Ohno Yoshiharu, Koyama Hisanobu, Onishi Yumiko, Takenaka Daisuke, Nogami Munenobu, Yoshikawa Takeshi, Matsumoto Sumiaki, Kotani Yoshikazu, Sugimura Kazuro
Department of Radiology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Radiology. 2008 Aug;248(2):643-54. doi: 10.1148/radiol.2482072039. Epub 2008 Jun 6.
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.
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.
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.
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.
前瞻性地直接比较全身扩散加权（DW）成像、有无DW成像的全身磁共振（MR）成像以及集成氟代脱氧葡萄糖（FDG）正电子发射断层扫描（PET）/计算机断层扫描（CT）在非小细胞肺癌（NSCLC）患者M分期评估中的能力。
本研究经机构审查委员会批准；获得了患者的知情同意。共有203例NSCLC患者（109例男性，94例女性；平均年龄72岁）前瞻性地接受了全身DW成像、全身MR成像和FDG PET/CT检查。根据所有影像学和随访检查结果确定每位患者的最终M分期诊断。两位胸部放射科医生和两位核医学医生独立评估所有检查结果，并使用五分视觉评分系统评估转移的可能性。基于每种方法的最终诊断由两位读者达成共识。采用受试者操作特征（ROC）分析在每位患者的基础上比较全身DW成像、有无DW成像的全身MR成像以及PET/CT在M分期评估中的能力。使用McNemar检验比较敏感性、特异性和准确性。
有DW成像的全身MR成像（A(z)=0.87，P=.04）和集成FDG PET/CT（A(z)=0.89，P=.02）的ROC曲线下面积（A(z)）值显著大于全身DW成像（A(z)=0.79）。有（特异性，P=.02；准确性，P<.01）和无DW成像（特异性，P=.02；准确性，P=.01）的全身MR成像以及集成FDG PET/CT（特异性，P<.01；准确性，P<.01）的特异性和准确性显著高于全身DW成像。
有DW成像的全身MR成像可用于NSCLC患者的M分期评估，其准确性与PET/CT相当。
