Yoshiharu Ohno MD, PhD, Presenter: Research Grant, Toshiba Corporation Research Grant, Koninklijke Philips NV Research Grant, Bayer AG Research Grant, DAIICHI SANKYO Group Research Grant, Eisai Co, Ltd Research Grant, Terumo Corporation Research Grant, Fuji Yakuhin Co, Ltd Research Grant, FUJIFILM Holdings Corporation Research Grant, Guerbet SA

Shinichiro Seki, Abstract Co-Author: Nothing to Disclose

Mizuho Nishio MD, PhD, Abstract Co-Author: Research Grant, Toshiba Corporation

Hisanobu Koyama MD, PhD, Abstract Co-Author: Nothing to Disclose

Yoshimori Kassai MS, Abstract Co-Author: Employee, Toshiba Corporation

Masao Yui, Abstract Co-Author: Employee, Toshiba Corporation

Hitoshi Yamagata PhD, Abstract Co-Author: Employee, Toshiba Corporation

Takeshi Yoshikawa MD, Abstract Co-Author: Research Grant, Toshiba Corporation

Sumiaki Matsumoto MD, PhD, Abstract Co-Author: Research Grant, Toshiba Corporation

Yu Ueda PhD, Abstract Co-Author: Nothing to Disclose

Katsusuke Kyotani RT, Abstract Co-Author: Nothing to Disclose

Kazuhiro Kubo RT, Abstract Co-Author: Nothing to Disclose

Kazuro Sugimura MD, PhD, Abstract Co-Author: Research Grant, Toshiba Corporation Research Grant, Koninklijke Philips NV Research Grant, Bayer AG Research Grant, Eisai Co, Ltd Research Grant, DAIICHI SANKYO Group

Diffusion-weighted MR imaging using an echo-planar imaging (EPI) sequence has been suggested at least as valuable as FDG-PET/CT for N stage assessment in non-small cell lung cancer (NSCLC) patients, although image distortion of DWI using EPI sequence may decrease diagnostic performance in this setting. Recently, we developed the new DWI by means of the fast spin-echo (FSE) sequence to overcome this problem. The purpose of this study was to determine the utility of DWI using FSE (FSE-DWI) for N-stage assessment in NSCLC patients as compared with DWI using EPI (EPI-DWI) and PET/CT.

66 consecutive operable NSCLC patients (37 men, 29 women; mean age 71 years) prospectively underwent FSE-DWI and EPI-DWI at a 3T system, integrated PET/CT, surgical treatment and pathological and follow-up examinations. In each subject, both DWI sequences were applied with b-value at 300 sec/mm2. Then, probability of lymph node metastasis at each station was visually assessed by 5-point visual scoring systems on both DWIs and PET/CT in each patient. To compare diagnostic capability of lymph node metastasis among all methods, ROC analyses were performed. Then, sensitivity, specificity and accuracy were compared among all methods by means of McNemar’s test on a per station basis. Finally, diagnostic accuracy of the N-stage was also statistically compared each other by McNemar’s test.

Area under the curve (Az) of FSE-DWI (Az=0.89) was significantly larger than that of EPI-DWI (Az=0.77, p<0.0001) and PET/CT (Az=0.83, p=0.03). On a per node basis, sensitivity (SE) and accuracy (AC) of FSE-DWI (SE: 80.0 <60/75> %, AC: 95.3 <427/448> %) were significantly higher than those of EPI-DWI (SE: 56.0 <42/75> %, p<0.0001; AC: 91.5 <410/448> %, p<0.0001) and PET/CT (SE: 72.0 <54/75> %, p<0.0001; AC: 94.0 <421/448> %, p<0.0001). While assessing N-stage, sensitivity (96.9 <31/32> %) and accuracy (95.3 <61/64> %) of FSE-DWI were significantly higher than those of EPI-DWI (SE: 75.0 <24/32> %, p=0.02; AC: 86.0 <55/64> %, p=0.03) and PET/CT (SE: 75.0 <24/32> %, p=0.02; AC: 86.0 <55/64> %, p=0.03).

DWI using FSE is more sensitive and accurate method than DWI using EPI and PET/CT for N-stage assessment in patients with non-small cell lung cancer.

DWI using the fast spin-echo sequence is more sensitive and accurate than DWI using the echo-planar imaging sequence and PET/CT for N-stage assessment in non-small cell lung cancer patients.

Ohno, Y, Seki, S, Nishio, M, Koyama, H, Kassai, Y, Yui, M, Yamagata, H, Yoshikawa, T, Matsumoto, S, Ueda, Y, Kyotani, K, Kubo, K, Sugimura, K, Newly Developed DWI Using Fast SE Sequence vs. DWI using EPI Sequence vs. FDG-PET/CT: Diagnostic Capability of N-Stage in Patients with Non-small Cell Lung Cancer.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14006558.html