Imaging, Diagnosis, Prognosis Improved Differentiation of Benign and Malignant Breast TumorswithMultiparametric FluorodeoxyglucosePositron Emission Tomography Magnetic Resonance Imaging: A Feasibility Study

Purpose: To assess whether multiparametric fluorodeoxyglucose positron emission tomography magnetic resonance imaging (MRI) (MP FDG PET-MRI) using dynamic contrast-enhanced MRI (DCE-MRI), diffusion-weighted imaging (DWI), three-dimensional protonMRspectroscopic imaging (3DH-MRSI), and 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 FDG-PET/CT and MP MRI at 3T. The likelihood ofmalignancy was assessed for all single parameters, forMPMRIwith two/three parameters, and for MP 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 FDG PET-MRI yielded a significantly higher area under the cure (AUC) of 0.935 than DCE-MRI (AUC, 0.86; P 1⁄4 0.044) and the combination of DCE-MRI and another parameter (AUC, 0.761–0.826; P 1⁄4 0.013–0.020). MP FDG PETMRI showed slight further improvement to MPMRI with three parameters (AUC, 0.925; P1⁄4 0.317). Using MP FDGPET-MRI there would have been a reduction of the unnecessary breast biopsies recommended by MP imaging with one or two parameters (P 1⁄4 0.002–0.011). Conclusion: This feasibility study shows thatMP FDGPET-MRI enables an improved differentiation of benign andmalignant breast tumors when several MRI and PET parameters are combined. MP FDG PETMRI may lead to a reduction in unnecessary breast biopsies. Clin Cancer Res; 1–10. 2014 AACR.