FDG-PET and PET/CT have significantly higher sensitivity, specificity, accuracy, and negative predictive value than bone scan [34,35]. MRI Brain MRI brain without and with IV contrast is recommended in any patient with clinical stage II, III, or IV NSCLC, even in the absence of neurologic symptoms [39]. MRI brain without and with IV contrast is optional in patients with clinical stage IB NSCLC without neurologic symptoms [39]. MRI brain without and with IV contrast is recommended in all NSCLC patients with neurologic symptoms, regardless of stage. MRI brain is the preferred imaging modality for evaluation of intracranial metastases, as it is more sensitive for small brain lesions than CT [11,40]. In a meta-analysis of NSCLC patients without neurologic symptoms, the median prevalence of brain lesions was 3% [11]. However, a small study found that 22% of asymptomatic patients with tumor size >3 cm had brain metastases [41]. Any NSCLC patient with neurologic symptoms should be screened for intracranial metastasis [11]. Brain metastases have been associated with adenocarcinoma NSCLC and N2 disease [11,42]. CT Head CT head with IV contrast can be used as an alternate imaging modality in stage III or IV NSCLC patients and NSCLC patients with neurologic symptoms if MRI head is not obtained. Dual-phase imaging may be useful in this clinical setting. CT scanning of the brain is an appropriate method of evaluating for brain metastases in patients with NSCLC [11]. Although MRI has greater sensitivity than CT, the identification of more and smaller brain lesions on MRI compared with CT has not been associated with better survival or the identification of more patients with brain lesions [43,44]. Noninvasive Clinical Staging of Primary Lung Cancer MRI Chest MRI chest without and with IV contrast may be indicated in specific clinical circumstances in NSCLC patients with equivocal findings on CT chest.
Noninvasive Clinical Staging of Primary Lung Cancer PCAs. FDG-PET and PET/CT have significantly higher sensitivity, specificity, accuracy, and negative predictive value than bone scan [34,35]. MRI Brain MRI brain without and with IV contrast is recommended in any patient with clinical stage II, III, or IV NSCLC, even in the absence of neurologic symptoms [39]. MRI brain without and with IV contrast is optional in patients with clinical stage IB NSCLC without neurologic symptoms [39]. MRI brain without and with IV contrast is recommended in all NSCLC patients with neurologic symptoms, regardless of stage. MRI brain is the preferred imaging modality for evaluation of intracranial metastases, as it is more sensitive for small brain lesions than CT [11,40]. In a meta-analysis of NSCLC patients without neurologic symptoms, the median prevalence of brain lesions was 3% [11]. However, a small study found that 22% of asymptomatic patients with tumor size >3 cm had brain metastases [41]. Any NSCLC patient with neurologic symptoms should be screened for intracranial metastasis [11]. Brain metastases have been associated with adenocarcinoma NSCLC and N2 disease [11,42]. CT Head CT head with IV contrast can be used as an alternate imaging modality in stage III or IV NSCLC patients and NSCLC patients with neurologic symptoms if MRI head is not obtained. Dual-phase imaging may be useful in this clinical setting. CT scanning of the brain is an appropriate method of evaluating for brain metastases in patients with NSCLC [11]. Although MRI has greater sensitivity than CT, the identification of more and smaller brain lesions on MRI compared with CT has not been associated with better survival or the identification of more patients with brain lesions [43,44]. Noninvasive Clinical Staging of Primary Lung Cancer MRI Chest MRI chest without and with IV contrast may be indicated in specific clinical circumstances in NSCLC patients with equivocal findings on CT chest.