Johannes Grueneisen1, Lino Morris Sawicki2, Axel Wetter3, Julian Kirchner2, Sonja Kinner3, Bahriye Aktas4, Michael Forsting3, Verena Ruhlmann5, Lale Umutlu3. 1. Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany. Electronic address: Johannes.grueneisen@uk-essen.de. 2. Department of Diagnostic and Interventional Radiology, University Hospital, Dusseldorf, University of Dusseldorf, D-40225 Dusseldorf, Germany. 3. Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany. 4. Department of Obstetrics and Gynecology, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany. 5. Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany.
Abstract
OBJECTIVES: To investigate the diagnostic value of different MR sequences and 18F-FDG PET data for whole-body restaging of breast cancer patients utilizing PET/MRI. METHODS: A total of 36 patients with suspected tumor recurrence of breast cancer based on clinical follow-up or abnormal findings in follow-up examinations (e.g. CT, MRI) were prospectively enrolled in this study. All patients underwent a PET/CT and subsequently an additional PET/MR scan. Two readers were instructed to identify the occurrence of a tumor relapse in subsequent MR and PET/MR readings, utilizing different MR sequence constellations for each session. The diagnostic confidence for the determination of a malignant or benign lesion was qualitatively rated (3-point ordinal scale) for each lesion in the different reading sessions and the lesion conspicuity (4-point ordinal scale) for the three different MR sequences was additionally evaluated. RESULTS: Tumor recurrence was present in 25/36 (69%) patients. All three PET/MRI readings showed a significantly higher accuracy as well as higher confidence levels for the detection of recurrent breast cancer lesions when compared to MRI alone (p<0.05). Furthermore, all three PET/MR sequence constellations showed comparable diagnostic accuracy for the identification of a breast cancer recurrence (p>0.05), yet the highest confidence levels were obtained, when all three MR sequences were used for image interpretation. Moreover, contrast-enhanced T1-weighted VIBE imaging showed significantly higher values for the delineation of malignant and benign lesions when compared to T2w HASTE and diffusion-weighted imaging. CONCLUSION: Integrated PET/MRI provides superior restaging of breast cancer patients over MRI alone. Facing the need for appropriate and efficient whole-body PET/MR protocols, our results show the feasibility of fast and morphologically adequate PET/MR protocols. However, considering an equivalent accuracy for the detection of breast cancer recurrences in the three PET/MR readings, the application of contrast-agent and the inclusion of DWI in the study protocol seems to be debatable.
OBJECTIVES: To investigate the diagnostic value of different MR sequences and 18F-FDG PET data for whole-body restaging of breast cancerpatients utilizing PET/MRI. METHODS: A total of 36 patients with suspected tumor recurrence of breast cancer based on clinical follow-up or abnormal findings in follow-up examinations (e.g. CT, MRI) were prospectively enrolled in this study. All patients underwent a PET/CT and subsequently an additional PET/MR scan. Two readers were instructed to identify the occurrence of a tumor relapse in subsequent MR and PET/MR readings, utilizing different MR sequence constellations for each session. The diagnostic confidence for the determination of a malignant or benign lesion was qualitatively rated (3-point ordinal scale) for each lesion in the different reading sessions and the lesion conspicuity (4-point ordinal scale) for the three different MR sequences was additionally evaluated. RESULTS:Tumor recurrence was present in 25/36 (69%) patients. All three PET/MRI readings showed a significantly higher accuracy as well as higher confidence levels for the detection of recurrent breast cancer lesions when compared to MRI alone (p<0.05). Furthermore, all three PET/MR sequence constellations showed comparable diagnostic accuracy for the identification of a breast cancer recurrence (p>0.05), yet the highest confidence levels were obtained, when all three MR sequences were used for image interpretation. Moreover, contrast-enhanced T1-weighted VIBE imaging showed significantly higher values for the delineation of malignant and benign lesions when compared to T2w HASTE and diffusion-weighted imaging. CONCLUSION: Integrated PET/MRI provides superior restaging of breast cancerpatients over MRI alone. Facing the need for appropriate and efficient whole-body PET/MR protocols, our results show the feasibility of fast and morphologically adequate PET/MR protocols. However, considering an equivalent accuracy for the detection of breast cancer recurrences in the three PET/MR readings, the application of contrast-agent and the inclusion of DWI in the study protocol seems to be debatable.
Authors: Lisa A Min; Wouter V Vogel; Max J Lahaye; Monique Maas; Maarten L Donswijk; Erik Vegt; Miranda Kusters; Henry J Zijlmans; Katarzyna Jóźwiak; Sander Roberti; Regina G H Beets-Tan; Doenja M J Lambregts Journal: Eur Radiol Date: 2019-05-22 Impact factor: 5.315
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Authors: Nils Martin Bruckmann; Lino M Sawicki; Julian Kirchner; Ole Martin; Lale Umutlu; Ken Herrmann; Wolfgang Fendler; Ann-Kathrin Bittner; Oliver Hoffmann; Svjetlana Mohrmann; Frederic Dietzel; Marc Ingenwerth; Benedikt M Schaarschmidt; Yan Li; Bernd Kowall; Andreas Stang; Gerald Antoch; Christian Buchbender Journal: Eur J Nucl Med Mol Imaging Date: 2020-04-24 Impact factor: 9.236