¹⁸F-FDG Dedicated Breast PET Complementary to Breast MRI for Evaluating Early Response to Neoadjuvant Chemotherapy

Purpose To compare quantitative measures of tumor metabolism and perfusion using fluorine 18 (¹⁸F) fluorodeoxyglucose (FDG) dedicated breast PET (dbPET) and breast dynamic contrast-enhanced (DCE) MRI during early treatment with neoadjuvant chemotherapy (NAC). Materials and Methods Prospectively collected DCE MRI and ¹⁸F-FDG dbPET examinations were analyzed at baseline (T0) and after 3 weeks (T1) of NAC in 20 participants with 22 invasive breast cancers. FDG dbPET-derived standardized uptake value (SUV), metabolic tumor volume, and total lesion glycolysis (TLG) and MRI-derived percent enhancement (PE), signal enhancement ratio (SER), and functional tumor volume (FTV) were calculated at both time points. Differences between FDG dbPET and MRI parameters were evaluated after stratifying by receptor status, Ki-67 index, and residual cancer burden. Parameters were compared using Wilcoxon signed rank and Mann-Whitney U tests. Results High Ki-67 tumors had higher baseline SUV_mean (difference, 5.1; P = .01) and SUV_peak (difference, 5.5; P = .04). At T1, decreases were observed in FDG dbPET measures (pseudo-median difference T0 minus T1 value [95% CI]) of SUV_max (-6.2 [-10.2, -2.6]; P < .001), SUV_mean (-2.6 [-4.9, -1.3]; P < .001), SUV_peak (-4.2 [-6.9, -2.3]; P < .001), and TLG (-29.1 mL³ [-71.4, -6.8]; P = .005) and MRI measures of SER_peak (-1.0 [-1.3, -0.2]; P = .02) and FTV (-11.6 mL³ [-22.2, -1.7]; P = .009). Relative to nonresponsive tumors, responsive tumors showed a difference (95% CI) in percent change in SUV_max of -34.3% (-55.9%, 1.5%; P = .06) and in PE_peak of -42.4% (95% CI: -110.5%, 8.5%; P = .08). Conclusion ¹⁸F-FDG dbPET was sensitive to early changes during NAC and provided complementary information to DCE MRI that may be useful for treatment response evaluation. Keywords: Breast, PET, Dynamic Contrast-enhanced MRI Clinical trial registration no. NCT01042379 Supplemental material is available for this article. © RSNA, 2024.