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J Thorac Cardiovasc Surg 2008;135:816-822
© 2008 The American Association for Thoracic Surgery

General Thoracic Surgery

Diffusion-weighted magnetic resonance imaging can be used in place of positron emission tomography for N staging of non–small cell lung cancer with fewer false-positive results

Hiroaki Nomori, MD, PhDa,*, Takeshi Mori, MD, PhDa, Koei Ikeda, MD, PhDa, Koichi Kawanaka, MD, PhDb, Shinya Shiraishi, MD, PhDb, Kazuhiro Katahira, MD, PhDc, Yasuyuki Yamashita, MD, PhDb

a Department of Thoracic Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
b Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
c Department of Radiology, Kumamoto Central Hospital, Kumamoto, Japan

Received for publication July 9, 2007; revisions received October 23, 2007; accepted for publication October 31, 2007.

* Address for reprints: Hiroaki Nomori, MD, PhD, Department of Thoracic Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan. (Email: hnomori{at}qk9.so-net.ne.jp).

Objective: One of the deficiencies of positron emission tomography for N staging in lung cancer is a false-positive result caused by concurrent lymphadenitis. Recently, diffusion-weighted magnetic resonance imaging has been reported to be able to image tumors of body organs. The aim of this study is to examine the usefulness of diffusion-weighted magnetic resonance imaging for N staging of non–small cell lung cancer compared with positron emission tomography–computed tomography.

Methods: Both positron emission tomography–computed tomography and diffusion-weighted magnetic resonance imaging were prospectively used in 88 patients before surgical intervention for non–small cell lung cancer to examine 734 lymph node stations. The diagnostic results of positron emission tomography–computed tomography and diffusion-weighted magnetic resonance imaging were compared. The diameters of the metastatic foci within lymph nodes were measured on hematoxylin and eosin–stained sections to compare the detectable size of metastatic foci between positron emission tomography–computed tomography and diffusion-weighted magnetic resonance imaging.

Results: The accuracy of N staging in the 88 patients was 0.89 with diffusion-weighted magnetic resonance imaging, which was significantly higher than the value of 0.78 obtained with positron emission tomography–computed tomography (P = .012), because of less overstaging in the former. Among the 734 lymph node stations examined pathologically, 36 had metastases, and the other 698 did not. Although there was no significant difference in the diagnosis of the 36 metastatic lymph node stations between the 2 methods, diffusion-weighted magnetic resonance imaging was more accurate for diagnosing the 698 nonmetastatic stations than positron emission tomography–computed tomography because of fewer false-positive results (P = .002). The detectable size of metastatic foci within lymph nodes was 4 mm in both positron emission tomography–computed tomography and diffusion-weighted magnetic resonance imaging.

Conclusions: Diffusion-weighted magnetic resonance imaging can be used in place of positron emission tomography–computed tomography for N staging of non–small cell lung cancer with fewer false-positive results compared with positron emission tomography–computed tomography.

Abbreviations and Acronyms ADC = apparent diffusion coefficient; CR = contrast ratio; CT = computed tomography; DWI = diffusion-weighted magnetic resonance imaging; FDG = fluorodeoxyglucose; FN = false-negative; FP = false-positive; MRI = magnetic resonance imaging; NSCLC = non–small cell lung cancer; PET = positron emission tomography; STIR = short tau inversion recovery; SUV = standard uptake value; TE = echocardiographic time; TN = true-negative; TP = true-positive; TR = repetition time






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