Towards a Fast PET/MRI Protocol for Breast Cancer Imaging: Maintaining Diagnostic Confidence While Reducing PET and MRI Acquisition Times

Overview

Journal Eur Radiol

Specialty Radiology

Date 2023 Apr 12

PMID 37045980

Authors

Kai Jannusch

Maike E Lindemann

Nils Martin Bruckmann

Janna Morawitz

Frederic Dietzel

Kelsey L Pomykala

Ken Herrmann

Ann-Kathrin Bittner

Oliver Hoffmann

Svjetlana Mohrmann

Lale Umutlu

Gerald Antoch

Harald H Quick

Julian Kirchner

Affiliations

Soon will be listed here.

Abstract

Objectives: To investigate the diagnostic feasibility of a shortened breast PET/MRI protocol in breast cancer patients.

Methods: Altogether 90 women with newly diagnosed T1 (T1) and T2 (T2) breast cancer were included in this retrospective study. All underwent a dedicated comprehensive breast [F]FDG-PET/MRI. List-mode PET data were retrospectively reconstructed with 20, 15, 10, and 5 min for each patient to simulate the effect of reduced PET acquisition times. The SUV of all malign breast lesions was measured. Furthermore, breast PET data reconstructions were analyzed regarding image quality, lesion detectability, signal-to-noise ratio (SNR), and image noise (IN). The simultaneously acquired comprehensive MRI protocol was then shortened by retrospectively removing sequences from the protocol. Differences in malignant breast lesion detectability between the original and the fast breast MRI protocol were evaluated lesion-based. The 20-min PET reconstructions and the original MRI protocol served as reference.

Results: In all PET reconstructions, 127 congruent breast lesions could be detected. Group comparison and T1 vs. T2 subgroup comparison revealed no significant difference of subjective image quality between 20, 15, 10, and 5 min acquisition times. SNR of qualitative image evaluation revealed no significant difference between different PET acquisition times. A slight but significant increase of IN with decreasing PET acquisition times could be detected. Lesion SUV group comparison between all PET acquisition times revealed no significant differences. Lesion-based evaluation revealed no significant difference in breast lesion detectability between original and fast breast MRI protocols.

Conclusions: Breast [F]FDG-PET/MRI protocols can be shortened from 20 to below 10 min without losing essential diagnostic information.

Key Points: • A highly accurate breast cancer evaluation is possible by the shortened breast [F]FDG-PET/MRI examination protocol. • Significant time saving at breast [F]FDG-PET/MRI protocol could increase patient satisfaction and patient throughput for breast cancer patients at PET/MRI.

Citing Articles

PET/MRI and Novel Targets for Breast Cancer.

Chung H, Park K, Lim I, Noh W, Yoo Y, Nam S Biomedicines. 2024; 12(1).

PMID: 38255277 PMC: 10813582. DOI: 10.3390/biomedicines12010172.

Recurrent prostate cancer: combined role for MRI and PSMA-PET in Ga-PSMA-11 PET/MRI.

Jannusch K, Bruckmann N, Morawitz J, Boschheidgen M, Quick H, Herrmann K Eur Radiol. 2023; 34(7):4789-4800.

PMID: 38038758 PMC: 11213774. DOI: 10.1007/s00330-023-10442-4.

References

Choudhery S, Chou S, Chang K, Kalpathy-Cramer J, Lehman C . Kinetic Analysis of Lesions Identified on a Rapid Abridged Multiphase (RAMP) Breast MRI Protocol. Acad Radiol. 2019; 27(5):672-681. PMC: 6879810. DOI: 10.1016/j.acra.2019.05.001. View

Grueneisen J, Schaarschmidt B, Heubner M, Suntharalingam S, Milk I, Kinner S . Implementation of FAST-PET/MRI for whole-body staging of female patients with recurrent pelvic malignancies: A comparison to PET/CT. Eur J Radiol. 2015; 84(11):2097-102. DOI: 10.1016/j.ejrad.2015.08.010. View

Spak D, Plaxco J, Santiago L, Dryden M, Dogan B . BI-RADS fifth edition: A summary of changes. Diagn Interv Imaging. 2017; 98(3):179-190. DOI: 10.1016/j.diii.2017.01.001. View

Murthy V, Sonni I, Jariwala N, Juarez R, Reiter R, Raman S . The Role of PSMA PET/CT and PET/MRI in the Initial Staging of Prostate Cancer. Eur Urol Focus. 2021; 7(2):258-266. DOI: 10.1016/j.euf.2021.01.016. View

Bruckmann N, Morawitz J, Fendler W, Ruckhaberle E, Bittner A, Giesel F . A Role of PET/MR in Breast Cancer?. Semin Nucl Med. 2022; 52(5):611-618. DOI: 10.1053/j.semnuclmed.2022.01.003. View

Plecha D, Faulhaber P . PET/MRI of the breast. Eur J Radiol. 2017; 94:A26-A34. DOI: 10.1016/j.ejrad.2017.05.006. View

Richard R, Thomassin I, Chapellier M, Scemama A, de Cremoux P, Varna M . Diffusion-weighted MRI in pretreatment prediction of response to neoadjuvant chemotherapy in patients with breast cancer. Eur Radiol. 2013; 23(9):2420-31. DOI: 10.1007/s00330-013-2850-x. View

Moy L, Noz M, Maguire Jr G, Melsaether A, Deans A, Murphy-Walcott A . Role of fusion of prone FDG-PET and magnetic resonance imaging of the breasts in the evaluation of breast cancer. Breast J. 2010; 16(4):369-76. DOI: 10.1111/j.1524-4741.2010.00927.x. View

Grueneisen J, Sawicki L, Schaarschmidt B, Suntharalingam S, von der Ropp S, Wetter A . Evaluation of a Fast Protocol for Staging Lymphoma Patients with Integrated PET/MRI. PLoS One. 2016; 11(6):e0157880. PMC: 4915683. DOI: 10.1371/journal.pone.0157880. View

10.

Paulus D, Quick H, Geppert C, Fenchel M, Zhan Y, Hermosillo G . Whole-Body PET/MR Imaging: Quantitative Evaluation of a Novel Model-Based MR Attenuation Correction Method Including Bone. J Nucl Med. 2015; 56(7):1061-6. PMC: 4894503. DOI: 10.2967/jnumed.115.156000. View

11.

Pinker K, Bogner W, Baltzer P, Karanikas G, Magometschnigg H, Brader P . Improved differentiation of benign and malignant breast tumors with multiparametric 18fluorodeoxyglucose positron emission tomography magnetic resonance imaging: a feasibility study. Clin Cancer Res. 2014; 20(13):3540-9. DOI: 10.1158/1078-0432.CCR-13-2810. View

12.

Koo H, Park J, Kang K, Cho N, Chang J, Bae M . 18F-FDG uptake in breast cancer correlates with immunohistochemically defined subtypes. Eur Radiol. 2013; 24(3):610-8. DOI: 10.1007/s00330-013-3037-1. View

13.

Kuhl C, Schrading S, Strobel K, Schild H, Hilgers R, Bieling H . Abbreviated breast magnetic resonance imaging (MRI): first postcontrast subtracted images and maximum-intensity projection-a novel approach to breast cancer screening with MRI. J Clin Oncol. 2014; 32(22):2304-10. DOI: 10.1200/JCO.2013.52.5386. View

14.

Grimm L, Soo M, Yoon S, Kim C, Ghate S, Johnson K . Abbreviated screening protocol for breast MRI: a feasibility study. Acad Radiol. 2015; 22(9):1157-62. DOI: 10.1016/j.acra.2015.06.004. View

15.

Heacock L, Weissbrot J, Raad R, Campbell N, Friedman K, Ponzo F . PET/MRI for the evaluation of patients with lymphoma: initial observations. AJR Am J Roentgenol. 2015; 204(4):842-8. PMC: 4465553. DOI: 10.2214/AJR.14.13181. View

16.

Kuhl C . Abbreviated breast MRI for screening women with dense breast: the EA1141 trial. Br J Radiol. 2017; 91(1090):20170441. PMC: 6350487. DOI: 10.1259/bjr.20170441. View

17.

Pickles M, Gibbs P, Lowry M, Turnbull L . Diffusion changes precede size reduction in neoadjuvant treatment of breast cancer. Magn Reson Imaging. 2006; 24(7):843-7. DOI: 10.1016/j.mri.2005.11.005. View

18.

Geach R, JONES L, Harding S, Marshall A, Taylor-Phillips S, McKeown-Keegan S . The potential utility of abbreviated breast MRI (FAST MRI) as a tool for breast cancer screening: a systematic review and meta-analysis. Clin Radiol. 2020; 76(2):154.e11-154.e22. DOI: 10.1016/j.crad.2020.08.032. View

19.

Mann R, Cho N, Moy L . Breast MRI: State of the Art. Radiology. 2019; 292(3):520-536. DOI: 10.1148/radiol.2019182947. View

20.

Lindemann M, Oehmigen M, Blumhagen J, Gratz M, Quick H . MR-based truncation and attenuation correction in integrated PET/MR hybrid imaging using HUGE with continuous table motion. Med Phys. 2017; 44(9):4559-4572. DOI: 10.1002/mp.12449. View