Improved differentiation of benign and malignant breast tumors with multiparametric 18fluorodeoxyglucose positron emission tomography magnetic resonance imaging: a feasibility study

Abstract

Purpose: To assess whether multiparametric (18)fluorodeoxyglucose positron emission tomography magnetic resonance imaging (MRI) (MP (18)FDG PET-MRI) using dynamic contrast-enhanced MRI (DCE-MRI), diffusion-weighted imaging (DWI), three-dimensional proton MR spectroscopic imaging (3D (1)H-MRSI), and (18)FDG-PET enables an improved differentiation of benign and malignant breast tumors.

Experimental design: Seventy-six female patients (mean age, 55.7 years; range, 25-86 years) with an imaging abnormality (BI-RADS 0, 4-5) were included in this Institutional Review Board (IRB)-approved study. Patients underwent fused PET-MRI of the breast with (18)FDG-PET/CT and MP MRI at 3T. The likelihood of malignancy was assessed for all single parameters, for MP MRI with two/three parameters, and for MP (18)FDG PET-MRI. Histopathology was used as the standard of reference. Appropriate statistical tests were used to assess sensitivity, specificity, and diagnostic accuracy for each assessment combination.

Results: There were 53 malignant and 23 benign breast lesions. MP (18)FDG PET-MRI yielded a significantly higher area under the cure (AUC) of 0.935 than DCE-MRI (AUC, 0.86; P = 0.044) and the combination of DCE-MRI and another parameter (AUC, 0.761-0.826; P = 0.013-0.020). MP (18)FDG PET-MRI showed slight further improvement to MP MRI with three parameters (AUC, 0.925; P = 0.317). Using MP (18)FDG PET-MRI there would have been a reduction of the unnecessary breast biopsies recommended by MP imaging with one or two parameters (P = 0.002-0.011).

Conclusion: This feasibility study shows that MP (18)FDG PET-MRI enables an improved differentiation of benign and malignant breast tumors when several MRI and PET parameters are combined. MP (18)FDG PET-MRI may lead to a reduction in unnecessary breast biopsies.