Hisanobu Koyama

Non–Small Cell Lung Cancer: Whole-Body MR Examination for M-Stage Assessment—Utility for Whole-Body Diffusion-weighted Imaging Compared with Integrated FDG PET/CT

PURPOSE To prospectively and directly compare the capability of whole-body diffusion-weighted (DW) imaging, whole-body magnetic resonance (MR) imaging with and that without DW imaging, and integrated fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) for M-stage assessment in non-small cell lung cancer (NSCLC) patients. MATERIALS AND METHODS The institutional review board approved this study; informed consent was obtained from patients. A total of 203 NSCLC patients (109 men, 94 women; mean age, 72 years) prospectively underwent whole-body DW imaging, whole-body MR imaging, and FDG PET/CT. Final diagnosis of the M-stage in each patient was determined on the basis of results of all radiologic and follow-up examinations. Two chest radiologists and two nuclear medicine physicians independently assessed all examination results and used a five-point visual scoring system to evaluate the probability of metastases. Final diagnosis based on each of the methods was made by consensus of two readers. Receiver operating characteristic (ROC) analysis was used to compare the capability for M-stage assessment among whole-body DW imaging, whole-body MR imaging with and that without DW imaging, and PET/CT on a per-patient basis. Sensitivity, specificity, and accuracy were compared with the McNemar test. RESULTS Area under ROC curve (A(z)) values of whole-body MR imaging with DW imaging (A(z) = 0.87, P = .04) and integrated FDG PET/CT (A(z) = 0.89, P = .02) were significantly larger than that of whole-body DW imaging (A(z) = 0.79). Specificity and accuracy of whole-body MR imaging with (specificity, P = .02; accuracy, P < .01) and that without DW imaging (specificity, P = .02; accuracy, P = .01) and integrated FDG PET/CT (specificity, P < .01; accuracy, P < .01) were significantly higher than those of whole-body DW imaging. CONCLUSION Whole-body MR imaging with DW imaging can be used for M-stage assessment in NSCLC patients with accuracy as good as that of PET/CT.

Detection of bone metastases in non-small cell lung cancer patients: comparison of whole-body diffusion-weighted imaging (DWI), whole-body MR imaging without and with DWI, whole-body FDG-PET/CT, and bone scintigraphy.

To prospectively compare the capability for bone metastasis assessment of whole‐body diffusion‐weighted imaging (DWI), magnetic resonance imaging (MRI) without and with DWI, [18F] fluoro‐2‐D‐glucose positron emission tomography with computed tomography (FDG‐PET/CT) and bone scintigraphy in non‐small cell carcinoma (NSCLC) patients.

Diffusion-weighted MRI versus 18F-FDG PET/CT: performance as predictors of tumor treatment response and patient survival in patients with non-small cell lung cancer receiving chemoradiotherapy.

OBJECTIVE The purpose of this study was to compare the predictive capabilities of diffusion-weighted MRI (DWI) and 18F-FDG PET/CT for tumor response to therapy and survival in patients with non-small cell lung cancer (NSCLC) receiving chemoradiotherapy. SUBJECTS AND METHODS The study included 64 patients with NSCLC diagnosed as stage III who underwent pretherapeutic DWI and FDG PET/CT and were treated with chemoradiotherapy. For quantitative prediction, apparent diffusion coefficient (ADC) for DWI and maximum standardized uptake value (SUVmax) for PET/CT were measured at all targeted lesions and averaged to obtain final values for each patient. To evaluate the predictive capability of either index for distinguishing partial response and nonresponse (stable or progressive disease) groups, receiver operating characteristic analysis was performed, and sensitivity, specificity, and accuracy of the two modalities were compared using the McNemar test. Finally, overall and progression-free survival curves divided by the corresponding threshold value were compared by means of the log-rank test. RESULTS The area under the curve (Az) for ADC (Az=0.84) was significantly larger than that for SUVmax (Az=0.64, p<0.05). The application of feasible threshold values resulted in specificity (44.4%) and accuracy (76.6%) of DWI becoming significantly higher than those of PET/CT (specificity, 11.1%; p<0.05 and accuracy, 67.2%, p<0.05). In addition, only overall survival and progression-free survival of the two groups divided by ADC at 2.1×10(-3) mm2/s and SUVmax at 10 showed a significant difference (p<0.05). CONCLUSION DWI may have better potential than FDG PET/CT for prediction of tumor response to therapy in NSCLC patients before chemoradiotherapy.

Differentiation of Malignant and Benign Pulmonary Nodules with Quantitative First-Pass 320–Detector Row Perfusion CT versus FDG PET/CT

PURPOSE To prospectively compare the capability of quantitative first-pass perfusion 320-detector row computed tomography (CT) (ie, area-detector CT) with that of combined positron emission tomography and CT (PET/CT) for differentiation between malignant and benign pulmonary nodules. MATERIALS AND METHODS This prospective study was approved by the institutional review board, and written informed consent was obtained from 50 consecutive patients with 76 pulmonary nodules. All patients underwent dynamic area-detector CT, PET/CT, and microbacterial and/or histopathologic examinations. All pulmonary nodules were divided into three groups: malignant nodules (n = 43), benign nodules with low biologic activity (n = 6), and benign nodules with high biologic activity (n = 27). For each dynamic area-detector CT data set, the perfusion derived by using the maximum slope model (PF(MS)), extraction fraction derived by using the Patlak plot model (EF(PP)), and blood volume derived by using the Patlak plot model (BV(PP)) were calculated. These parameters were statistically compared among the three nodule groups. Receiver operating characteristic (ROC) analyses were used to compare the diagnostic capability of the CT and PET/CT indexes. Finally, the sensitivity, specificity, and accuracy of each index were compared by using the McNemar test. RESULTS All indexes in the malignant nodule group were significantly different from those in the low-biologic-activity benign nodule group (P < .05). Areas under the ROC curve for PF(MS) and EF(PP) were significantly larger than those for BV(PP) (P < .05) and maximal standard uptake value (SUV(max)) (P < .05). The specificity and accuracy of PF(MS) and EF(PP) were significantly higher than those of BV(PP) and SUV(max) (P < .05). CONCLUSION Dynamic first-pass area-detector perfusion CT has the potential to be more specific and accurate than PET/CT for differentiating malignant from benign pulmonary nodules. SUPPLEMENTAL MATERIAL http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10100245/-/DC1.

N stage disease in patients with non-small cell lung cancer: efficacy of quantitative and qualitative assessment with STIR turbo spin-echo imaging, diffusion-weighted MR imaging, and fluorodeoxyglucose PET/CT.

PURPOSE To prospectively compare the diagnostic capability of short inversion time inversion-recovery (STIR) turbo spin-echo (SE) imaging, diffusion-weighted (DW) magnetic resonance (MR) imaging, and fluorodeoxyglucose (FDG) combined positron emission tomography (PET) and computed tomography (CT) in N stage assessment in patients with non-small cell lung cancer (NSCLC). MATERIALS AND METHODS This prospective study was approved by the institutional review board, and written informed consent was obtained from all patients. A total of 250 consecutive patients with NSCLC (136 men; mean age, 73 years; 114 women; mean age, 72 years) prospectively underwent pretherapeutic STIR turbo SE imaging, DW MR imaging, and FDG PET/CT, as well as surgical and pathologic examinations (N0 disease, n = 157; N1 disease, n = 72; N2 disease, n = 16; N3 disease, n = 5). Lymph node-to-saline ratio (LSR), lymph node-to-muscle ratio (LMR), apparent diffusion coefficient (ADC), maximal standardized uptake value (SUV(max)), and visual scoring were assessed for 135 metastatic lymph nodes and 135 randomly selected nonmetastatic lymph nodes. Receiver operating characteristic curve analysis was used to determine feasible threshold values. Diagnostic capabilities for N stage assessment were compared with the McNemar test on a per-patient basis. RESULTS When feasible, threshold values were used for quantitative assessment; sensitivity and accuracy of LSR and LMR (sensitivity, 82.8%; accuracy, 86.8%) proved to be significantly higher than those of ADC (sensitivity: 74.2%, P = .01; accuracy: 84.4%, P = .04) and SUV(max) (sensitivity: 74.2%, P = .01). For qualitative assessment, sensitivity of STIR turbo SE imaging (77.4%) was significantly higher than that of DW MR imaging (71.0%, P = .03) and FDG PET/CT (69.9%, P = .02). CONCLUSION Quantitative and qualitative assessments of N stage disease in patients with NSCLC obtained with STIR turbo SE MR imaging are more sensitive and/or more accurate than those obtained with DW MR imaging and FDG PET/CT. SUPPLEMENTAL MATERIAL http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11110281/-/DC1.

Whole-body MR imaging vs. FDG-PET: Comparison of accuracy of M-stage diagnosis for lung cancer patients†

To conduct a prospective comparison of the accuracy of whole‐body MR imaging and positron emission tomography (PET) with fluorine‐18 deoxyglucose (FDG) (FDG‐PET) to assess the M‐stage in lung cancer patients.

Postoperative Lung Function in Lung Cancer Patients: Comparative Analysis of Predictive Capability of MRI, CT, and SPECT

OBJECTIVE The purpose of this study was to prospectively compare the utility of dynamic contrast-enhanced perfusion MRI in the prediction of postoperative lung function in patients with lung cancer with the utility of quantitative and qualitative assessment of CT and perfusion SPECT. SUBJECTS AND METHODS One hundred fifty lung cancer patients (87 men, 63 women) underwent dynamic perfusion MRI, MDCT, perfusion SPECT, and measurement of preoperative and postoperative forced expiratory volume in the first second of expiration (FEV1) expressed as percentage of predicted value. Postoperative FEV1 was predicted with dynamic perfusion MRI by semiquantitative assessment of the perfusion of whole lungs and resected segments of lungs, with quantitative assessment of functional lung volume on CT with commercially available software, with qualitative assessment of CT on the basis of the number of segments of total and resected lung, and with perfusion SPECT by assessment of uptake of microaggregated albumin particles in whole lungs and resected segments of lungs. Correlation and limits of agreement between actual and predicted postoperative FEV1 values were statistically evaluated. RESULTS Actual postoperative FEV1 had stronger correlation with postoperative FEV1 predicted from perfusion MRI (r = 0.87, p < 0.0001) and quantitative CT (r = 0.88, p < 0.0001) than with postoperative FEV1 predicted from qualitative CT (r = 0.83, p < 0.0001) and perfusion SPECT (r = 0.83, p < 0.0001). The limits of agreement between the actual postoperative FEV1 and postoperative FEV1 predicted from perfusion MRI (5.3% +/- 11.8% [mean +/- 2 SD]) were smaller than the values for postoperative FEV1 predicted from qualitative CT (6.8% +/- 14.4%) and perfusion SPECT (5.1% +/- 14.0%) and was almost equal to the value for postoperative FEV1 predicted from quantitative CT (5.0% +/- 11.6%). CONCLUSION Dynamic perfusion MRI is more accurate in prediction of the postoperative lung function of patients with lung cancer than are qualitative CT and perfusion SPECT and may be at least as accurate as quantitative CT.

Recent technological and application developments in computed tomography and magnetic resonance imaging for improved pulmonary nodule detection and lung cancer staging

This review compares the emerging technologies and approaches in the application of magnetic resonance (MR) and computed tomography (CT) imaging for the assessment of pulmonary nodules and staging of malignant findings. Included in this review is a brief definition of pulmonary nodules and an introduction to the challenges faced. We have highlighted the current status of both MR and CT for the early detection of lung nodules. Developments are detailed in this review for the management of pulmonary nodules using advanced imaging, including: dynamic imaging studies, dual energy CT, computer aided detection and diagnosis, and imaging assisted nodule biopsy approaches which have improved lung nodule detection and diagnosis rates. Recent advancements linking in vivo imaging to corresponding histological pathology are also highlighted. In vivo imaging plays a pivotal role in the clinical staging of pulmonary nodules through TNM assessment. While CT and positron emission tomography (PET)/CT are currently the most commonly clinically employed modalities for pulmonary nodule staging, studies are presented that highlight the augmentative potential of MR. J. Magn. Reson. Imaging 2010;32:1353–1369.

STIR turbo SE MR imaging vs. coregistered FDG‐PET/CT: Quantitative and qualitative assessment of N‐stage in non‐small‐cell lung cancer patients

To conduct a prospective comparison of the accuracy of short inversion time (TI) inversion‐recovery (STIR) turbo spin‐echo (SE) imaging and coregistered 2‐[fluorine‐18] fluoro‐2‐deoxy‐D‐glucose (FDG)–positron emission tomography (PET) with computed tomography (CT) (coregistered FDG‐PET/CT) to assess the N‐stage in non‐small‐cell lung cancer (NSCLC) patients.

Dynamic Oxygen-Enhanced MRI Versus Quantitative CT: Pulmonary Functional Loss Assessment and Clinical Stage Classification of Smoking-Related COPD

OBJECTIVE The purpose of the present study is to prospectively compare the capability of dynamic oxygen-enhanced MRI and quantitative CT for pulmonary functional loss assessment and clinical stage classification of smoking-related chronic obstructive pulmonary disease (COPD). SUBJECTS AND METHODS Ten nonsmoking and 61 consecutive smoking-related COPD subjects underwent dynamic oxygen-enhanced MRI, CT, and pulmonary function tests. COPD subjects were classified into four clinical stages on the basis of the ATS-ERS guidelines. Wash-in time and relative enhancement ratio maps were generated by pixel-by-pixel analyses. Mean wash-in time and relative enhancement ratio were determined as averages of region of interest (ROI) measurements. CT-based functional lung volumes were measured on quantitative CT using the density-masked CT technique. For comparison of assessment capability for smoking-related functional loss, the three parameters were correlated with the percentage predicted forced expiratory volume in 1 second (%FEV1) and the percentage predicted diffusing capacity of the lung for carbon monoxide corrected for alveolar volume (%DL(CO)/VA). To determine the clinical stage classification capability, these parameters were statistically compared for nonsmoking subjects and all clinical stages of smoking-related COPD subjects. RESULTS Correlation between mean wash-in time and %FEV1 (r = -0.74, p < 0.0001) and between mean relative enhancement ratio and %DL(CO)/VA (r = 0.66, p < 0.0001) was better than that between CT-based functional lung volume and either %FEV1 (r = 0.61, p < 0.0001) or %DL(CO)/VA (r = 0.56, p < 0.0001). Mean wash-in time showed a significant difference between nonsmoking and smoking-related COPD subjects at all clinical stages (p < 0.05). CONCLUSION Dynamic oxygen-enhanced MRI has potential for pulmonary functional loss assessment and clinical stage classification of smoking-related COPD as does quantitative CT.