Noninvasive staging of lung cancer

Accurate evaluation of disease extent is mandatory when the diagnosis of resectable lung cancer is established. Staging has a significant impact on subsequent therapeutic options and prognosis. Radiologists can now rely on numerous instruments, each with different advantages and limitations. The procedure of choice is still chest X-ray whose intrinsic limitations require better tumor characterization with chest CT. CT difficulties in the differential diagnosis between the tumor and secondary changes occurring in adjacent structures can be overcome by 18F-FDG-PET or MRI. Functional information is acquired with the former and multiparametric information with the latter. According to the case, further extension to adjacent structures can be evaluated based on CT or MRI. For lymph node and distant metastasis PET is increasingly used, except for brain parenchyma where MRI is definitely more accurate in the detection of brain metastasis.