Whole-body diffusion-weighted imaging vs. FDG-PET for the detection of non-small-cell lung cancer. How do they measure up?

Objective: To compare the diagnostic efficacy of whole-body diffusion-weighted imaging (WB-DWI) and [18F] fluoro-2-D-glucose PET/CT(FDG-PET/CT)for assessment of non small cell lung cancer (NSCLC) patients. Materials and Methods: A group of 56 patients (21 female, 35 male; 35-76 years) with NSCLC proved by pathologic examination or follow-up imaging findings was set as reference standards, and all patients underwent both WB-DWI at 1.5T (MAGNETOM Avanto) and PET/CT (Biograph 16). For WB-DWI, a free breathing diffusion-weighted single-shot spin-echo epi-sequence in five-stations (head-neck, thorax, abdomen, pelvis-thigh) was used. Each station-series contained 30 contiguous axial slices. Imaging parameters: FOV 360x360 mm, matrix size 128x80. B-values: 0 and 1000 s/mm(2) applied along x, y and z, 5 averages, acquisition time: 2.23 min/series, total: 11.55 min. The efficacy of WB-DWI and PET/CT were determined in a blinded reading by two radiologists and two nuclear medicine physicians using pathology and size change during follow up exams as the reference standard. Results: Primary tumors (n=56 patients) were correctly detected in 56 (100%) patients by both PET/CT and WB-DWI. Ninety-six lymph nodes metastases were determined with pathologic and follow-up examinations. Sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV) being for lymph node metastases: 91%, 90%, 90%, 96%, 80% with WB-DWI and 98%, 97%, 97%, 99%, 93% with PET-CT, other metastases: 90%, 95%, 92%, 97%, 83% with WB-DWI and 98%, 100%, 98%, 100%, 95% with PET-CT). Differences in the accuracy of lymph node metastasis detection between PET/CT and WB-DWI (P=.031) were significant. The differences were not statistically significant for detection of other metastases. Conclusions: WB-DWI is a feasible clinical technique for the assessment of NSCLC, lymph nodes and metastastic spread with high sensitivity and accuracy, but it was limited in the evaluation of neck lymph node metastases and small metastastic lung nodules. (C) 2010 Elsevier Inc. All rights reserved.