Whole-Body MRI with Diffusion-Weighted Imaging: A Valuable Tool for Staging of Lung Cancer

Abstract Lung cancer stands as the second most commonly diagnosed cancer and the leading cause of cancer-related death worldwide. The staging of lung cancer is a pivotal aspect of management and serves as the most crucial predictor of survival. The current staging pathway with fluorine-18 fluoro-D-glucose positron emission tomography/computed tomography (18F FDG-PET/CT) presents several drawbacks. Whole-body magnetic resonance imaging (MRI) with diffusion-weighted imaging (WB-MRI with DWI) emerges as a noninvasive and radiation-free imaging modality for staging. This study aims to analyze the role of WB-MRI with DWI as a one-stop-shop modality for comprehensive lung cancer staging, aiming to reduce treatment initiation delays. Thirty-one patients with biopsy-proven lung cancer underwent WB contrast-enhanced MRI with DWI and 18F-FDG PET/CT for separate TNM staging. The diagnostic accuracies and correlations between WB-MRI with and without DWI and postcontrast sequences were compared to determine the utility of DWI and contrast enhancement in TNM staging. WB-MRI with DWI proves ideal for delineating fat planes, contributing to accurate T staging. Notably, WB-MRI with DWI exhibited higher diagnostic accuracy than WB-MRI without DWI in N and M staging. WB-MRI demonstrated superior brain metastasis identification and correlated with 18F-FDG PET/CT in overall TNM staging. Contrast enhancement, however, did not provide any additional value for TNM staging. WB-MRI with DWI emerges as good imaging tool for lung cancer staging, boasting adequate diagnostic accuracy. Its adoption benefits the prompt initiation of treatment and serves as an adjunct imaging modality in patients in whom contrast cannot be administered.