Hybrid PET/MRI is highly valuable, having made significant strides in overcoming technical challenges and offering unique advantages such as reduced radiation, precise data coregistration, and motion correction. Growing evidence highlights the value of PET/MRI in broad clinical aspects, including inflammatory and oncological imaging in adults, pregnant women, and pediatrics, potentially surpassing PET/CT. This newly integrated solution may be preferred over PET/CT in many clinical conditions. However, further technological advancements are required to facilitate its broader adoption as a routine diagnostic modality. 

Update on Positron Emission Tomography/Magnetic Resonance Imaging: Cancer and Inflammation Imaging in the Clinic.

Lung cancer is highly aggressive, which has a high mortality rate. Major types encompass lung adenocarcinoma, lung squamous cell carcinoma, lung adenosquamous carcinoma, small cell carcinoma, and large cell carcinoma. Lung adenocarcinoma and lung squamous cell carcinoma together account for more than 80% of cases. Diverse subtypes demand distinct treatment approaches. The application of precision medicine necessitates prompt and accurate evaluation of treatment effectiveness, contributing to the improvement of treatment strategies and outcomes. Medical imaging is crucial in the diagnosis and management of lung cancer, with techniques such as fluoroscopy, computed radiography (CR), digital radiography (DR), computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET)/CT, and PET/MRI being essential tools. The surge of radiomics in recent times offers fresh promise for cancer diagnosis and treatment. In particular, PET/CT and PET/MRI radiomics, extensively studied in lung cancer research, have made advancements in diagnosing the disease, evaluating metastasis, predicting molecular subtypes, and forecasting patient prognosis. While conventional imaging methods continue to play a primary role in diagnosis and assessment, PET/CT and PET/MRI radiomics simultaneously provide detailed morphological and functional information. This has significant clinical potential value, offering advantages for lung cancer diagnosis and treatment. Hence, this manuscript provides a review of the latest developments in PET-related radiomics for lung cancer.

Current status and prospect of PET-related imaging radiomics in lung cancer

Editorial for “Predictive Value of F-FDG PET/MRI for Pleural Invasion in Solid and Subsolid Lung Adenocarcinomas Smaller Than 3 cm” According to Fleischner Society guidelines and new classification scheme issued in 2011 by the joint committee of thorax societies, invasiveness of cancer, in particular adenocarcinomas, can be of many subtypes such as lepidic growth, papillary, micropapillary, acinar, and mucinous. In adenocarcinomas presenting with nodular pattern, nodule size (≥6 mm) represents an important parameter for predicting malignant progression in lung cancer screening. On the other hand, lung nodules <6 mm despite being relatively not of utmost importance in clinical standpoint still bear a clinical impact to be further delineated with other hybrid imaging modalities including PET/CT, MRI, and PET/MRI. Improved anatomic registration with PET secondary to simultaneous image acquisition is now a reality with the advent of simultaneous PET-MR imaging scanners. In this article by Zhang et al, the authors investigated F-FDG PET/MRI for predicting PI of lung adenocarcinoma ≤3 cm. Once problematic tissue border artifact due to the influence of positron range even at higher magnetic fields (3T), advent in hybrid PET-MRI imaging scanners is now considered superior to PET/CT imaging that renders margin of lesions with enhanced evaluation. Following its introduction in 2011, the clinical utility of hybrid PET/MRI still holds a potential area of research in which organs and/or diseases it is preferable over PET/CT. This article elucidates the role of PET/MRI in pleural invasion of lung adenocarcinomas. In its essence, more superior spatial and temporal registrations may be achieved via concurrent acquisition of PET and MRI signals. Technically speaking, simultaneous acquisition of PET and MR is of valuable utility. However, overcoming technical hindrance in orchestration of PET/MRI is much more challenging than PET/CT. The main unwanted implication of MRI utility on lung parenchymal nodules is a susceptibility artifact created by air within the lung, low signal-to-nose ratio of the aerated lung, and motion artifacts from breathing during image acquisition. Generally recommended sequences are half-Fourier acquisition single-shot turbo SE and STIR turbo SE T1-weighted and/or T2-weighted sequences; in-phase and opposed-phase T1-weighted gradient-echo (GRE) and contrast-enhanced in-phase T1-weighted GRE sequence; and the 3D T1 high-resolution isotropic volume excitation and/or quick and segmented 3D T1-weighted GRE sequence (Quick 3D) combined with various fat suppression techniques as well as DWI obtained by echo-planar (EPI) or fast advanced SE sequences. The sensitivity of the T2-weighted HASTE MR imaging sequence to detect nodules less than 3, 3–5, 5–10 mm, and greater than 10 mm has been reported to be 73%, 86%, 96%, and 100%, respectively. In another study, hybrid PET with zero-TE MRI and Dixon-MRI were compared with better outcome of PET/ZTE in the detection of FDG-avid and nonFDG-avid lung lesions smaller than 4 mm in size. In this article, T2FS and DWI potency was set forward in assessment of pleural invasion of lung adenocarcinomas of size greater than 3 cm and in a group of patients with advanced age. There are currently limited data regarding SUV quantification in lung cancer on PET-MR imaging compared with PET-CT. Given that current clinical PET-MR imaging scanners use a tissue-classification system for estimation of lung density compared with direct measurements obtained on PET-CT, some quantitative differences are expected, which may be attributable to misclassification of soft tissue as air in some regions on the MR imaging attenuation maps. In this article, auto-measurement of SUV-max values from PET/CT only and incorporating this value with DWI and T2WI characteristics reflect a reasonable approach in placating such misinterpretation. With respect to smaller nodules, the performance of PET-MR imaging is on the verge of being in routine implementation for lung cancers. This study is a preliminary contribution to our understanding of clinical utility of hybrid PET/MRI in smaller lung nodules and its potential effectiveness in assessing pleural invasion, which may go unnoticed with other imaging modalities. In conclusion, in this article, Zhang et al provided an insight for using F-FDG PET/MRI for diagnosing pleural

Editorial for “Predictive Value of 18F‐FDG PET/MRI for Pleural Invasion in Solid and Subsolid Lung Adenocarcinomas Smaller Than 3 cm”

Background Visceral pleural invasion (VPI) is a poor prognostic factor that contributes to the upstaging of early lung cancers. However, the preoperative assessment of VPI presents challenges. This study was conducted to examine intraoperative pleural carcinoembryonic antigen (pCEA) level and maximum standardized uptake value (SUVmax) as predictive markers of VPI in patients with clinical T1N0M0 lung adenocarcinoma. Methods A retrospective review was conducted of the medical records of 613 patients who underwent intraoperative pCEA sampling and lung resection for non-small cell lung cancer. Of these, 390 individuals with clinical stage I adenocarcinoma and tumors ≤30 mm were included. Based on computed tomography findings, these patients were divided into pleural contact (n=186) and non-pleural contact (n=204) groups. A receiver operating characteristic (ROC) curve was constructed to analyze the association between pCEA and SUVmax in relation to VPI. Additionally, logistic regression analysis was performed to evaluate risk factors for VPI in each group. Results ROC curve analysis revealed that pCEA level greater than 2.565 ng/mL (area under the curve [AUC]=0.751) and SUVmax above 4.25 (AUC=0.801) were highly predictive of VPI in patients exhibiting pleural contact. Based on multivariable analysis, pCEA (odds ratio [OR], 3.00; 95% confidence interval [CI], 1.14–7.87; p=0.026) and SUVmax (OR, 5.25; 95% CI, 1.90–14.50; p=0.001) were significant risk factors for VPI in the pleural contact group. Conclusion In patients with clinical stage I lung adenocarcinoma exhibiting pleural contact, pCEA and SUVmax are potential predictive indicators of VPI. These markers may be helpful in planning for lung cancer surgery.

Pleural Carcinoembryonic Antigen and Maximum Standardized Uptake Value as Predictive Indicators of Visceral Pleural Invasion in Clinical T1N0M0 Lung Adenocarcinoma

<title>Abstract</title> Rationale and Objectives: Bone metastasis (BM) significantly affects the prognosis of lung adenocarcinoma (LUAD) patients. Currently, no effective clinical model exists for predicting early BM in category T1 LUAD. This study aims to develop a model for timely BM detection by analyzing relevant influencing factors. Materials and Methods This retrospective study analyzed data from 478 patients with category T1 LUAD from August 2017 to August 2023. Of these, 334 patients were assigned to a training cohort and 144 to an internal validation cohort. Univariate and multivariate analyses identified BM risk factors, leading to a nomogram model. Model performance was evaluated using area under the curve (AUC), calibration curves, and decision curve analysis (DCA). An online calculator was also created to assess BM risk. Results Multivariate analysis revealed that alkaline phosphatase (ALP), carcinoembryonic antigen (CEA), nodule type, CT-reported N staging, and pleural effusion are independent BM risk factors. The nomogram showed strong accuracy, with AUC values of 0.929 in the training cohort and 0.954 in the validation cohort. Calibration analyses confirmed reliability, with DCA indicating high clinical benefit for both cohorts. Conclusion This nomogram effectively identifies high-risk patients for BM in category T1 LUAD, aiding personalized clinical decision-making. 

A nomogram model for diagnosing bone metastasis in category T1 Lung Adenocarcinoma

Positron emission tomography (PET)/MRI combines the characteristics of metabolism imaging and high soft tissue resolution, and could provide high diagnostic efficacy for assessment of pleural invasion (PI) of lung cancer.

Predictive Value of 18F‐FDG PET/MRI for Pleural Invasion in Solid and Subsolid Lung Adenocarcinomas Smaller Than 3 cm

The value of 18F-FDG PET/MRI in characterizing pleural effusion and detecting pleural metastasis for staging lung cancer

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Predictive Value of 18F‐FDG PET/MRI for Pleural Invasion in Solid and Subsolid Lung Adenocarcinomas Smaller Than 3 cm

The value of 18F-FDG PET/MRI in characterizing pleural effusion and detecting pleural metastasis for staging lung cancer