Combined use of 18F-FDG PET/CT and MRI for response monitoring of breast cancer during neoadjuvant chemotherapy

  • Kenneth E. Pengel
  • Bas B. Koolen
  • Claudette E. Loo
  • Wouter V. Vogel
  • Jelle Wesseling
  • Esther H. Lips
  • Emiel J. Th. Rutgers
  • Renato A. Valdés Olmos
  • Marie Jeanne T. F. D. Vrancken Peeters
  • Sjoerd Rodenhuis
  • Kenneth G. A. Gilhuijs
Original Article



To explore the potential complementary value of PET/CT and dynamic contrast-enhanced MRI in predicting pathological response to neoadjuvant chemotherapy (NAC) of breast cancer and the dependency on breast cancer subtype.


We performed 18F-FDG PET/CT and MRI examinations before and during NAC. The imaging features evaluated on both examinations included baseline and changes in 18F-FDG maximum standardized uptake value (SUVmax) on PET/CT, and tumour morphology and contrast uptake kinetics on MRI. The outcome measure was a (near) pathological complete response ((near-)pCR) after surgery. Receiver operating characteristic curves with area under the curve (AUC) were used to evaluate the relationships between patient, tumour and imaging characteristics and tumour responses.


Of 93 patients, 43 achieved a (near-)pCR. The responses varied among the different breast cancer subtypes. On univariate analysis the following variables were significantly associated with (near-)pCR: age (p = 0.033), breast cancer subtype (p < 0.001), relative change in SUVmax on PET/CT (p < 0.001) and relative change in largest tumour diameter on MRI (p < 0.001). The AUC for the relative reduction in SUVmax on PET/CT was 0.78 (95 % CI 0.68–0.88), and for the relative reduction in tumour diameter at late enhancement on MRI was 0.79 (95 % CI 0.70–0.89). The AUC increased to 0.90 (95 % CI 0.83–0.96) in the final multivariate model with PET/CT, MRI and breast cancer subtype combined (p = 0.012).


PET/CT and MRI showed comparable value for monitoring response during NAC. Combined use of PET/CT and MRI had complementary potential. Research with more patients is required to further elucidate the dependency on breast cancer subtype.


Breast cancer Neoadjuvant chemotherapy Positron emission tomography Magnetic resonance imaging Response monitoring 



The authors thank Anita Paape, Inge Kemper, Marjo Holtkamp, Margaret Schot, and Jacqueline van Zyll de Jong for their contribution to this study.

Conflicts of interest



This study was performed within the framework of CTMM, the Center for Translational Molecular Medicine (, project Breast CARE (grant 03O-104).


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Kenneth E. Pengel
    • 1
  • Bas B. Koolen
    • 2
  • Claudette E. Loo
    • 1
  • Wouter V. Vogel
    • 2
  • Jelle Wesseling
    • 3
  • Esther H. Lips
    • 3
  • Emiel J. Th. Rutgers
    • 4
  • Renato A. Valdés Olmos
    • 2
  • Marie Jeanne T. F. D. Vrancken Peeters
    • 4
  • Sjoerd Rodenhuis
    • 5
  • Kenneth G. A. Gilhuijs
    • 1
    • 6
  1. 1.Department of RadiologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
  2. 2.Department of Nuclear MedicineThe Netherlands Cancer InstituteAmsterdamThe Netherlands
  3. 3.Department of PathologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
  4. 4.Department of Surgical OncologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
  5. 5.Department of Medical OncologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
  6. 6.Department of Radiology/Image Sciences InstituteUniversity Medical Center UtrechtUtrechtThe Netherlands

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