Three-way Comparison of Whole-Body MR, Coregistered Whole-Body FDG PET/MR, and Integrated Whole-Body FDG PET/CT Imaging: TNM and Stage Assessment Capability for Non-Small Cell Lung Cancer Patients

Purpose: To prospectively compare the capabilities for TNM classification and assessment of clinical stage and operability among whole-body magnetic resonance (MR) imaging, coregistered positron emission tomographic (PET)/MR imaging with and without MR signal intensity (SI) assessment, and integrated fluorine 18 fluorodeoxyglucose (FDG) PET/computed tomography (CT) in non-small cell lung cancer (NSCLC) patients. Materials and Methods: The institutional review board approved this study, and written informed consent was obtained from each patient. One hundred forty consecutive NSCLC patients (75 men, 65 women; mean age, 72 years) prospectively underwent whole-body MR imaging, FDG PET/CT, conventional radiologic examinations, and surgical, pathologic, and/or follow-up examinations. All factors and clinical stage and operability were then visually assessed. All PET/MR examinations were assessed with and without SI assessment. One examination used anatomic, metabolic, and relaxation-time information, and the other used only anatomic and metabolic information. kappa statistics were used for assessment of all factors and clinical stages with final diagnoses. McNemar test was used to compare the capability of all methods to assess operability. Results: Agreements of assessment of every factor (kappa = 0.63-0.97) and clinical stage (kappa = 0.65-0.90) were substantial or almost perfect. Regarding capability to assess operability, accuracy of whole-body MR imaging and PET/MR imaging with SI assessment (97.1% [136 of 140]) was significantly higher than that of MR/PET without SI assessment and integrated FDG PET/CT (85.0% [119 of 140]; P, < .001). Conclusion: Accuracies of whole-body MR imaging and PET/MR imaging with SI assessment are superior to PET/MR without SI assessment and PET/CT for identification of TNM factor, clinical stage, and operability evaluation of NSCLC patients. (C) RSNA, 2015