Incidence of Brain Metastases on Follow-up 18F-FDG PET/CT Scans of Non–Small Cell Lung Cancer Patients: Should We Include the Brain?

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FIGURE 1.
A total of 1,175 ¹⁸F-FDG PET/CT examinations in 363 patients were reviewed. Exclusion criteria included brain metastases on initial staging, histological subtype of small-cell lung cancer, and no follow up ¹⁸F-FDG PET/CT examinations. After we applied our exclusion criteria as well as eliminated all initial staging scans (only follow-up scans included), a total of 809 follow-up ¹⁸F-FDG PET/CT scans in 227 patients were included in the final analysis.
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FIGURE 2.
Axial ¹⁸F-FDG PET image of brain demonstrates focal hypometabolism in the right frontal lobe (A) corresponding to vasogenic edema on low-dose CT images (B). Subsequent axial T2-FLAIR and contrast-enhanced MR images confirm metastasis with adjacent vasogenic edema (C and D).
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FIGURE 3.
(A and B) Axial ¹⁸F-FDG PET and low-dose CT images of brain demonstrate hypermetabolic lesion in left caudate. (C) Subsequent contrast-enhanced axial MRI of brain confirmed metastasis. (D) Axial T2 FLAIR imaging demonstrates surrounding vasogenic edema. (E) PET also shows crossed-cerebellar diaschisis with decreased activity in contralateral right cerebellum.

TABLE 1

Patients with Incidentally Found Brain Metastasis

Patient	Age (y)	Sex	Cancer type	Time until incidental brain metastasis (mo)	No. of metastases seen on ¹⁸F-FDG PET/CT	No. of metastases seen on subsequent MRI
Patient 1	60	Male	Adenosquamous cell carcinoma	27	1	1
Patient 2	60	Female	Adenocarcinoma	19	1	1
Patient 3	67	Female	Squamous cell carcinoma	53	Multiple	Multiple
Patient 4	77	Female	Adenocarcinoma	66	1	1
Patient 5	77	Male	Adenocarcinoma	15	1	1
Average	68			36