Metabolic–flow relationships in primary breast cancer: feasibility of combined PET/dynamic contrast-enhanced CT
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To assess the feasibility and first experience of combined 18F-FDG-PET)/dynamic contrast-enhanced (DCE) CT in evaluating breast cancer.
Nine consecutive female patients (mean age 64.2 years, range 52–74 years) with primary breast carcinoma were prospectively recruited for combined 18F-FDG PET/DCE-CT. Dynamic CT data were used to calculate a range of parameters of tumour vascularity, and tumour 18F-FDG uptake (standardized uptake value, SUVmax) was used as a metabolic indicator.
One tumour did not enhance and was excluded. The mean tumour SUVmax was 7.7 (range 2.4–26.1). The mean values for tumour perfusion, perfusion normalized to cardiac output, standard perfusion value (SPV) and permeability were 41 ml/min per 100 g (19–59 ml/min per 100 g), 0.56%/100 g (0.33–1.09%/100 g), 3.6 (2.5–5.9) and 0.15/min (0.09–0.30/min), respectively. Linear regression analysis showed a positive correlation between tumour SUV and tumour perfusion normalized to cardiac output (r=0.55, p=0.045) and a marginal correlation between tumour SUV and tumour SPV (r=0.19, p=0.065). There were no significant correlations between tumour SUV and tumour perfusion (r=0.29, p=0.401) or permeability (r=0.03, p=0.682).
The first data from combined 18F-FDG-PET/DCE-CT in breast cancer are reported. The technique was successful in eight of nine patients. Breast tumour metabolic and vascular parameters were consistent with previous data from 15O-H2O-PET.
KeywordsBreast cancer Tumour blood flow Glucose metabolism 18F-Fluorodeoxyglucose Dynamic contrast-enhanced CT
The Breast Cancer Campaign (UK charity) funded this work. This work was undertaken at UCLH UCL, which received a proportion of the funding from the NIHR Biomedical Research Centres funding scheme of the UK Department of Health. Gordon Wishart receives some funding from the Cambridge Biomedical Research Centre. None of the authors has a financial relationship with a commercial entity that has an interest in the subject of this article. We acknowledge the expertise of Professor Brian Hutton, Chair of Nuclear Medicine Physics, for his advice on normalizing SUV. We are grateful to Alison Hallett and other staff of the Cambridge Breast Unit for their help with this project, and thank the patients for volunteering for this study.
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