Purpose

[¹⁸F]-FDG PET/CT and brain MRI are common approaches to detect metastasis in patients of lung cancer. Current guidelines for the use of PET/CT and MRI in clinical T1-category lung cancer lack risk-based stratification and require optimization. This study stratified patients based on metastatic risk in terms of the lesions' size and morphological characteristics.

Methods

The detection rate of metastasis was measured in different sizes and morphological characteristics (solid and sub-solid) of tumors. To confirm the cut-off value for discriminating metastasis and overall survival (OS) prediction, the receiver operating characteristic (ROC) analysis was performed based on PET/CT metabolic parameters (SUVmax/SUVmean/SULpeak/MTV/TLG), followed by Kaplan–Meier analysis for survival in post-operation patients with and without PET/CT plus MRI.

Results

2,298 patients were included. No metastasis was observed in patients with solid nodules < 8.0 mm and sub-solid nodules < 10.0 mm. The cut-off of PET/CT metabolic parameters on discriminating metastasis were 1.09 (SUVmax), 0.26 (SUVmean), 0.31 (SULpeak), 0.55 (MTV), and 0.81 (TLG), respectively. Patients undergoing PET/CT plus MRI exhibited longer OS compared to those who did not receive it in solid nodules ≥ 8.0 mm & sub-solid nodules ≥ 10.0 mm (HR, 0.44; p < 0.001); in solid nodules ≥ 8.0 mm (HR, 0.12; p<0.001) and in sub-solid nodules ≥ 10.0 mm (HR; 0.61; p=0.075), respectively. Compared to patients with metabolic parameters lower than cut-off values, patients with higher metabolic parameters displayed shorter OS: SUVmax (HR, 12.94; p < 0.001), SUVmean (HR, 11.33; p <0.001), SULpeak (HR, 9.65; p < 0.001), MTV (HR, 9.16; p = 0.031), and TLG (HR, 12.06; p < 0.001).

Conclusion

The necessity of PET/CT and MRI should be cautiously evaluated in patients with solid nodules < 8.0 mm and sub-solid nodules < 10.0 mm, however, these examinations remained essential and beneficial for patients with solid nodules ≥ 8.0 mm and sub-solid nodules ≥ 10.0 mm.

中文翻译：

---

PET/CT 和脑 MRI 对临床 T1 类肺癌患者转移检测的影响：大规模队列研究的结果

目的

[ ¹⁸ F]-FDG PET/CT 和脑 MRI 是检测肺癌患者转移的常用方法。目前关于在临床 T1 类肺癌中使用 PET/CT 和 MRI 的指南缺乏基于风险的分层，需要优化。该研究根据病灶大小和形态特征的转移风险对患者进行分层。

方法

测量不同大小和形态特征（实性和亚实性）肿瘤的转移检出率。为了确认区分转移和总生存 (OS) 预测的截止值，根据 PET/CT 代谢参数 (SUVmax/SUVmean/SULpeak/MTV/TLG) 进行受试者工作特征 (ROC) 分析，然后进行 Kaplan –对接受或不接受 PET/CT 加 MRI 的术后患者的生存情况进行 Meier 分析。

结果

共纳入 2,298 名患者。实性结节<8.0mm和亚实性结节<10.0mm的患者未观察到转移。 PET/CT 代谢参数区分转移的截止值分别为 1.09 (SUVmax)、0.26 (SUVmean)、0.31 (SULpeak)、0.55 (MTV) 和 0.81 (TLG)。对于≥ 8.0 mm 的实性结节和≥ 10.0 mm 的亚实性结节，接受 PET/CT 加 MRI 的患者与未接受 PET/CT 联合 MRI 的患者相比，表现出更长的 OS（HR，0.44；p < 0.001）；分别为≥ 8.0 mm 的实性结节（HR，0.12；p<0.001）和≥ 10.0 mm 的亚实性结节（HR；0.61；p=0.075）。与代谢参数低于临界值的患者相比，代谢参数较高的患者表现出更短的 OS：SUVmax（HR，12.94；p < 0.001）、SUVmean（HR，11.33；p <0.001）、SULpeak（HR，9.65；p <0.001）。 p < 0.001）、MTV（HR，9.16；p = 0.031）和 TLG（HR，12.06；p < 0.001）。

结论

对于实性结节<8.0mm和亚实性结节<10.0mm的患者，应谨慎评估PET/CT和MRI的必要性，然而，这些检查对于实性结节≥8.0mm和亚实性结节的患者仍然是必要和有益的≥10.0毫米。