Skip to main content

Advertisement

SpringerLink
Log in

Comparison of contrast-enhanced CT, dual-layer detector spectral CT, and whole-body MRI in suspected metastatic breast cancer: a prospective diagnostic accuracy study

  • Oncology
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To compare diagnostic accuracy of contrast-enhanced CT, dual-layer detector spectral CT (DL-CT), and whole-body MRI (WB-MRI) for diagnosing metastatic breast cancer.

Methods

One hundred eighty-two biopsy-verified breast cancer patients suspected of metastatic disease prospectively underwent contrast-enhanced DL-CT and WB-MRI. Two radiologists read the CT examinations with and without spectral data in consensus with 3-month washout between readings. Two other radiologists read the WB-MRI examinations in consensus. Lymph nodes, visceral lesions, and bone lesions were assessed. Readers were blinded to other test results. Reference standard was histopathology, previous or follow-up imaging, and clinical follow-up.

Results

Per-lesion AUC was 0.80, 0.84, and 0.82 (CT, DL-CT, and WB-MRI, respectively). DL-CT showed significantly higher AUC than CT (p = 0.001) and WB-MRI (p = 0.02). Sensitivity and specificity of CT, DL-CT, and WB-MRI were 0.66 and 0.94, 0.75 and 0.95, and 0.65 and 0.98, respectively. DL-CT significantly improved sensitivity compared to CT (p < 0.0001) and WB-MRI (p = 0.002). Per-patient AUC was 0.85, 0.90, and 0.92 (CT, DL-CT, and WB-MRI, respectively). DL-CT and WB-MRI had significantly higher AUC than CT (p = 0.04 and p = 0.03). DL-CT significantly increased sensitivity compared to CT (0.89 vs. 0.79, p = 0.04). WB-MRI had significantly higher specificity than CT (0.84 vs. 0.96, p = 0.001) and DL-CT (0.87 vs. 0.96, p = 0.02).

Conclusions

DL-CT showed significantly higher per-lesion diagnostic performance and sensitivity than CT and WB-MRI. On a per-patient basis, DL-CT and WB-MRI had equal diagnostic performance superior to CT.

Key Points

• Spectral CT has higher diagnostic performance for diagnosing breast cancer metastases compared to conventional CT and whole-body MRI on a per-lesion basis.

• Spectral CT and whole-body MRI are superior to conventional CT for diagnosing patients with metastatic breast cancer.

• Whole-body MRI is superior to conventional CT and spectral CT for diagnosing bone metastases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Abbreviations

ADC:

Apparent diffusion coefficient

AUC:

Area under the curve

DE-CT:

Dual-energy computed tomography

DL-CT:

Dual-layer detector spectral computed tomography

DWI:

Diffusion-weighted imaging

DWIBS:

Diffusion-weighted whole-body imaging with background body signal suppression

PET/CT:

Positron emission tomography/computed tomography

ROC:

Receiver operating characteristics

WB-MRI:

Whole-body magnetic resonance imaging

References

  1. Bray F, Ferlay J, Soerjomataram I et al (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68:394–424

    Google Scholar 

  2. Siegel RL, Miller KD, Jemal A (2018) Cancer statistics, 2018. CA Cancer J Clin 68:7–30

    Article  Google Scholar 

  3. Cardoso F, Kyriakides S, Ohno S et al (2019) Early breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 30:1194–1220

    Article  CAS  Google Scholar 

  4. Khatcheressian JL, Hurley P, Bantug E et al (2013) Breast cancer follow-up and management after primary treatment: American society of clinical oncology clinical practice guideline update. J Clin Oncol 31:961–965

    Article  CAS  Google Scholar 

  5. Cardoso F, Senkus E, Costa A et al (2018) 4th ESO-ESMO international consensus guidelines for advanced breast cancer (ABC 4). Ann Oncol 29:1634–1657

    Article  CAS  Google Scholar 

  6. Haraldsen A, Bluhme H, Røhl L et al (2016) Single photon emission computed tomography (SPECT) and SPECT/low-dose computerized tomography did not increase sensitivity or specificity compared to planar bone scintigraphy for detection of bone metastases in advanced breast cancer. Clin Physiol Funct Imaging 36:40–46

    Article  Google Scholar 

  7. Hamaoka T, Madewell JE, Podoloff D a et al (2004) Bone imaging in metastatic breast cancer. J Clin Oncol 22:2942–2953

    Article  Google Scholar 

  8. Hildebrandt MG, Gerke O, Baun C et al (2016) [181F] Fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) in suspected recurrent breast cancer: a prospective comparative study of dual-time-point FDG-PET/CT, contrast-enhanced CT, and bone scintigraphy. J Clin Oncol 34:1889–1897

    Article  CAS  Google Scholar 

  9. Yang HL, Liu T, Wang XM et al (2011) Diagnosis of bone metastases: a meta-analysis comparing 18FDG PET, CT, MRI and bone scintigraphy. Eur Radiol 21:2604–2617

    Article  Google Scholar 

  10. Jambor I, Kuisma A, Ramadan S et al (2016) Prospective evaluation of planar bone scintigraphy, SPECT, SPECT/CT, 18F-NaF PET/CT and whole body 1.5T MRI, including DWI, for the detection of bone metastases in high risk breast and prostate cancer patients: SKELETA clinical trial. Acta Oncol 55:59–67

    Article  Google Scholar 

  11. Takahara T, Yamashita T (2003) Diffusion weighted whole body imaging with background body signal suppression (DWIBS): technical improvement using free breathing, STIR and high resolution 3D display. Radiat Med 22:275–282

    Google Scholar 

  12. Padhani AR, Liu G, Mu-Koh D et al (2009) Diffusion-weighted magnetic resonance imaging as a cancer biomarker: consensus and recommendations. Neoplasia 11:102–125

    Article  CAS  Google Scholar 

  13. Kosmin M, Padhani AR, Gogbashian A et al (2020) Comparison of whole-body MRI, CT, and bone scintigraphy for response evaluation of cancer therapeutics in metastatic breast cancer to bone. Radiology. 297:622–629

    Article  Google Scholar 

  14. Padhani AR, Lecouvet FE, Tunariu N et al (2017) METastasis reporting and data system for prostate cancer: practical guidelines for acquisition, interpretation, and reporting of whole-body magnetic resonance imaging-based evaluations of multiorgan involvement in advanced prostate cancer [figure presente. Eur Urol 71:81–92

  15. Johnson TRC, Krauß B, Sedlmair M et al (2007) Material differentiation by dual energy CT: initial experience. Eur Radiol 17:1510–1517

    Article  Google Scholar 

  16. Fredenberg E (2018) Spectral and dual-energy X-ray imaging for medical applications. Nucl Instruments Methods Phys Res Sect A Accel Spectrometers, Detect Assoc Equip 878:74–87

    Article  Google Scholar 

  17. Carmi R, Naveh G, Altman A (2005) Material separation with dual-layer CT. IEEE Nucl Sci Symp Conf Rec 4:1876–1878

    Google Scholar 

  18. McCollough CH, Leng S, Yu L, Fletcher JG (2015) Review: dual-and multi-energy CT. RSNA Radiology 276:637–653

  19. Simons D, Kachelrieß M, Schlemmer HP (2014) Recent developments of dual-energy CT in oncology. Eur Radiol 24:930–939

    Article  Google Scholar 

  20. Abdullayev N, Große Hokamp N, Lennartz S et al (2019) Improvements of diagnostic accuracy and visualization of vertebral metastasis using multi-level virtual non-calcium reconstructions from dual-layer spectral detector computed tomography. Eur Radiol 29:5941–5949

    Article  CAS  Google Scholar 

  21. Andersen MB, Ebbesen D, Thygesen J et al (2020) Impact of spectral body imaging in patients suspected for occult cancer: a prospective study of 503 patients. Eur Radiol 30:5539–5550

    Article  Google Scholar 

  22. Pesapane F, Downey K, Rotili A et al (2020) Imaging diagnosis of metastatic breast cancer. Insights Imaging 11:79

    Article  Google Scholar 

  23. Heusner TA, Kuemmel S, Koeninger A et al (2010) Diagnostic value of diffusion-weighted magnetic resonance imaging (DWI) compared to FDG PET/CT for whole-body breast cancer staging. Eur J Nucl Med Mol Imaging 37:1077–1086

    Article  Google Scholar 

  24. Fausto A, Bernini M, Giacomo LD et al (2018) Diagnostic value and safety of dynamic MRI of contralateral breast and axilla in subjects with tissue expander. J Plast Reconstr Aesthet Surg 71:1282–1285

    Article  Google Scholar 

  25. van Ommen F, de Jong HWAM, Dankbaar JW et al (2019) Dose of CT protocols acquired in clinical routine using a dual-layer detector CT scanner: a preliminary report. Eur J Radiol 112:65–71

    Article  Google Scholar 

  26. van Ommen F, Bennink E, Vlassenbroek A et al (2018) Image quality of conventional images of dual-layer SPECTRAL CT: a phantom study. Med Phys 45:3031–3042

    Article  Google Scholar 

  27. Fischer MA, Nanz D, Hany T et al (2011) Diagnostic accuracy of whole-body MRI/DWI image fusion for detection of malignant tumours: a comparison with PET/CT. Eur Radiol 21:246–255

    Article  Google Scholar 

  28. Harris PA, Taylor R, Thielke R et al (2009) Research electronic data capture (REDCap)-A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42:377–381

    Article  Google Scholar 

  29. DeLong ER, DeLong DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44:837–845

    Article  CAS  Google Scholar 

  30. McNemar Q (1947) Note on the sampling error of the difference between correlated proportions or percentages. Psychometrika 12:153–157

    Article  CAS  Google Scholar 

  31. Zhang X, Zheng C, Yang Z et al (2018) Axillary sentinel lymph nodes in breast cancer: quantitative evaluation at dual-energy CT. Radiology 289:337–346

    Article  Google Scholar 

  32. Volterrani L, Gentili F, Fausto A et al (2020) Dual-energy CT for locoregional staging of breast cancer: preliminary results. AJR Am J Roentgenol 214:707–714

    Article  Google Scholar 

  33. Chae EJ, Song JW, Seo JB et al (2008) Clinical utility of dual-energy CT in the evaluation of solitary pulmonary nodules: Initial experience. Radiology 249:671–681

    Article  Google Scholar 

  34. Schmid-Bindert G, Henzler T, Chu TQ et al (2012) Functional imaging of lung cancer using dual energy CT: how does iodine related attenuation correlate with standardized uptake value of 18FDG-PET-CT? Eur Radiol 22:93–103

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The authors would like to thank research radiographer Olga Vendelbo for helping set up scan protocols and scanning the patients.

Funding

This study was supported by the Health Research Foundation of Central Denmark Region.

Author information

Authors and Affiliations

  1. Department of Radiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark

    Thomas Winther Buus, Finn Rasmussen, Hanne Marie Nellemann & Erik Morre Pedersen

  2. Department of Radiology, Herlev Hospital, Borgmester Ib Juuls Vej 17, 2730, Herlev, Denmark

    Vibeke Løgager

  3. Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark

    Anders Bonde Jensen

  4. Department of Plastic and Breast Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 35, 8200, Aarhus N, Denmark

    Katrine Rye Hauerslev & Peer Christiansen

Authors
  1. Thomas Winther Buus
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Finn Rasmussen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hanne Marie Nellemann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vibeke Løgager
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anders Bonde Jensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Katrine Rye Hauerslev
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Peer Christiansen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Erik Morre Pedersen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thomas Winther Buus.

Ethics declarations

Guarantor

Erik Morre Pedersen, MD PhD DMSc.

Conflict of Interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and Biometry

No complex statistical methods were necessary for this paper.

Informed Consent

Prior to DL-CT and WB-MRI, written informed consent was obtained from all subjects (patients) in this study.

Ethical Approval

Institutional Review Board approval was obtained. This prospective single-centre study was approved by the Central Denmark Region Committee on Health Research Ethics (reference number 1-10-72-425-17) and was conducted between April 2018 and November 2019.

Methodology

• prospective

• diagnostic study

• performed at one institution

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

ESM 1

(DOCX 19 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Buus, T.W., Rasmussen, F., Nellemann, H.M. et al. Comparison of contrast-enhanced CT, dual-layer detector spectral CT, and whole-body MRI in suspected metastatic breast cancer: a prospective diagnostic accuracy study. Eur Radiol 31, 8838–8849 (2021). https://doi.org/10.1007/s00330-021-08041-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-021-08041-2

Keywords

Search

Navigation