Grueneisen Johannes, Nagarajah James, Buchbender Christian, Hoffmann Oliver, Schaarschmidt Benedikt Michael, Poeppel Thorsten, Forsting Michael, Quick Harald H, Umutlu Lale, Kinner Sonja
From the Departments of *Diagnostic and Interventional Radiology and Neuroradiology, and †Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen; ‡Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf, Dusseldorf; §Department of Obstetrics and Gynecology, University Hospital Essen, ∥Erwin L. Hahn Institute for Magnetic Resonance Imaging, and ¶High-Field and Hybrid MR Imaging, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Invest Radiol. 2015 Aug;50(8):505-13. doi: 10.1097/RLI.0000000000000197.
This study aimed to assess the diagnostic performance of integrated positron emission tomography (PET)/magnetic resonance imaging (MRI) of the breast for lesion detection and local tumor staging of patients with primary breast cancer in comparison to PET/computed tomography (CT) and MRI.
The study was approved by the local institutional review board. Forty-nine patients with biopsy-proven invasive breast cancer were prospectively enrolled in our study. All patients underwent a PET/CT, and subsequently, a contrast-enhanced PET/MRI of the breast after written informed consent was obtained before each examination. Two radiologists independently evaluated the corresponding data sets (PET/CT, PET/MRI, and MRI) and were instructed to identify primary tumors lesions as well as multifocal/multicentric and bilateral disease. Furthermore, the occurrence of lymph node metastases was assessed, and the T-stage for each patient was determined. Histopathological verification of the local tumor extent and the axillary lymph node status was available for 30 of 49 and 48 of 49 patients, respectively. For the remaining patients, a consensus characterization was performed for the determination of the T-stage and nodal status, taking into account the results of clinical staging, PET/CT, and PET/MRI examinations. Statistical analysis was performed to test for differences in diagnostic performance between the different imaging procedures. P values less than 0.05 were considered to be statistically significant.
Positron emission tomography/MRI and MRI correctly identified 47 (96%) of the 49 patients with primary breast cancer, whereas PET/CT enabled detection of 46 (94%) of 49 breast cancer patients and missed a synchronous carcinoma in the contralateral breast in 1 patient. In a lesion-by-lesion analysis, no significant differences could be obtained between the 3 imaging procedures for the identification of primary breast cancer lesions (P > 0.05). Positron emission tomography/MRI and MRI allowed for a correct identification of multifocal/multicentric disease in 3 additional patients if compared with PET/CT. For the definition of the correct T-stage, PET/MRI and MRI showed identical results and were correct in significantly more cases than PET/CT (PET/MRI and MRI, 82%; PET/CT, 68%; P < 0.05). Furthermore, the calculated sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for the detection of nodal positive patients (n = 18) were 78%, 94%, 88%, 88%, and 88% for PET/CT; 67%, 87%, 75%, 82%, and 80% for MRI; and 78%, 90%, 82%, 88%, and 86% for PET/MRI, respectively. Differences between the imaging modalities were not statistically significant (P > 0.05).
Integrated PET/MRI does not provide diagnostic advantages for local tumor staging of breast cancer patients in comparison to MRI alone. Positron emission tomography/MRI and MRI enable an improved determination of the local tumor extent in comparison to PET/CT, whereas all 3 imaging modalities offer a comparable diagnostic performance for the identification of axillary disease.
本研究旨在评估乳腺正电子发射断层显像（PET）/磁共振成像（MRI）一体机在原发性乳腺癌患者病变检测及局部肿瘤分期方面的诊断性能，并与PET/计算机断层扫描（CT）及MRI进行比较。
本研究经当地机构审查委员会批准。49例经活检证实为浸润性乳腺癌的患者前瞻性纳入本研究。所有患者均接受PET/CT检查，随后，在每次检查前获得书面知情同意后，接受乳腺对比增强PET/MRI检查。两名放射科医生独立评估相应数据集（PET/CT、PET/MRI和MRI），并被要求识别原发性肿瘤病变以及多灶/多中心和双侧病变。此外，评估淋巴结转移的发生情况，并确定每位患者的T分期。49例患者中有30例和48例分别获得了局部肿瘤范围和腋窝淋巴结状态的组织病理学证实。对于其余患者，综合临床分期、PET/CT和PET/MRI检查结果，进行共识性特征分析以确定T分期和淋巴结状态。进行统计学分析以检验不同成像方法在诊断性能上的差异。P值小于0.05被认为具有统计学意义。
PET/MRI和MRI正确识别了49例原发性乳腺癌患者中的47例（96%），而PET/CT检测出49例乳腺癌患者中的46例（94%），漏诊了1例对侧乳腺的同步癌。在逐个病变分析中，三种成像方法在识别原发性乳腺癌病变方面未获得显著差异（P>0.05）。与PET/CT相比，PET/MRI和MRI又额外正确识别了3例多灶/多中心疾病患者。对于正确T分期的定义，PET/MRI和MRI显示出相同的结果，且在显著更多的病例中正确，优于PET/CT（PET/MRI和MRI为82%；PET/CT为68%；P<0.05）。此外，对于检测淋巴结阳性患者（n = 18），PET/CT计算出的灵敏度、特异度、阳性预测值、阴性预测值和诊断准确性分别为78%、94%、88%、88%和88%；MRI为67%、87%、75%、82%和80%；PET/MRI为78%、90%、82%、88%和86%。成像方式之间的差异无统计学意义（P>0.05）。
与单独的MRI相比，联合PET/MRI在乳腺癌患者局部肿瘤分期方面未提供诊断优势。与PET/CT相比，PET/MRI和MRI能够更好地确定局部肿瘤范围，而三种成像方式在识别腋窝疾病方面具有相当的诊断性能。
