Voxelwise analysis of simultaneously acquired and spatially correlated ¹⁸F‐fluorodeoxyglucose (FDG)‐PET and intravoxel incoherent motion metrics in breast cancer

Abstract

Purpose Diffusion weighted imaging (DWI) and 18F-FDG-PET independently correlate with malignancy in breast cancer, but the relationship between their structural and metabolic metrics are not completely understood. This study spatially correlates diffusion, perfusion, and glucose avidity in breast cancer with simultaneous positron emission tomography/magnetic resonance (PET/MR) imaging and compares correlations with clinical prognostics. Methods In this HIPAA-compliant prospective study with written informed consent and approval of the institutional review board, using simultaneously acquired FDG-PET and DWI, tissue diffusion (Dt) and perfusion fraction (fp) from intravoxel incoherent motion (IVIM) analysis were registered to FDG-PET within 14 locally advanced breast cancers. Lesions were analyzed using two-dimensional histograms and correlation coefficients between Dt, fp, and standardized uptake value (SUV). Correlations were compared with prognostics from biopsy, metastatic burden from whole-body PET, and treatment history. Results SUV||Dt correlation coefficient significantly distinguished treated (0.11 ± 0.24) from non-treated (−0.33 ± 0.26) patients (p = 0.005). SUV||fp correlations were on average negative for the whole cohort (−0.17 ± 0.13). Conclusions Simultaneously acquired and registered FDG-PET/DWI allowed quantifiable descriptions of breast cancer microenvironments that may provide a framework for monitoring and predicting response to treatment.

Application of Simultaneous 18F‐FDG PET With Monoexponential, Biexponential, and Stretched Exponential Model‐Based Diffusion‐Weighted MR Imaging in Assessing the Proliferation Status of Lung Adenocarcinoma

“…One study has found a weak negative correlation between f values and SUV values in breast cancer patients. 37 However, another study, also about breast cancer, concluded that SUV values were positively correlated with microvessel density. 38 In addition, in a comparative study of benign and malignant lesions, Patel et al concluded that increased perfusion can also occur in benign lesions.…”

“…However, the relationship between tumor perfusion and metabolism is controversial. One study has found a weak negative correlation between f values and SUV values in breast cancer patients 37 . However, another study, also about breast cancer, concluded that SUV values were positively correlated with microvessel density 38 .…”

PET/MRI in Breast Cancer

“…MRI sequences are then run simultaneously with the acquisition of PET data and gadolinium is administered IV after precontrast imaging at the normal weight‐based dose. It is recommended that the PET data be collected for at least 2 minutes, although times from 3½ to 15 minutes have been reported . MRI sequences can vary, including the sequences recommended by the American College of Radiology or can be customized; for example, to include abbreviated breast MRI sequences (a single pre‐ and postcontrast T 1 ‐weighted image set) and/or DWI and MRS.…”

Voxel-Based Analysis of the Relation of 3′-Deoxy-3′-[18F]fluorothymidine ([18F]FLT) PET and Diffusion-Weighted (DW) MR Signals in Subcutaneous Tumor Xenografts Does Not Reveal a Direct Spatial Relation of These Two Parameters

“…Some further clinical reports investigated the spatial relation of glucose metabolism ([ 18 F]FDG) and water diffusivity (ADC). In breast cancer patients, the negative correlation of these two imaging parameters was statistically significant (PCC = − 0.39 ± 0.24 in untreated tumors, n = 7 [ 13 ]). And also in lung cancer patients, a significant negative correlation of [ 18 F]FDG and ADC was observed ( n = 5, ranging from − 0.41 to − 0.17) [ 14 ].…”