TNM Staging of Non-Small Cell Lung Cancer: Comparison of PET/MR and PET/CT

The purpose of this study was to compare the diagnostic accuracy of whole-body unenhanced PET/MR with that of PET/CT in determining the stage of non small cell lung cancer. Methods: This study was approved by the institutional review board and by national government authorities. Forty-two consecutive patients referred for the initial staging of non small cell lung cancer underwent whole-body imaging with a sequential trimodality PET/CT/MR system. PET/MR and PET/CT datasets were evaluated separately, and a TNM stage was assigned on the basis of the image analysis. Nodal stations in the chest were identified according to the mapping system of the American Thoracic Society. The standard of reference was histopathology for the tumor stage in 20 subjects, for the nodal stage in 22 patients, and for extrathoracic metastases in 5 subjects. All other lesions were confirmed by at least 1 different imaging method. A Wilcoxon signed-ranks test was used for comparing PET/MR with PET/CT. Results: PET/MR did not provide additional information compared with PET/CT. The diagnostic accuracy of both imaging modalities was equal (T staging, P = 0.177; N staging, P = 0.114; M staging, P = 0.465), however, with advantages for PET/CT by trend. In the subgroup with histopathologic confirmation of T and N stages, the situation was similar (T staging, P = 0.705; N staging, P = 0.334). Conclusion: This study indicates that PET/MR using a fast MR protocol does not improve the diagnostic accuracy of the staging of non small cell lung cancer.