Katja Pinker MD, Presenter: Nothing to Disclose

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

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

Heinrich Magometschnigg, Abstract Co-Author: Nothing to Disclose

Melanie B. Schernthaner MD, 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 demonstrate the feasibility of multimodal multiparametric PET-MRI in the assessment of breast tumors.

69 patients with breast tumors 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 multiparametric MRI of the breast. Examinations were scheduled no longer than 7 days apart. MRI protocol included: a diffusion-weighted sequence (DWI), a T2-w sequence and a contrast-enhanced combined high temporal and spatial resolution 3D-T1-w sequence before and after application of a standard dose Gd-DOTA. For PET-CT patients fasted at least 6 h before injection of approx. 300 MBq 18F-FDG based on the patients weight. Scanning was started 45 min after injection. Blood glucose levels were <150 mg/dl. A prone PET dataset over the breasts was acquired using a positioning device allowing the same patient geometry as the breast MRI coil. CT data was used for attenuation correction. Co-registration of imaging data and image fusion were performed. PET-MRI was assessed for lesion morphologyand EH-kinetics according to BI-RADS and restricted diffusivity with an ADC threshold 1.25 x10-3mm2/s set as the cut-off for malignancy. Lesions were assed for 18F-FDG–avidity and classified as positive when 18F-FDG-uptake was greater than blood-pool activity. Nodal status was recorded for each technique and patient. All lesions were histopathologically verified.

Multimodal multiparametric PET-MRI achieved an excellent sensitivity of 98.1% and good specificity of 72.2% in the diagnosis of breast cancer. Diagnostic accuracy was 91.4%. The PPV was 0.91 (95% CI 0.81-0.96) and the NPV was 0.93 (95% CI 0.69-0.99). PET-MRI increased sensitivity in the diagnosis of lymphnode metastases from 71% to 88% compared to MRI alone (Fig.1).

Multimodal multiparametric PET-MRI leads to an increase in sensitivity, specificity and diagnostic accuracy in the diagnosis of breast cancer and lymphnode metastases.

Multimodal multiparametric PET-MRI allows an accurate staging as well as an improved assessment of nodal status.

Pinker, K, Bickel, H, Bogner, W, Magometschnigg, H, Schernthaner, M, Helbich, T, Multimodal Multiparametric PET-MRI in the Assessment of Breast Lesions.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11015469.html