Original contributionWhole-body diffusion-weighted imaging vs. FDG-PET for the detection of non-small-cell lung cancer. How do they measure up?
Introduction
Lung cancer is the leading cause of tumor-related deaths, while non-small cell lung cancer (NSCLC) accounts for 80% of all lung cancers [1], and the selections of therapy for lung cancer are based on the staging of the TNM classification of malignant tumors staging currently. Hence, accurate TNM staging is one of the most valuable parameters for lung cancer diagnosis. Plain film, computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) all have been used for this purpose [2]. Past clinical practice has shown that Fluorine 18 fluorodeoxyglucose positron emission tomography/CT (FDG PET/CT) possesses substantially higher sensitivity and specificity in TNM staging for NSCLC, presenting better efficacy for staging lung cancer than CT or PET alone [3], [4], [5], [6], [7], although expensive and radioactive ions such as fluorine-18-2-fluoro-2-deoxy-d-glucose are its disadvantages. Whole-body MRI (WB-MRI) has been put forward as another whole-body technique for the assessment of distant metastases in patients with malignant tumor [8], [9], [10], [11]. Recently, it has been reported that WB-MRI was superior to skeletal scintigraphy tumor skeletal metastases and M stage assessment for NSCLC [12], [13], and literatures suggesting diffusion-weighted (DW) imaging could be useful for the assessment of primary malignancy and lymph node and/or distant metastases were published [14], [15], [16], [17], [18]. Diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) has been introduced for 1.5-T MR scanners by Takahara et al. [19] In the DWIBS approach, it allows three-dimensional (3D) reconstructions like maximum intensity projection (MIP), obtaining PET-like three-dimensional images, on which 3D distributions of lesions can be recognized [19].To evaluate value of the whole-body DW imaging (WB-DWI) in NSCLC, we designed this study to determine the accuracy of WB-DWI for assessment of non-small cell lung cancer (NSCLC) patients by comparing with FDG PET/CT.
Section snippets
Subjects
The study was approved by the Ethics Committee of Southwest hospital, and written consent forms were obtained from all participants. From January to March in 2008, 56 consecutive patients with NSCLC underwent WB-DWI and integrated FDG PET/CT for primary tumor, lymph node metastasis and distant metastasis; all patients were confirmed by pathologic examination or follow-up imaging findings for reference standards [21 female, 35 male; 35–76 years old (mean age, 51years] were included.
WB-DWI
All patients
Primary tumors
The distribution of primary tumors in 56 patients were as follows: right upper lobe in 18 patients, right middle lobe in nine patients, right lower lobe in 12 patients, left upper lobe in 11 patients and left lower lobe in six patients. Tumor sizes were 2.2–6.3 cm, and all of which were correctly detected by WB-DWI and PET/CT. The abnormal concentration on PET/CT and highly intensified signal on WB-DWI was the typical presentation of primary tumors (see Fig. 1).
Lymph nodes
A total of 135 lymph enlarged
Discussion
The regimen selection of NSCLC treatment and its prognosis are strongly influenced by lymph node and distant metastases. Although CT has been considered the standard modality for the assessment of metastases of lung cancer, PET/CT is the primary tool for lung cancer staging, and it has been shown to be substantially more sensitive and specific in the detection and characterization of metastases to mediastinal lymph nodes, which possesses unique value in identifying distant metastases that are
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