Department of Radiation Oncology, Medical University of Vienna, Austria.
Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University Vienna, Austria.
Contrast Media Mol Imaging. 2019 Jan 8;2019:1307247. doi: 10.1155/2019/1307247. eCollection 2019.
The aim of this study was to assess whether sequential multiparametric [F]fluoro-desoxy-glucose ([F]FDG)/[F]fluoromisonidazole ([F]FMISO) PET-MRI in breast cancer patients is possible, facilitates information on tumor heterogeneity, and correlates with prognostic indicators. In this pilot study, IRB-approved, prospective study, nine patients with ten suspicious breast lesions (BIRADS 5) and subsequent breast cancer diagnosis underwent sequential combined [F]FDG/[18F]FMISO PET-MRI. [F]FDG was used to assess increased glycolysis, while [F]FMISO was used to detect tumor hypoxia. MRI protocol included dynamic breast contrast-enhanced MRI (DCE-MRI) and diffusion-weighted imaging (DWI). Qualitative and quantitative multiparametric imaging findings were compared with pathological features (grading, proliferation, and receptor status) and clinical endpoints (recurrence/metastases and disease-specific death) using multiple correlation analysis. Histopathology was the standard of reference. There were several intermediate to strong correlations identified between quantitative bioimaging markers, histopathologic tumor characteristics, and clinical endpoints. Based on correlation analysis, multiparametric criteria provided independent information. The prognostic indicators proliferation rate, death, and presence/development of recurrence/metastasis correlated positively, whereas the prognostic indicator estrogen receptor status correlated negatively with PET parameters. The strongest correlations were found between disease-specific death and [F]FDG (=0.83, < 0.01) and between the presence/development of metastasis and [F]FDG (=0.79, < 0.01), respectively. This pilot study indicates that multiparametric [F]FDG/[F]FMISO PET-MRI might provide complementary quantitative prognostic information on breast tumors including clinical endpoints and thus might be used to tailor treatment for precision medicine in breast cancer.
本研究旨在评估乳腺癌患者行序贯多参数 [F]氟脱氧葡萄糖([F]FDG)/[F]氟米索硝唑([F]FMISO) PET-MRI 是否可行，能否提供肿瘤异质性信息，并与预后指标相关。在这项前瞻性、经机构审查委员会批准的初步研究中，9 名 10 个可疑乳腺病变（BIRADS 5）的患者随后被诊断为乳腺癌，接受了序贯联合 [F]FDG/[18F]FMISO PET-MRI 检查。[F]FDG 用于评估葡萄糖代谢增加，[F]FMISO 用于检测肿瘤缺氧。MRI 方案包括动态乳腺对比增强 MRI（DCE-MRI）和弥散加权成像（DWI）。使用多元相关分析将定性和定量多参数成像结果与病理特征（分级、增殖和受体状态）及临床终点（复发/转移和疾病特异性死亡）进行比较。组织病理学为参考标准。在定量生物成像标志物、组织病理学肿瘤特征和临床终点之间发现了几种中等至强相关性。基于相关性分析，多参数标准提供了独立信息。增殖率、死亡和复发/转移的存在/发展等预后指标呈正相关，而雌激素受体状态这一预后指标呈负相关。疾病特异性死亡与 [F]FDG（=0.83， < 0.01）和转移的存在/发展与 [F]FDG（=0.79， < 0.01）之间的相关性最强。这项初步研究表明，多参数 [F]FDG/[F]FMISO PET-MRI 可能为乳腺癌肿瘤提供补充的定量预后信息，包括临床终点，从而可能用于为精准医学定制治疗方案。
