The sensitivity, specificity, accuracy, and negative predictive value of FDG-PET for bone metastases is greater than 90% and is superior to bone scintigraphy [33,34]. MRI Brain MRI brain with IV contrast is recommended in all SCLC patients. MRI brain identifies metastatic lesions in 10% to 15% of newly diagnosed SCLC patients without neurologic symptoms. Up to 12% of patients with otherwise LS-SCLC have intracranial metastases on MRI [61]. MRI is more sensitive than CT for detection of intracranial metastases. MRI brain without IV contrast may be performed. CT Head CT head with IV contrast can be used as an alternate imaging modality in SCLC patients if brain MRI is not performed. Although MRI has greater sensitivity for small brain metastases, CT scanning of the brain is an appropriate method of evaluating for brain metastases in patients with SCLC [51]. Bone Scan Whole Body Tc-99m bone scintigraphy may be used as an alternate imaging modality to evaluate for extrathoracic bone metastasis in SCLC patients if FDG-PET or PET/CT is not performed. Bone metastases are present at the time of diagnosis in up to 37% of SCLCs and are a poor prognostic factor [62,63]. Historically, bone scintigraphy was indicated for the workup of all SCLC patients, but FDG-PET and PET/CT have largely replaced it [51]. Noninvasive Clinical Staging of Primary Lung Cancer MRI Chest MRI chest without and with IV contrast may be indicated in specific clinical circumstances in SCLC patients with equivocal findings on CT chest. Focused MRI of the chest may be useful in assessment of chest wall or spinal invasion and tumor involvement of mediastinal structures including the heart, great vessels, or pericardium. SCLC of the superior sulcus is less common than NSCLC [64] but requires MRI evaluation for locoregional disease affecting the brachial plexus [45]. MRI is superior to CT for detecting involvement of the neural foramina and spinal canal.
Noninvasive Clinical Staging of Primary Lung Cancer PCAs. The sensitivity, specificity, accuracy, and negative predictive value of FDG-PET for bone metastases is greater than 90% and is superior to bone scintigraphy [33,34]. MRI Brain MRI brain with IV contrast is recommended in all SCLC patients. MRI brain identifies metastatic lesions in 10% to 15% of newly diagnosed SCLC patients without neurologic symptoms. Up to 12% of patients with otherwise LS-SCLC have intracranial metastases on MRI [61]. MRI is more sensitive than CT for detection of intracranial metastases. MRI brain without IV contrast may be performed. CT Head CT head with IV contrast can be used as an alternate imaging modality in SCLC patients if brain MRI is not performed. Although MRI has greater sensitivity for small brain metastases, CT scanning of the brain is an appropriate method of evaluating for brain metastases in patients with SCLC [51]. Bone Scan Whole Body Tc-99m bone scintigraphy may be used as an alternate imaging modality to evaluate for extrathoracic bone metastasis in SCLC patients if FDG-PET or PET/CT is not performed. Bone metastases are present at the time of diagnosis in up to 37% of SCLCs and are a poor prognostic factor [62,63]. Historically, bone scintigraphy was indicated for the workup of all SCLC patients, but FDG-PET and PET/CT have largely replaced it [51]. Noninvasive Clinical Staging of Primary Lung Cancer MRI Chest MRI chest without and with IV contrast may be indicated in specific clinical circumstances in SCLC patients with equivocal findings on CT chest. Focused MRI of the chest may be useful in assessment of chest wall or spinal invasion and tumor involvement of mediastinal structures including the heart, great vessels, or pericardium. SCLC of the superior sulcus is less common than NSCLC [64] but requires MRI evaluation for locoregional disease affecting the brachial plexus [45]. MRI is superior to CT for detecting involvement of the neural foramina and spinal canal.