N stage disease in patients with non-small cell lung cancer: Efficacy of quantitative and qualitative assessment with STIR turbo spin-echo imaging, diffusion-weighted MR imaging, and fluorodeoxyglucose PET/CT

Yoshiharu Ohno, Hisanobu Koyama, Takeshi Yoshikawa, Mizuho Nishio, Nobukazu Aoyama, Yumiko Onishi, Daisuke Takenaka, Sumiaki Matsumoto, Yoshimasa Maniwa, Wataru Nishio, Yoshihiro Nishimura, Tomoo Itoh, Kazuro Sugimura

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Abstract

Purpose: To prospectively compare the diagnostic capability of short inversion time inversion-recovery (STIR) turbo spin-echo (SE) imaging, diffusion-weighted (DW) magnetic resonance (MR) imaging, and fluorodeoxyglucose (FDG) combined positron emission tomography (PET) and computed tomography (CT) in N stage assessment in patients with non-small cell lung cancer (NSCLC). Materials and Methods: This prospective study was approved by the institutional review board, and written informed consent was obtained from all patients. A total of 250 consecutive patients with NSCLC (136 men; mean age, 73 years; 114 women; mean age, 72 years) prospectively underwent pretherapeutic STIR turbo SE imaging, DW MR imaging, and FDG PET/ CT, as well as surgical and pathologic examinations (N0 disease, n = 157; N1 disease, n = 72; N2 disease, n = 16; N3 disease, n = 5). Lymph node-to-saline ratio (LSR), lymph node-to-muscle ratio (LMR), apparent diffusion coefficient (ADC), maximal standardized uptake value (SUV max), and visual scoring were assessed for 135 metastatic lymph nodes and 135 randomly selected nonmetastatic lymph nodes. Receiver operating characteristic curve analysis was used to determine feasible threshold values. Diagnostic capabilities for N stage assessment were compared with the McNemar test on a per-patient basis. Results: When feasible, threshold values were used for quantitative assessment; sensitivity and accuracy of LSR and LMR (sensitivity, 82.8%; accuracy, 86.8%) proved to be signifi cantly higher than those of ADC (sensitivity: 74.2%, P = .01; accuracy: 84.4%, P = .04) and SUV max (sensitivity: 74.2%, P = .01). For qualitative assessment, sensitivity of STIR turbo SE imaging (77.4%) was significantly higher than that of DW MR imaging (71.0%, P = .03) and FDG PET/CT (69.9%, P = .02). Conclusion: Quantitative and qualitative assessments of N stage disease in patients with NSCLC obtained with STIR turbo SE MR imaging are more sensitive and/or more accurate than those obtained with DW MR imaging and FDG PET/CT.

Original languageEnglish
Pages (from-to)605-615
Number of pages11
JournalRadiology
Volume261
Issue number2
DOIs
Publication statusPublished - 11-2011

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging

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    Ohno, Y., Koyama, H., Yoshikawa, T., Nishio, M., Aoyama, N., Onishi, Y., Takenaka, D., Matsumoto, S., Maniwa, Y., Nishio, W., Nishimura, Y., Itoh, T., & Sugimura, K. (2011). N stage disease in patients with non-small cell lung cancer: Efficacy of quantitative and qualitative assessment with STIR turbo spin-echo imaging, diffusion-weighted MR imaging, and fluorodeoxyglucose PET/CT. Radiology, 261(2), 605-615. https://doi.org/10.1148/radiol.11110281