Initial experience of integrated PET/MR mammography in patients with invasive ductal carcinoma.

Abstract

The purpose of this study was to evaluate the feasibility of integrated fluorine-18-fluorodeoxyglucose positron emission tomography/magnetic resonance ((18)F-FDG PET/MR) mammography in invasive ductal carcinoma (IDC) patients. From August 2012 to March 2013, we enrolled 42 consecutive breast cancer patients who received whole- body PET/MR and subsequent PET/MR mammography by an integrated PET/MR scanner and were scheduled for surgery within 2 weeks after the of scan. On the whole body PET/MR, 2-point Dixon VIBE, coronal T1w image, axial T2w image, and post-contrast T1 sequences were acquired with simultaneous PET acquisition. For PET/MR mammography, T1w, T2w, and dynamic contrast-enhancement (DCE) sequences were acquired using a breast coil during simultaneous PET acquisition. We compared the detectability of the lesions between whole-body PET/MR and PET/MR mammography. Forty-eight IDC (1.89±1.19cm of width) were diagnosed in 42 women. Lesion conspicuity in (18)F-FDG PET was equivalent between whole-body PET/MR and PET/MR mammography; both PET/MR images showed 38 hypermetabolic masses. In the analysis of 10 IDC with <1.0cm wide lesions, only 1 IDC showed (18)F-FDG uptake, and 4 IDC were noted on whole-body PET/MR; however, all 10 IDC showed a depictable mass on PET/MR mammography. In the analysis of 38 IDC >1.0cm wide, 37 IDC showed (18)F-FDG uptake, and 38 IDC were detected on both whole-body PET/MR and PET/MR mammography. The overall sensitivity was 79.2% (38/48) on PET, 87.5% (42/48) on whole-body PET/MR, and 100% on PET/MR mammography. The SUV between whole-body PET/MR and PET/MR mammography showed strong and highly significant correlation (r=0.987, P<0.001). In conclusion, our results, although in a limited number of cases show that integrated PET/MR mammography is feasible and has the advantage of combining high-resolution breast images with metabolic images. Furthermore, PET/MR mammography could provide an accurate diagnosis in case of IDC that are less than 1cm in size.