Detection of bone metastases in non-small cell lung cancer patients: Comparison of whole-body diffusion-weighted imaging (DWI), whole-body MR imaging without and with DWI, whole-body FDGPET/CT, and bone scintigraphy

Purpose: To prospectively compare the capability for bone metastasis assessment of whole-body diffusion-weighted imaging (DWI), magnetic resonance imaging (MRI) without and with DWI, [¹⁸F] fluoro-2-D-glucose positron emission tomography with computed tomography (FDG-PET/CT) and bone scintigraphy in non-small cell carcinoma (NSCLC) patients. Materials and Methods: In all, 115 consecutive NSCLC patients (66 men, 49 women; mean age 72 years) prospectively underwent whole-body MRI, PET/CT, and bone scintigraphy before treatment. For each method, probability of metastasis was independently assessed by using a 5-point visual scoring system on a per-site basis. Receiver operating characteristic (ROC)-based positive tests were used to determine the practical threshold value for each method on a per-site basis. Sensitivities, specificities, and accuracies were then compared on a per-site and per-patient basis by means of McNemar's test. Results: When the practical threshold values were adapted, specificity and accuracy of whole-body MRI with DWI were significantly higher than those of bone scintigraphy and PET/CT (P < 0.05). On a per-patient basis, specificity and accuracy of whole-body MRI with DWI were significantly higher than those of bone scintigraphy (P < 0.05). Conclusion: Whole-body MRI with DWI can be used for bone metastasis assessment of NSCLC patients as accurate as bone scintigraphy and/or PET/CT.