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- Title
Impact of FDG-PET and Dynamic Contrast-Enhanced MRI in Comparison with DWI for N-Staging in Lung Cancer Patients.
- Authors
Flechsig, Paul; Zabeck, Heike; Reubold, Sebastian; Sachpekidis, Christos; Rathke, Hendrik; Röhrich, Manuel; Holland-Letz, Tim; Heussel, Claus-Peter; Harms, Alexander; Kauczor, Hans-Ulrich; Haberkorn, Uwe; Giesel, Frederik L.
- Abstract
Background: Regarding mediastinal N-staging in lung cancer patients, computed tomography (CT), magnetic resonance imaging (MRI), and integrated 18Fluorine-fluorodeoxyglucose-positron emission tomography/CT (18F-FDG-PET/CT) are the most widespread imaging methodologies in clinical routine. Objectives: In order to further extract information from non-invasive staging, we evaluated the use of 18F-FDG-PET/CTand dynamic contrast enhanced (DCE) and diffusion-weighted imaging (DWI) MRI using histopathology as the diagnostic gold standard. Patients and Methods: A total number of 50 patients had undergone MRI of the chest within two weeks prior to surgery for histopathological proof. DCE-MRI was evaluated on the basis of region of interest (ROI)-based signal intensity/time (SI/T) curves in the respective mediastinal lymph nodes (LNs). In total, 28 LNs could be allocated to the corresponding histopathological findings, as well as to corresponding findings in18 F-FDG-PET/CT. Results: Malignant LNs presented with significantly higher FDG uptake in PET. Significant differences between malignant and benign LNs were found for DCE-MRI regarding the parameters MaxE, 4-minutes value, SE, EP and EP/MaxE. In DWI-MRI, malignant LNs presented with significantly lower signal intensity compared to benign LNs (p < 0.01). An apparent diffusion coefficient (ADC) threshold of 1528 mm²/s was found to exclude malignancy for LNs that are above the threshold. Conclusion: 18F-FDG-PET in addition with MRI that includes DWI might improve mediastinal N-staging, which is of interest in cases of FDG-equivocal LNs. An ADC threshold of 1528 mm²/s might potentially help to further classify LNs with indefinite PET-findings. DCE-MRI of mediastinal LNs seems not yet to be approved for clinical routine.
- Subjects
LUNG tumors; CANCER patients; THORACIC surgery; DEOXY sugars; LYMPH nodes; MAGNETIC resonance imaging; RADIOPHARMACEUTICALS; POSITRON emission tomography; TUMOR classification; PREOPERATIVE period; DIAGNOSIS
- Publication
Iranian Journal of Radiology, 2019, Vol 16, Issue 1, p1
- ISSN
1735-1065
- Publication type
Article
- DOI
10.5812/iranjradiol.68638