: technical aspects and clinical integration. Eur Respir J. 2009;33(1):201-212. doi:10.1183/09031936.00035108
Lardinois D, Weder W, Hany TF, et al. Staging of non-small-cell lung cancer with integrated positron-emission tomography and computed tomography. N Engl J Med. 2003;348(25):2500-2507. doi:10.1056/NEJMoa022136
De Wever W, Ceyssens S, Mortelmans L, et al. Additional value of PET-CT in the staging of lung cancer: comparison with CT alone, PET alone and visual correlation of PET and CT. Eur Radiol. 2007;17(1):23-32. doi:10.1007/s00330-006-0284-4
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(5):995. doi:10.1183/09031936.00119106
Wu Y, Li P, Zhang H, et al. Diagnostic value of fluorine 18 fluorodeoxyglucose positron emission tomography/computed tomography for the detection of metastases in non-small-cell lung cancer patients. Int J Cancer. 2013;132(2):E37-E47. doi:10.1002/ijc.27779
Cerfolio RJ, Ojha B, Bryant AS, Raghuveer V, Mountz JM, Bartolucci AA. The accuracy of integrated PET-CT compared with dedicated PET alone for the staging of patients with nonsmall cell lung cancer. Ann Thorac Surg. 2004;78(3):1017-1023. doi:10.1016/j.athoracsur.2004.02.067
Weder W, Schmid RA, Bruchhaus H, Hillinger S, von Schulthess GK, Steinert HC. Detection of extrathoracic metastases by positron emission tomography in lung cancer. Ann Thorac Surg. 1998;66(3):886-893. doi:10.1016/s0003-4975(98)00675-4
Krüger S, Mottaghy FM, Buck AK, et al. Brain metastasis in lung cancer. Comparison of cerebral MRI and 18F-FDG-PET/CT for diagnosis in the initial staging. Nuklearmedizin. 2011;50(3):101-106. doi:10.3413/Nukmed-0338-10-07
Lee HY, Lee KS, Kim BT, et al. Diagnostic efficacy of PET/CT plus brain MR imaging for detection of extrathoracic metastases in patients with lung adenocarcinoma. J Korean Med Sci. 2009;24(6):1132-1138. doi:10.3346/jkms.2009.24.6.1132
Ho KC, Toh CH, Li SH, et al. Prognostic impact of combining whole-body PET/CT and brain PET/MR in patients with lung adenocarcinoma and brain metastases. Eur J Nucl Med Mol Imaging. 2019;46(2):467-477. doi:10.1007/s00259-018-4210-1
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