Evaluation of 18F-FDG PET/MRI, 18F-FDG PET/CT, MRI, and CT in whole-body staging of recurrent breast cancer. Issue 2 (February 2016)

• Record Type: Journal Article
• Authors: Sawicki, Lino M.; Grueneisen, Johannes; Schaarschmidt, Benedikt M.; Buchbender, Christian; Nagarajah, James; Umutlu, Lale; Antoch, Gerald; Kinner, Sonja
• Is Part Of: European journal of radiology. Volume 85:Issue 2(2016)
• Page Start: 459
• Page End: 465
• Publication Date: 2016-02
• Subjects: Recurrent -- Breast cancer -- PET/MRI -- PET/CT -- MRI -- CT; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2015.12.010
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: On a per-lesion basis, PET/MRI demonstrated the highest diagnostic performance. On a per-patient basis, PET/MRI, PET/CT, and MRI were equally suitable. Utility of CT appears limited both on a per-lesion and per-patient basis. Abstract: Objectives: To compare the diagnostic performance of 18 F-fluordesoxyglucose positron emission tomography/magnetic resonance imaging ( 18 F-FDG PET/MRI) with 18 F-FDG PET/computed tomography ( 18 F-FDG PET/CT), MRI, and CT in whole-body staging of recurrent breast cancer. Material and methods: Twenty-one consecutive patients (age 59.4 ± 11.5 years, range 38.5–76.9 years; 20 female, 1 male) with suspected breast cancer recurrence underwent a clinically indicated 18 F-FDG PET/CT and subsequently a 18 F-FDG PET/MRI examination in a single injection protocol (mean injected activity: 257 ± 44 MBq 18 F-FDG). Each 18 F-FDG PET/MRI, 18 F-FDG PET/CT, as well as the CT component of PET/CT (CTPET/CT ) and MR images of PET/MRI (MRIPET/MRI ) were separately evaluated by two radiologists regarding lesion count, lesion localization, and lesion categorization (benign/malignant). The reference standard was based on histopathological results as well as prior and follow-up imaging. A Wilcoxon test assessed differences in SUVmax between 18 F-FDG PET/MRI and 18 F-FDG PET/CT. Correlation of SUVmax between 18 F-FDG PET/MRI and 18 F-FDG PET/CT was calculated using Pearson's correlation coefficient. Interobserver agreement on dignity ratings was evaluated using Cohen's kappa. Results: According to the reference standard, 17 patients had breast cancer recurrence. 18 F-FDG PET/MRI, 18 F-FDG PET/CT, and MRIPET/MRI correctly identified each of the 17 patients, whereas CTPET/CT correctly identified 15 of the 17 patients. A total of 134 lesions were described (116 malignant, 18 benign). 18 F-FDG PET/MRI detected all 134 lesions, of which 18 F-FDG PET/CT, MRIPET/MRI, and CTPET/CT detected 97.0%, 96.2%, and 74.6%, respectively. 18 F-FDG PET/MRI yielded the highest proportion of correctly categorized lesions (98.5%) compared with 18 F-FDG PET/CT (94.8%), MRIPET/MRI (88.1%), and CTPET/CT (57.5%). SUVmax was strongly correlated ( r = 0.72) but measured significantly higher on 18 F-FDG PET/MRI than on 18 F-FDG PET/CT in corresponding PET-positive lesions (SUVmax: 5.6 ± 2.8 vs. 4.9 ± 1.8; p = 0.001). Interobserver agreement on lesion dignity was substantial with 18 F-FDG PET/MRI ( k = 0.65; p < 0.001) and 18 F-FDG PET/CT ( k = 0.65; p < 0.001). With MRIPET/MRI interobserver analysis yielded a moderate agreement ( k = 0.56; p < 0.001), whereas there was only fair agreement evaluating the CTPET/CT datasets ( k = 0.31; p = 0.002). Conclusions: 18 F-FDG PET/MRI offered the highest diagnostic performance compared with 18 F-FDG PET/CT, MRI and CT. Thus, 18 F-FDG PET/MRI should be regarded as a valuable alternative in whole-body staging of recurrent breast cancer.