Abstract
PurposeTo develop a multiparametric [18F]FDG positron emission tomography/magnetic resonance imaging (PET/MRI) model for breast cancer diagnosis incorporating imaging biomarkers of breast tumors and contralateral healthy breast tissue.MethodsIn this prospective study and retrospective data analysis, 141 patients (mean 57 years) with an imaging abnormality detected on mammography and/or ultrasound (BI-RADS 4/5) underwent combined multiparametric [18F]FDG PET/MRI with PET/computed tomography and multiparametric MRI of the breast at 3 T. Images were evaluated and the following were recorded: for the tumor, BI-RADS descriptors on dynamic contrast-enhanced (DCE)-MRI, mean apparent diffusion co-efficient (ADCmean) on diffusion-weighted imaging (DWI), and maximum standard uptake value (SUVmax) on [18F]FDG-PET; and for the contralateral healthy breast, background parenchymal enhancement (BPE) and amount of fibroglandular tissue (FGT) on DCE-MRI, ADCmean on DWI, and SUVmax. Histopathology served as standard of reference. Uni-, bi-, and multivariate logistic regression analyses were performed to assess the relationships between malignancy and imaging features. Predictive discrimination of benign and malignant breast lesions was examined using area under the receiver operating characteristic curve (AUC).ResultsThere were 100 malignant and 41 benign lesions (size: median 1.9, range 0.5–10 cm). The multivariate regression model incorporating significant univariate predictors identified tumor enhancement kinetics (P = 0.0003), tumor ADCmean (P < 0.001), and BPE of the contralateral healthy breast (P = 0.0019) as independent predictors for breast cancer diagnosis. Other biomarkers did not reach significance. Combination of the three significant biomarkers achieved an AUC value of 0.98 for breast cancer diagnosis.ConclusionA multiparametric [18F]FDG PET/MRI diagnostic model incorporating both qualitative and quantitative parameters of the tumor and the healthy contralateral tissue aids breast cancer diagnosis.
Highlights
In recent years, positron emission tomography (PET) and multiparametric magnetic resonance imaging of the breast have been established as promising tools [1,2,3] that provide morphologic and functional data and are of complementary value for the differentiation of benign and malignant breast tumors [4]
With the increasing use of positron emission tomography/magnetic resonance imaging (PET/MRI) worldwide, it is of interest to clarify whether qualitative and quantitative MRI and PET imaging biomarkers can contribute to accurate breast cancer diagnosis
We analyzed the contribution of tumor [18F]FDG SUVmax, breast parenchymal uptake (BPU) of healthy breast tissue, tumor dynamic contrast-enhanced (DCE)-MRI BI-RADS descriptors, background parenchymal enhancement (BPE), and fibroglandular tissue (FGT) of the contralateral healthy breast and ADCmean of the tumor and healthy breast tissue
Summary
Positron emission tomography (PET) and multiparametric magnetic resonance imaging (mpMRI) of the breast have been established as promising tools [1,2,3] that provide morphologic and functional data and are of complementary value for the differentiation of benign and malignant breast tumors [4]. The predictive and prognostic value of imaging features derived from healthy breast tissue such as background parenchymal enhancement (BPE) in DCE-MRI have been recognized only recently. Similar to MRI, healthy breast parenchyma shows varying degrees of tracer uptake in [18F]FDG PET, reflecting its physiologic activity, referred to as breast parenchymal uptake (BPU) [16, 17] and is directly correlated with BPE and FGT. It has been suggested that BPU could potentially serve as another breast cancer imaging biomarker [16,17,18]
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