Holmstrand Hanna, Lindskog M, Sundin A, Hansen T
Radiology, Department of Surgical Sciences, Uppsala University, Uppsala University Hospital, entry 70, 1st floor, Uppsala, 751 85, Sweden.
Department of Immunology, Genetics and Pathology, Uppsala University, Dag Hammarskjölds väg 20, Uppsala, 751 85, Sweden.
Cancer Imaging. 2025 Mar 11;25(1):30. doi: 10.1186/s40644-025-00852-6.
Non-small cell lung cancer (NSCLC) is a common neoplasm with poor prognosis in advanced stages. The clinical work-up in patients with locally advanced NSCLC mostly includes F-fluorodeoxyglucose positron emission tomography computed tomography (F-FDG PET/CT) because of its high sensitivity for malignant lesion detection; however, specificity is lower. Diverging results exist whether whole-body MRI (WB-MRI) improves the staging accuracy in advanced lung cancer. Considering WB-MRI being a more time-consuming examination compared to brain MRI, it is important to establish whether or not additional value is found in detecting and characterizing malignant lesions. The purpose of this study is to investigate the value of additional whole-body magnetic resonance imaging, instead of only brain MRI, together with F-FDG PET/CT in staging patients with advanced NSCLC planned for curative treatment.
In a prospective single center study, 28 patients with NSCLC stage 3 or oligometastatic disease were enrolled. In addition to F-FDG PET/CT, they underwent WB-MRI including the thorax, abdomen, spine, pelvis, and contrast-enhanced examination of the brain and liver. F-FDG PET/CT and WB-MRI were separately evaluated by two blinded readers, followed by consensus reading in which the likelihood of malignancy was assessed in detected lesions. Imaging and clinical follow-up for at least 12 months was used as reference standard. Statistical analyses included Fischer's exact test and Clopped-Pearson.
28 patients (mean age ± SD 70.5 ± 8.4 years, 19 women) were enrolled. WB-MRI and FDG-PET/CT both showed maximum sensitivity and specificity for primary tumor diagnosis and similar sensitivity (p = 1.00) and specificity (p = 0.70) for detection of distant metastases. For diagnosis of lymph node metastases, WB-MRI showed lower sensitivity, 0.65 (95% CI: 0.38-0.86) than FDG-PET/CT, 1.00 (95% CI: 0.80-1.00) (p < 0.05), but similar specificity (p = 0.59).
WB-MRI in conjunction with F-FDG PET/CT provides no additional value over MRI of the brain only, in staging patients with advanced NSCLC.
Registered locally and approved by the Uppsala University Hospital committee, registration number ASMR020.
非小细胞肺癌（NSCLC）是一种常见肿瘤，晚期预后较差。局部晚期NSCLC患者的临床检查主要包括F-氟脱氧葡萄糖正电子发射断层扫描计算机断层扫描（F-FDG PET/CT），因为其对恶性病变检测具有高敏感性；然而，特异性较低。全身MRI（WB-MRI）是否能提高晚期肺癌的分期准确性存在不同结果。考虑到与脑部MRI相比，WB-MRI检查耗时更长，确定在检测和表征恶性病变方面是否具有额外价值很重要。本研究的目的是探讨在计划进行根治性治疗的晚期NSCLC患者分期中，额外的全身磁共振成像（而非仅脑部MRI）联合F-FDG PET/CT的价值。
在一项前瞻性单中心研究中，纳入了28例3期或寡转移疾病的NSCLC患者。除F-FDG PET/CT外，他们还接受了包括胸部、腹部、脊柱、骨盆的WB-MRI以及脑部和肝脏的对比增强检查。F-FDG PET/CT和WB-MRI由两名盲法阅片者分别评估，随后进行共识阅片，评估检测到的病变的恶性可能性。以至少12个月的影像和临床随访作为参考标准。统计分析包括Fisher精确检验和Clopped-Pearson检验。
纳入28例患者（平均年龄±标准差70.5±8.4岁，19名女性）。WB-MRI和FDG-PET/CT对原发性肿瘤诊断均显示出最大敏感性和特异性，对远处转移检测的敏感性（p = 1.00）和特异性（p = 0.70）相似。对于淋巴结转移的诊断，WB-MRI的敏感性为0.65（95%CI：0.38 - 0.86），低于FDG-PET/CT的1.00（95%CI：0.80 - 1.00）（p < 0.05），但特异性相似（p = 0.59）。
在晚期NSCLC患者分期中，WB-MRI联合F-FDG PET/CT与仅脑部MRI相比，没有额外价值。
在当地注册并经乌普萨拉大学医院委员会批准，注册号ASMR020。
