Download PDF
Nuklearmedizin 2011; 50(03): 101-106
DOI: 10.3413/Nukmed-0338-10-07
Original article
Schattauer GmbH

Brain metastasis in lung cancer[*]

Comparison of cerebral MRI and 18F-FDG-PET/CT for diagnosis in the initial stagingHirnmetastasen beim Bronchialkarzinom[*]: Vergleich der zerebralen MRT mit dem 18F-FDGPET/ CT beim initialen Staging für die Diagnose
S. Krüger
1   Medical Clinic II, University Hospital, Ulm, Germany
4   Medical Clinic I, University Hospital RWTH, Aachen, Germany
,
M F. Mottaghy
2   Department of Nuclear Medicine, University Hospital, Ulm, Germany
5   Department of Nuclear Medicine, University Hospital RWTH, Aachen, Germany
,
K A. Buck
2   Department of Nuclear Medicine, University Hospital, Ulm, Germany
6   Department of Nuclear Medicine, Klinikum Rechts der Isar, University Hospital Technical University, Munich, Germany
,
S Maschke
1   Medical Clinic II, University Hospital, Ulm, Germany
,
H Kley
1   Medical Clinic II, University Hospital, Ulm, Germany
,
D Frechen
4   Medical Clinic I, University Hospital RWTH, Aachen, Germany
,
T Wibmer
1   Medical Clinic II, University Hospital, Ulm, Germany
,
N S. Reske
2   Department of Nuclear Medicine, University Hospital, Ulm, Germany
,
S Pauls
3   Department of Diagnostic and Interventional Radiology, University Hospital, Ulm, Germany
› Author Affiliations
Further Information

Publication History

received: 23 July 2010

accepted in revised form: 25 November 2010

Publication Date:
28 December 2017 (online)

    Permissions and Reprints

Summary

FDG-PET/CT is increasingly used in staging of lung cancer as single „one stop shop” method. Aim, patients, methods: We prospectively included 104 neurological asymptomatic patients (65 years, 26% women) with primary diagnosis of lung cancer. In all patients PET/CT including cerebral imaging and cerebral MRI were performed. Results: Diagnosis of brain metastases (BM) was made by PET/CT in 8 patients only (7.7%), by MRI in 22 (21.2%). In 80 patients both PET/CT and MRI showed no BM. In 6 patients (5.8%) BM were detectable on PET/CT as well as on MRI. Exclusive diagnosis of BM by MRI with negative finding on PET/CT was present in 16 patients (15.4%). 2 patients (1.9%) had findings typical for BM on PET/CT but were negative on MRI. With MRI overall 100 BM were detected, with PET/CT only 17 BM (p < 0.01). For the diagnosis of BM PET/CT showed a sensitivity of 27.3%, specificity of 97.6%, positive predictive value of 75% and negative predictive value of 83.3%. BM diameter on PET/CT and MRI were consistent in 43%, in 57% BM were measured larger on MRI. Discussion: Compared to the gold standard of MRI for cerebral staging a considerable number of patients are falsely diagnosed as free from BM by PET/CT. MRI is more accurate than PET/CT for detecting multiple and smaller BM. Conclusion: In patients with a curative option MRI should be performed additionally to PET/CT for definitive exclusion of brain metastases.

Zusammenfassung

Das FDG-PET/CT wird zunehmend beim Staging des Bronchialkarzinoms als eine Onestop- shop-Methode verwendet. Ziel, Patienten, Methoden: Wir untersuchten prospektiv 104 neurologisch asymptomatische Patienten (65 Jahre, 26% w) mit der primären Diagnose eines Bronchialkarzinoms. Bei allen Patienten wurde ein PET/CT inklusive einer zerebralen Bildgebung und ein zerebrales MRT durchgeführt. Ergebnisse: Die Diagnose von Hirnmetastasen erfolgte mittels PET/CT bei 8 (7,7%) und mittels MRT bei 22 (21,2%) Patienten. Bei 80 Patientenzeigten sich weder im PET/CT noch im MRT Hirnmetastasen (HM). Bei 6 Patienten (5,8%) waren die HM sowohl im PET/CT als auch im MRT erkennbar. Die exklusive Diagnose von HM durch MRT mit einem negativen Befund im PET/CT fand sich bei 16 Patienten (15,4%). 2 Patienten (1,9%) hatten eine für HM typischen Befund im PET/CT, waren aber im MRT negativ. Mit dem MRT wurden insgesamt 100 HM diagnostiziert, mit dem PET/CT nur 17 HM (p < 0,01). Für die Diagnose von HM zeigte die PET/CT eine Sensitivität von of 27,3%, Spezifität von 97,6%, positiven prädiktiven Wert von 75% und einen negativen prädiktiven Wert von 83,3%. Der HM Durchmesser im PET/CT und MRT waren vergleichbar bei 43%, bei 57% waren die HM größer im MRT. Diskussion: Verglichen mit dem Goldstandard MRT zum zerebralen Staging wird eine bedeutende Anzahl von Patienten durch das PET/CT fälschlich als frei von HM diagnostiziert. Das MRT ist genauer als das PET/CT für die Diagnose multipler und kleiner HM. Schlussfolgerungen: Bei Bronchialkarzinom-Patienten mit kurativer Option sollte das MRT zusätzlich zum PET/CT durchgeführt werden zum definitiven Ausschluss von Hirnmetastasen.

Keywords

PET/CT - MRI - brain metastasis - lung cancer

Schlüsselwörter

PET/CT - MRI - Hirnmetastasen - Lungenkrebs

* This work was partly presented at the 13th World Conference on Lung Cancer (WCLC) 2009 in San Francisco, USA.


 

  • References

  • 1 Andrews DW, Scott CB, Sperduto PW. et al. Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial. Lancet 2004; 363: 1665-1672.
    CrossrefPubMedGoogle Scholar
  • 2 Bonnette P, Puyo P, Gabriel C. et al. the Groupe Thorax. Surgical management of non-small cell lung cancer with synchronous brain metastases. Chest 2001; 119: 1469-1475.
    CrossrefPubMedGoogle Scholar
  • 3 Earnest F, Ryn JH, Miller GM. et al. Suspected non-small cell lung cancer: Incidence of occult brain and skeletal metastases and effectiveness of imaging for detection. Pilot study. Radiology 1999; 211: 137-145.
    CrossrefPubMedGoogle Scholar
  • 4 Ferrigno D, Buccheri G. Cranial computed tomography as a part of the initial staging procedures for patients with non small cell lung cancer. Chest 1994; 106: 1025-1029.
    CrossrefPubMedGoogle Scholar
  • 5 Goeckenjan G, Sitter H, Thomas M. et al. Prävention, Diagnostik, Therapie und Nachsorge des Lungenkarzinoms. Interdisziplinäre S3-Leitlinie der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin und der Deutschen Krebsgesellschaft. Pneumologie 2010; 64 (Suppl. 02) e1-e164.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Hellwig D, Baum RP, Kirsch C. FDG-PET, PET/CT and conventional nuclear medicine procedures in the evaluation of lung cancer: a systematic review. Nuklearmedizin 2009; 48: 59-69.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Hochstenbag MMH, Twijnstra A, Hofman P. et al. MR-imaging of the brain of neurologic asymptomatic patients with large cell or adenocarcinoma of the lung. Does it influence prognosis and treatment?. Lung Cancer 2003; 42: 189-193.
    CrossrefPubMedGoogle Scholar
  • 8 I H Lee JI, Nam DH. et al. Surgical treatment of non-small cell lung cancer with isolated synchronous brain metastases. J Korean Med Sci 2006; 21: 236-241.
    PubMedGoogle Scholar
  • 9 Jena A, Taneja S, Talwar V, Sharma JB. Magnetic resonance (MR) patterns of brain metastasis in lung cancer patients: correlation of imaging findings with symptom. J Thorac Oncol 2008; 3: 140-144.
    CrossrefPubMedGoogle Scholar
  • 10 Kormas P, Bradshaw JR, Jeyasingham K. Preoperative computed tomography of the brain in non-small cell bronchogenic carcinoma. Thorax 1992; 47: 106-108.
    CrossrefPubMedGoogle Scholar
  • 11 Kotzerke J, Oehme L, Lindner O, Hellwig D. Positron emission tomography 2008 in Germany - results of the query and current status. Nuklearmedizin 2010; 49: 58-64.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Krüger S, Buck AK, Mottaghy FM. et al. Detection of bone metastases in patients with lung cancer: 99mTc-MDP planar bone scintigraphy, 18F-fluoride PET or 18F-FDG PET/CT. Eur J Nucl Med Mol Imaging 2009; 36: 1807-1812.
    CrossrefPubMedGoogle Scholar
  • 13 Lardinois D, Weder W, Hany TF. et al. Staging of non-small-lung cancer with integrated positron-emission tomography and computed tomography. N Engl J Med 2003; 348: 2500-2507.
    CrossrefPubMedGoogle Scholar
  • 14 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: 1132-1138.
    CrossrefPubMedGoogle Scholar
  • 15 Mehta M, Tremont-Lukats IW. Evaluation and management of brain metastasis. In: 2002 Educational Book. 38th Annual Meeting of American Society of Clinical Oncology. Orlando: American Society of Clinical Oncology; 2002: 375-382.
    Google Scholar
  • 16 Mujoomdar A, Austin JH, Malhotra R. et al. Clinical predictors of metastatic disease to the brain from non-small cell lung carcinoma: primary tumor size, cell type, and lymph node metastases. Radiology 2007; 242: 882-888.
    CrossrefPubMedGoogle Scholar
  • 17 Ohno Y, Koyama H, Nogami M. et al. Whole-body MR imaging vs. FDG-PET: comparison of accuracy of M-stage diagnosis for lung cancer patients. J Magn Reson Imaging 2007; 26: 498-509.
    CrossrefPubMedGoogle Scholar
  • 18 Pfister DG, Johnson DH, Azzoli ChG. et al. American Society of Clinical Oncology. Treatment of unresectable non-small cell lung cancer guideline: update 2003. J Clin Oncol 2004; 22: 330-353.
    CrossrefPubMedGoogle Scholar
  • 19 Salbeck R, Grau HC, Artmann H. Cerebral tumor-staging in patients with bronchial carcinoma by computed tomography. Cancer 1990; 66: 2007-2011.
    CrossrefPubMedGoogle Scholar
  • 20 Salvatierra A, Baamonde C, Llamas JM. et al. Extrathoracic staging of bronchogenic carcinoma. Chest 1990; 97: 1052-1058.
    CrossrefPubMedGoogle Scholar
  • 21 Schellinger PD, Meinck HM, Thron A. Diagnostic accuracy of MRI compared to CCT in patients with brain metastases. J Neurooncol 1999; 44: 275-281.
    CrossrefPubMedGoogle Scholar
  • 22 Schouten LJ, Rutten J, Huveneers HAM, Twijnstra A. Incidence of brain metastases in a cohort of patients with carcinoma of the breast, colon, kidney, and lung and melanoma. Cancer 2002; 94: 2698-2705.
    CrossrefPubMedGoogle Scholar
  • 23 Silvestri GA, Gould MK, Margolis ML. et al. American College of Chest Physicians. Noninvasive staging of non-small cell lung cancer: ACCP evidenced based clinical practice guidelines (2nd ed). Chest 2007; 132 (Suppl. 03) S178-S201.
    CrossrefPubMedGoogle Scholar
  • 24 Silvestri GA, Littenberg B, Colice GL. The clinical evaluation for detecting metastatic lung cancer. A metaanalysis. Am J Respir Crit Care Med 1995; 152: 225-230.
    CrossrefPubMedGoogle Scholar
  • 25 Silvestri GA, Tanoue LT, Margolis ML. et al. The noninvasive staging of non-small cell lung cancer. Chest 2003; 123: 147S-156S.
    CrossrefPubMedGoogle Scholar
  • 26 Sorensen JB, Hansen HH, Hansen M, Dombernowsky P. Brain metastases in adenocarcinoma of the lung: frequency, risk groups, and prognosis. J Clin Oncol 1988; 6: 1474-1480.
    CrossrefPubMedGoogle Scholar
  • 27 Sze G, Shin J, Krol G. et al. Intraparenchymal brain metastases: MR Imaging versus contrast-enhanced CT. Radiology 1988; 168: 187-194.
    CrossrefPubMedGoogle Scholar
  • 28 The American Thoracic Society and The European Respiratory Society. Pretreatment evaluation of non-small cell lung cancer. Am J Respir Crit Care Med 1997; 156: 320-332.
    CrossrefPubMedGoogle Scholar
  • 29 Toloza EM, Harpole L, Mc Crory DC. Noninvasive staging of non-small cell lung cancer. A review of the current evidence. Chest 2003; 123: 137S-146S.
    CrossrefPubMedGoogle Scholar
  • 30 Vogelbaum MA, Suh JH. Resectable brain metastases. J Clin Oncol 2006; 24: 1289-1294.
    CrossrefPubMedGoogle Scholar
  • 31 Yi CA, Shin KM, Lee KS. et al. Non-small cell lung cancer staging: efficacy comparison of integrated PET/CT versus 3.0-T whole-body MR imaging. Radiology 2008; 248: 632-642.
    CrossrefPubMedGoogle Scholar
  • 32 Yokoi K, Kamiya N, Matsuguma H. et al. Detection of brain metastasis in potentially operable non-small cell lung cancer. A comparison of CT and MRI. Chest 1999; 115: 714-719.
    CrossrefPubMedGoogle Scholar
  • 33 Zabel A, Milker-Zabel S, Thilmann C. et al. Treatment of brain metastasis in patients with non-small cell lung cancer (NSCLC) by stereotactic linac-based radiosurgery: prognostic factors. Lung Cancer 2002; 37: 87-94.
    CrossrefPubMedGoogle Scholar