Is diffusion-weighted magnetic resonance imaging superior to positron emission tomography with fludeoxyglucose F 18 in imaging non-small cell lung cancer?

doi:10.1016/j.jtcvs.2008.12.026

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Is diffusion-weighted magnetic resonance imaging superior to positron emission tomography with fludeoxyglucose F 18 in imaging non–small cell lung cancer?

Yasuomi Ohba, MD^a, Hiroaki Nomori, MD, PhD^a^,d^,_*, Takeshi Mori, MD, PhD^a, Koei Ikeda, MD, PhD^a, Hidekatsu Shibata, MD^a, Hironori Kobayashi, MD, PhD^a, Shinya Shiraishi, MD, PhD^b, Kazuhiro Katahira, MD, PhD^c

^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 Chuo Hospital, Kumamoto, Japan
^d Division of General Thoracic Surgery, Department of Surgery, School of Medicine, Keio University, Tokyo, Japan

Received for publication April 27, 2008; revisions received October 11, 2008; accepted for publication December 27, 2008.

^_* 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: This retrospective analysis examined whether diffusion-weightedmagnetic resonance imaging might be as useful as positron emissiontomography with fludeoxyglucose F 18 for (1) discriminatingbetween non–small cell lung cancer and benign pulmonarynodules and (2) predicting aggressiveness of non–smallcell lung cancer.

Methods: Diffusion-weighted magnetic resonance imaging and positron emissiontomography were performed before surgery in 110 patients with124 pulmonary nodules smaller than 3 cm, including 96 non–smallcell lung cancers and 28 benign nodules. Diffusion of watermolecules in magnetic resonance imaging was measured by minimumvalue of apparent diffusion coefficient. The criterion standardwas the result of histologic diagnosis or follow-up examination.Sensitivity and specificity for differentiating between cancersand benign nodules were compared between diffusion-weightedimaging and positron emission tomography. Apparent diffusioncoefficient in diffusion-weighted imaging and fludeoxyglucoseF 18 uptake in positron emission tomography were examined withrespect to pathologic tumor stage; lymphatic, vascular and pleuralinvolvements; and histologic differentiation.

Results: There were no significant differences between diffusion-weightedmagnetic resonance imaging and positron emission tomographyin sensitivity or specificity for non–small cell lungcancer. Whereas positron emission tomography showed significantdifferences in fludeoxyglucose F 18 uptake between pathologicstages IA versus IB or more advanced stages; between tumorswith and without lymphatic, vascular, or pleural involvement;and between well-differentiated and moderately or poorly differentiatedadenocarcinomas (P <.01–0.001), no significant differencesin apparent diffusion coefficient values in were observed.

Conclusion: Diffusion-weighted magnetic resonance imaging is equivalentto positron emission tomography in distinguishing non–smallcell lung cancer from benign pulmonary nodules but is not asuseful for predicting aggressiveness of non–small celllung cancer.

Abbreviations and Acronyms ADC = apparent diffusion coefficient;CT = computed tomography; DWI = diffusion-weighted magneticresonance imaging; FDG = fludeoxyglucose F 18; FDG-PET = positronemission tomography with fludeoxyglucose F 18; FN = false-negativeresult; FP = false-positive result; MR = magnetic resonance;PET = positron emission tomography; ROI = region of interest;SUV = standard uptake value; SUV_CR = contrast ratio of standarduptake value; SUV_max = maximum standard uptake value; TE =echo time; TN = true-negative result; TP = true-positive result;TR = repetition time