Brain metastasis in lung cancer

S. Krüger; M F. Mottaghy; K A. Buck; S Maschke; H Kley; D Frechen; T Wibmer; N S. Reske; S Pauls

doi:10.3413/Nukmed-0338-10-07

Nuklearmedizin - NuclearMedicine, Table of Contents

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

Authors

S. Krüger

¹Medical Clinic II, University Hospital, Ulm, Germany

⁴Medical Clinic I, University Hospital RWTH, Aachen, Germany
M F. Mottaghy

²Department of Nuclear Medicine, University Hospital, Ulm, Germany

⁵Department of Nuclear Medicine, University Hospital RWTH, Aachen, Germany
K A. Buck

²Department of Nuclear Medicine, University Hospital, Ulm, Germany

⁶Department of Nuclear Medicine, Klinikum Rechts der Isar, University Hospital Technical University, Munich, Germany
S Maschke

¹Medical Clinic II, University Hospital, Ulm, Germany
H Kley

¹Medical Clinic II, University Hospital, Ulm, Germany
D Frechen

⁴Medical Clinic I, University Hospital RWTH, Aachen, Germany
T Wibmer

¹Medical Clinic II, University Hospital, Ulm, Germany
N S. Reske

²Department of Nuclear Medicine, University Hospital, Ulm, Germany
S Pauls

³Department of Diagnostic and Interventional Radiology, University Hospital, Ulm, Germany

Abstract

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

Full Text

References

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Brain metastasis in lung cancer[*]

Authors

Brain metastasis in lung cancer^[*]