Katja Pinker-Domenig MD, Presenter: Nothing to Disclose

Hubert Bickel MD, Abstract Co-Author: Nothing to Disclose

Wolfgang Bogner MSC, Abstract Co-Author: Nothing to Disclose

Stephan Gruber MD, Abstract Co-Author: Nothing to Disclose

Heinrich Magometschnigg, Abstract Co-Author: Nothing to Disclose

Thomas Hans Helbich MD, Abstract Co-Author: Research Consultant, Siemens AG Research Consultant, Hologic, Inc Research Grant, Siemens AG

To assess sensitivity, specificity and diagnostic accuracy of multiparametric PET-MRI at 3 Tesla in breast cancer diagnosis.

56 patients with breast lesions detected by mammography or ultrasound and classified as BIRADS 3-5 were included in this IRB approved prospective study. All patients were examined with dedicated 18FDG-PET-CT and 3T MRI of the breast. Examinations were scheduled no longer than 7 days apart. MRI protocol included: 3D-1H-magnetic spectroscopic imaging (MRSI) before application of contrast agent to avoid contamination of spectra, diffusion-weighted imaging (DWI), a T2-weighted sequence and a combined contrast-enhanced high temporal and spatial resolution 3D-T1-weighted sequence before and after application of a standard dose Gd-DOTA. Patients were injected of approximately 300 MBq 18F-FDG. A prone PET dataset over the breasts was acquired using a positioning device allowing the same patient geometry as in breast MRI. CT data was only used for attenuation correction. Co-registration of imaging data and image fusion were performed. PET-MRI was assessed for lesion morphology and EH-kinetics according to BIRADS, restricted diffusivity, increased Choline (Cho)-levels and 18FDG -avidity. An ADC threshold 1.25 x10-3mm2/s and a signal-to-noise ratio of the Cho resonance peak >2.55 were defined as a marker of malignancy. Lesions classified as positive when 18F-FDG-uptake was greater than blood-pool activity. All lesions were histopathologically verified.

Multiparametric PET-MRI at 3T achieved an excellent sensitivity of 100% and very good specificity of 90% in the diagnosis of breast cancer. Diagnostic accuracy was 96%. The PPV was 0.94 (95% CI 0.83-0.99) and the NPV was 1 (95% CI 0.82-0.1). There were 36 malignant and 20 benign lesions. Two thirds of unnecessary breast biopsies recommended by MRI alone would have been obviated without missing any cancers.

Multiparametric PET-MRI at 3T enabled an accurate breast cancer diagnosis with improved sensitivity, specificity and diagnostic accuracy.

Multiparametric PET-MRI at 3T obviates unnecessary breast biopsies in 90% of benign lesions without missing any cancers.

Pinker-Domenig, K, Bickel, H, Bogner, W, Gruber, S, Magometschnigg, H, Helbich, T, Multiparametric PET-MRI of Breast Tumors at 3T Obviates Unnecessary Breast Biopsies Without Missing Cancers.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12034293.html