What is the role of MRI scans in the N classification of lung cancer staging?

Updated: Jan 28, 2019
  • Author: Omar Lababede, MD; Chief Editor: Eugene C Lin, MD  more...
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MRI size criteria are used to identify nodal involvement, and these are comparable to those used at CT scanning. However, MRI can be used to distinguish nodes from vessels without intravenous contrast enhancement. In addition, direct imaging in the sagittal and coronal planes is helpful in the assessment of the subcarinal and aortopulmonary regions.

One study demonstrated that STIR turbo SE imaging is at least as valid as coregistered FDG-PET/CT for quantitative and qualitative assessment of the N-stage for non–small cell lung cancer patients. The metastatic lymph nodes are recognized by having high signal intensity on this sequence, compared with the metastatic nodes, which have low signal intensity. In the same study, the reported sensitivity of 90.1% and accuracy of 92.2% were higher compared with those of the PET/CT. [28]

Diffusion-weighted imaging has been reported to be more accurate than PET/CT in differentiating inflammatory from metastatic FDG-avid nodes by demonstrating no restricted diffusion in the inflammatory lymphadenitis. However, this technique has limited spatial resolution and can be false positive with adenitis from mycobacterial infection. [16]

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