Although there is heterogeneous physiologic FDG activity in the liver, the accuracy of FDG-PET and PET/CT for liver metastases is reported to be 92% to 100% [37]. When findings are discordant or indeterminate, MRI and/or biopsy are appropriate strategies to evaluate liver lesions. FDG-PET cannot be used for tumor measurement purposes, but integrated PET/CT allows anatomic measurement on the CT portion of the examination for the T descriptor. CT Abdomen and Pelvis CT abdomen and pelvis with oral and IV contrast may be used as an alternate imaging modality to evaluate for extrathoracic metastasis in lung cancer patients being considered for curative therapy if FDG-PET or PET/CT is not performed [11]. Acquisitions of arterial and portal venous phase sequences are advised. CT abdomen and pelvis with oral and IV contrast is recommended in NSCLC patients with abnormal clinical evaluation, including signs or symptoms referable to the abdomen and pelvis and no suspicious extrathoracic findings on chest CT [11]. All NSCLC with locally advanced stage III or stage IV disease should undergo extrathoracic imaging with either CT abdomen and pelvis or FDG-PET or PET/CT because of the likelihood of occult extrathoracic metastatic disease in up to 37% of cases [11]. Bone Scan Whole Body Technetium-99m (Tc-99m) bone scintigraphy may be used as an alternate imaging modality to evaluate for bone metastasis in NSCLC patients if FDG-PET or PET/CT is not performed or is equivocal for osseous findings. Bone scintigraphy was historically used to detect osseous metastatic disease in lung cancer patients. A recent meta-analysis found it has a pooled sensitivity of 91.8%; however, the pooled specificity for bone metastases from lung cancer on bone scintigraphy was 68.8%, which is primarily due to confounders such as degenerative disease, inflammation, and prior trauma [38].
Noninvasive Clinical Staging of Primary Lung Cancer PCAs. Although there is heterogeneous physiologic FDG activity in the liver, the accuracy of FDG-PET and PET/CT for liver metastases is reported to be 92% to 100% [37]. When findings are discordant or indeterminate, MRI and/or biopsy are appropriate strategies to evaluate liver lesions. FDG-PET cannot be used for tumor measurement purposes, but integrated PET/CT allows anatomic measurement on the CT portion of the examination for the T descriptor. CT Abdomen and Pelvis CT abdomen and pelvis with oral and IV contrast may be used as an alternate imaging modality to evaluate for extrathoracic metastasis in lung cancer patients being considered for curative therapy if FDG-PET or PET/CT is not performed [11]. Acquisitions of arterial and portal venous phase sequences are advised. CT abdomen and pelvis with oral and IV contrast is recommended in NSCLC patients with abnormal clinical evaluation, including signs or symptoms referable to the abdomen and pelvis and no suspicious extrathoracic findings on chest CT [11]. All NSCLC with locally advanced stage III or stage IV disease should undergo extrathoracic imaging with either CT abdomen and pelvis or FDG-PET or PET/CT because of the likelihood of occult extrathoracic metastatic disease in up to 37% of cases [11]. Bone Scan Whole Body Technetium-99m (Tc-99m) bone scintigraphy may be used as an alternate imaging modality to evaluate for bone metastasis in NSCLC patients if FDG-PET or PET/CT is not performed or is equivocal for osseous findings. Bone scintigraphy was historically used to detect osseous metastatic disease in lung cancer patients. A recent meta-analysis found it has a pooled sensitivity of 91.8%; however, the pooled specificity for bone metastases from lung cancer on bone scintigraphy was 68.8%, which is primarily due to confounders such as degenerative disease, inflammation, and prior trauma [38].