From the Departments of Radiology and Biomedical Imaging (D.D., N.O., D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.), Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University of California San Francisco, 550 16th St, San Francisco, CA 94158; and I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.).
Radiol Imaging Cancer. 2024 Mar;6(2):e230082. doi: 10.1148/rycan.230082.
Purpose To compare quantitative measures of tumor metabolism and perfusion using fluorine 18 (F) fluorodeoxyglucose (FDG) dedicated breast PET (dbPET) and breast dynamic contrast-enhanced (DCE) MRI during early treatment with neoadjuvant chemotherapy (NAC). Materials and Methods Prospectively collected DCE MRI and F-FDG dbPET examinations were analyzed at baseline (T0) and after 3 weeks (T1) of NAC in 20 participants with 22 invasive breast cancers. FDG dbPET-derived standardized uptake value (SUV), metabolic tumor volume, and total lesion glycolysis (TLG) and MRI-derived percent enhancement (PE), signal enhancement ratio (SER), and functional tumor volume (FTV) were calculated at both time points. Differences between FDG dbPET and MRI parameters were evaluated after stratifying by receptor status, Ki-67 index, and residual cancer burden. Parameters were compared using Wilcoxon signed rank and Mann-Whitney tests. Results High Ki-67 tumors had higher baseline SUV (difference, 5.1; = .01) and SUV (difference, 5.5; = .04). At T1, decreases were observed in FDG dbPET measures (pseudo-median difference T0 minus T1 value [95% CI]) of SUV (-6.2 [-10.2, -2.6]; < .001), SUV (-2.6 [-4.9, -1.3]; < .001), SUV (-4.2 [-6.9, -2.3]; < .001), and TLG (-29.1 mL [-71.4, -6.8]; = .005) and MRI measures of SER (-1.0 [-1.3, -0.2]; = .02) and FTV (-11.6 mL [-22.2, -1.7]; = .009). Relative to nonresponsive tumors, responsive tumors showed a difference (95% CI) in percent change in SUV of -34.3% (-55.9%, 1.5%; = .06) and in PE of -42.4% (95% CI: -110.5%, 8.5%; = .08). Conclusion F-FDG dbPET was sensitive to early changes during NAC and provided complementary information to DCE MRI that may be useful for treatment response evaluation. Breast, PET, Dynamic Contrast-enhanced MRI Clinical trial registration no. NCT01042379 © RSNA, 2024.
目的 比较氟 18（F）氟脱氧葡萄糖（FDG）专用乳腺正电子发射断层扫描（dbPET）和乳腺动态对比增强（DCE）MRI 在新辅助化疗（NAC）早期治疗期间肿瘤代谢和灌注的定量测量。
材料与方法 前瞻性收集了 20 名 22 例浸润性乳腺癌患者的基线（T0）和 NAC 后 3 周（T1）的 DCE MRI 和 F-FDG dbPET 检查。在两个时间点计算了 FDG dbPET 衍生的标准化摄取值（SUV）、代谢肿瘤体积和总肿瘤糖酵解（TLG）以及 MRI 衍生的百分比增强（PE）、信号增强比（SER）和功能肿瘤体积（FTV）。根据受体状态、Ki-67 指数和残留癌负荷对 FDG dbPET 参数进行分层后，评估了 FDG dbPET 和 MRI 参数之间的差异。使用 Wilcoxon 符号秩和 Mann-Whitney U 检验比较参数。
结果 Ki-67 高肿瘤的基线 SUV 更高（差异，5.1； =.01）和 SUV（差异，5.5； =.04）。在 T1，FDG dbPET 测量值（T0 减去 T1 值的伪中位数差异[95%CI]）观察到下降：SUV（-6.2 [-10.2，-2.6]； <.001）、SUV（-2.6 [-4.9，-1.3]； <.001）、SUV（-4.2 [-6.9，-2.3]； <.001）和 TLG（-29.1 mL [-71.4，-6.8]； =.005）和 MRI 测量值的 SER（-1.0 [-1.3，-0.2]； =.02）和 FTV（-11.6 mL [-22.2，-1.7]； =.009）。与无反应性肿瘤相比，反应性肿瘤的 SUV 百分比变化差异为-34.3%（95%CI：-55.9%，1.5%； =.06），PE 差异为-42.4%（95%CI：-110.5%，8.5%； =.08）。
结论 F-FDG dbPET 对 NAC 期间的早期变化敏感，并提供了 DCE MRI 的补充信息，这可能对治疗反应评估有用。
乳腺、正电子发射断层扫描、动态对比增强 MRI
临床试验注册号 NCT01042379
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