乳腺癌的 F-FDG PET/MRI 整合：新辅助化疗反应的早期预测。
Integrated F-FDG PET/MRI in breast cancer: early prediction of response to neoadjuvant chemotherapy.
机构信息
Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea.
出版信息
Eur J Nucl Med Mol Imaging. 2018 Mar;45(3):328-339. doi: 10.1007/s00259-017-3849-3. Epub 2017 Nov 4.
PURPOSE
To explore whether integrated F-FDG PET/MRI can be used to predict pathological response to neoadjuvant chemotherapy (NAC) in patients with breast cancer.
METHODS
Between November 2014 and April 2016, 26 patients with breast cancer who had received NAC and subsequent surgery were prospectively enrolled. Each patient underwent F-FDG PET/MRI examination before and after the first cycle of NAC. Qualitative MRI parameters, including morphological descriptors and the presence of peritumoral oedema were assessed. Quantitatively, PET parameters, including maximum standardized uptake value, metabolic tumour volume and total lesion glycolysis (TLG), and MRI parameters, including washout proportion and signal enhancement ratio (SER), were measured. The performance of the imaging parameters singly and in combination in predicting a pathological incomplete response (non-pCR) was assessed.
RESULTS
Of the 26 patients, 7 (26.9%) exhibited a pathological complete response (pCR), and 19 (73.1%) exhibited a non-pCR. No significant differences were found between the pCR and non-pCR groups in the qualitative MRI parameters. The mean percentage reductions in TLG on PET and SER on MRI were significantly greater in the pCR group than in the non-pCR group (TLG -64.8 ± 15.5% vs. -25.4 ± 48.7%, P = 0.005; SER -34.6 ± 19.7% vs. -8.7 ± 29.0%, P = 0.040). The area under the receiver operating characteristic curve for the percentage change in TLG (0.789, 95% CI 0.614 to 0.965) was similar to that for the percentage change in SER (0.789, 95% CI 0.552 to 1.000; P = 1.000).The specificity of TLG in predicting pCR) was 100% (7/7) and that of SER was 71.4% (5/7). The sensitivity of TLG in predicting non-pCR was 63.2% (12/19) and that of SER was 84.2% (16/19). When the combined TLG and SER criterion was applied, sensitivity was 100% (19/19), and specificity was 71.4% (5/7).
CONCLUSION
F-FDG PET/MRI can be used to predict non-pCR after the first cycle of NAC in patients with breast cancer and has the potential to improve sensitivity by the addition of MRI parameters to the PET parameters.
目的
探索氟代脱氧葡萄糖正电子发射断层扫描/磁共振成像（F-FDG PET/MRI）能否用于预测乳腺癌患者新辅助化疗（NAC）的病理反应。
方法
2014 年 11 月至 2016 年 4 月，前瞻性纳入 26 例接受 NAC 及后续手术的乳腺癌患者。每位患者在 NAC 前和第一周期后均接受 F-FDG PET/MRI 检查。评估定性 MRI 参数，包括形态学描述符和肿瘤周围水肿的存在。定量评估，包括最大标准化摄取值、代谢肿瘤体积和总肿瘤糖酵解（TLG），以及 MRI 参数，包括洗脱比例和信号增强比（SER）。评估成像参数单独和联合预测病理不完全缓解（非 pCR）的性能。
结果
26 例患者中，7 例（26.9%）表现为病理完全缓解（pCR），19 例（73.1%）表现为非 pCR。pCR 组和非 pCR 组之间定性 MRI 参数无显著差异。与非 pCR 组相比，pCR 组 PET 上 TLG 的平均百分比降低（TLG -64.8 ± 15.5% vs. -25.4 ± 48.7%，P=0.005）和 MRI 上 SER 的平均百分比降低（SER -34.6 ± 19.7% vs. -8.7 ± 29.0%，P=0.040）更为显著。TLG 百分比变化的受试者工作特征曲线下面积（0.789，95%CI 0.614 至 0.965）与 SER 百分比变化的面积相似（0.789，95%CI 0.552 至 1.000；P=1.000）。TLG 预测 pCR 的特异性为 100%（7/7），SER 为 71.4%（5/7）。TLG 预测非 pCR 的敏感性为 63.2%（12/19），SER 为 84.2%（16/19）。当应用 TLG 和 SER 联合标准时，敏感性为 100%（19/19），特异性为 71.4%（5/7）。
结论
F-FDG PET/MRI 可用于预测乳腺癌患者 NAC 后首个周期的非 pCR，通过向 PET 参数中添加 MRI 参数，有可能提高敏感性。
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