title: Improved differentiation of benign and malignant breast tumors with multiparametric 18fluorodeoxyglucose positron emission tomography magnetic resonance imaging: a feasibility study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors: Authors' Affiliations: Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging.
authors: Katja
authors: K
authors: Pinker
authors: Department of Biomedical Imaging and Image-guided Therapy, MR Centre of Excellence.
authors: Wolfgang
authors: W
authors: Bogner
authors: Authors' Affiliations: Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging.
authors: Pascal
authors: P
authors: Baltzer
authors: Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Departments of.
authors: Georgios
authors: G
authors: Karanikas
authors: Authors' Affiliations: Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging.
authors: Heinrich
authors: H
authors: Magometschnigg
authors: Authors' Affiliations: Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging.
authors: Peter
authors: P
authors: Brader
authors: Department of Biomedical Imaging and Image-guided Therapy, MR Centre of Excellence.
authors: Stephan
authors: S
authors: Gruber
authors: Authors' Affiliations: Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging.
authors: Hubert
authors: H
authors: Bickel
authors: Surgery and.
authors: Peter
authors: P
authors: Dubsky
authors: Pathology, and.
authors: Zsuzsanna
authors: Z
authors: Bago-Horvath
authors: Department of Internal Medicine, Division of Oncology, Medical University of Vienna, Vienna, Austria.
authors: Rupert
authors: R
authors: Bartsch
authors: Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Departments of.
authors: Michael
authors: M
authors: Weber
authors: Department of Biomedical Imaging and Image-guided Therapy, MR Centre of Excellence.
authors: Siegfried
authors: S
authors: Trattnig
authors: Authors' Affiliations: Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, thomas.helbich@meduniwien.ac.at.
authors: Thomas H
authors: TH
authors: Helbich
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D060787:Neoplasm Grading; D049268:Positron-Emission Tomography; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden
chemical_list: D019788:Fluorodeoxyglucose F18