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Cancer Imaging

Open Access

The value of head imaging after PET-CT staging in NSCLC

Cancer Imaging201515(Suppl 1):P16

Published: 2 October 2015


Brain MetastasisSmall Cell Lung CancerPosterior FossaBritish Thoracic SocietyHead Imaging

20-40% of patients with non small cell lung cancer (NSCLC) can develop brain metastases. Physiological activity on 18 F- FDG PET-CT can mask FDG-avid brain metastases. At our institution PET-CT is acquired from orbits to thighs and will not identify brain metastases extrinsic to the posterior fossa. Inaccurate staging could initiate futile radical treatment.

The British Thoracic Society recommends NSCLC patients, considered for radical treatment (particularly stage III), should have a CT or MRI brain.


We evaluated results of patients who underwent head imaging in those considered for radical treatment of NSCLC and effect on baseline 18 F- FDG PET-CT staging.


Retrospective study. 200 NSCLC cases from 2010 to 2015 that underwent PET-CT for potentially curative disease, were reviewed.


17% (34/200) patients had head imaging. There was an average interval of 115 days between head imaging and PET-CT, ranging from 1 day to up to 2 years.

67% (23/34) patients received head imaging due to presenting neurological symptoms.

32% (15/49) patients with Stage IIIA disease had a CT/MRI brain resulting in 27% (4/15) having their initial PET-CT staging increased.

7.5% (15/200) patients had brain metastases. 93% (14/15) of these patients had presenting neurological symptoms.


Occult brain metastases can cause under staging with 18 F- FDG PET-CT imaging. CT/MRI head imaging requires more vigorous implementation into routine staging of patients with potentially resectable NSCLC.

Authors’ Affiliations

University Hospitals Of Leicester NHS Trust, Leicester, UK


© Kamil et al. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.