DOI: 10.1148/rg.27si075517
FDG PET, PET/CT, and Breast Cancer Imaging1
Eric L. Rosen, MD,
William B. Eubank, MD, and
David A. Mankoff, MD, PhD
1 From the Department of Radiology, University of Washington Medical Center, Seattle Cancer Care Alliance, 825 Eastlake Ave East, G3-200, Seattle, WA 98109-1023. Received March 16, 2007; revision requested May 1 and received June 18; accepted June 22. Supported in part by grants CA72064, CA90771, and CA42045 from the National Institutes of Health. E.L.R. is an author for McGraw-Hill, New York, NY; D.A.M. receives research support from General Electric, Fairfield, Conn; the other author has no financial relationships to disclose.
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Figure 2. Metabolism of FDG compared with that of glucose. FDG is transported into the cell and phosphorylated in parallel with glucose. FDG phosphorylated by hexokinase is "metabolically trapped" and therefore has increased uptake and retention in metabolically active tissue.
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Figure 3a. Demonstration of small invasive breast carcinomas with FDG PEM. Images from dedicated breast PEM units show 9-mm (circle in a) and 1.3-cm (rectangle in b) invasive carcinomas.
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Figure 3b. Demonstration of small invasive breast carcinomas with FDG PEM. Images from dedicated breast PEM units show 9-mm (circle in a) and 1.3-cm (rectangle in b) invasive carcinomas.
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Figure 4a. FDG PET in a patient with locally advanced breast cancer (LABC). Coronal images show multiple sites of malignancy in both the breast (arrows in a) and the axilla (arrow in b). FDG PET clearly depicts the extent of metastatic spread to all levels of the axilla. Myocardial uptake (arrowhead in b), which is normal, is also demonstrated.
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Figure 4b. FDG PET in a patient with locally advanced breast cancer (LABC). Coronal images show multiple sites of malignancy in both the breast (arrows in a) and the axilla (arrow in b). FDG PET clearly depicts the extent of metastatic spread to all levels of the axilla. Myocardial uptake (arrowhead in b), which is normal, is also demonstrated.
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Figure 5. FDG PET image of a patient with LABC shows uptake (arrow) in an IM node. Our experience suggests that FDG uptake in IM nodes is associated with non–upper outer quadrant primary breast cancers and inflammatory breast cancer (26). In our series, FDG uptake in IM nodes was predictive of both the likelihood of treatment failure and the pattern of failure, results suggestive of disease involvement and progression in IM nodes.
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Figure 6a. Restaging with PET/CT in a patient suspected of having metastatic disease. Axial CT (a), axial PET/CT fusion (b), coronal PET (c), and coronal PET/CT fusion (d) images show hilar metastases.
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Figure 6b. Restaging with PET/CT in a patient suspected of having metastatic disease. Axial CT (a), axial PET/CT fusion (b), coronal PET (c), and coronal PET/CT fusion (d) images show hilar metastases.
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Figure 6c. Restaging with PET/CT in a patient suspected of having metastatic disease. Axial CT (a), axial PET/CT fusion (b), coronal PET (c), and coronal PET/CT fusion (d) images show hilar metastases.
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Figure 6d. Restaging with PET/CT in a patient suspected of having metastatic disease. Axial CT (a), axial PET/CT fusion (b), coronal PET (c), and coronal PET/CT fusion (d) images show hilar metastases.
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Figure 7a. Results of PET/CT in a patient suspected of having recurrent breast carcinoma. Axial contrast-enhanced CT (a), coronal PET (b), coronal fusion (c), and sagittal fusion (d) images show extensive local recurrence involving the breast, sternum, anterior chest wall, and pleura as well as hilar metastases and diffuse bone metastases.
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Figure 7b. Results of PET/CT in a patient suspected of having recurrent breast carcinoma. Axial contrast-enhanced CT (a), coronal PET (b), coronal fusion (c), and sagittal fusion (d) images show extensive local recurrence involving the breast, sternum, anterior chest wall, and pleura as well as hilar metastases and diffuse bone metastases.
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Figure 7c. Results of PET/CT in a patient suspected of having recurrent breast carcinoma. Axial contrast-enhanced CT (a), coronal PET (b), coronal fusion (c), and sagittal fusion (d) images show extensive local recurrence involving the breast, sternum, anterior chest wall, and pleura as well as hilar metastases and diffuse bone metastases.
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Figure 7d. Results of PET/CT in a patient suspected of having recurrent breast carcinoma. Axial contrast-enhanced CT (a), coronal PET (b), coronal fusion (c), and sagittal fusion (d) images show extensive local recurrence involving the breast, sternum, anterior chest wall, and pleura as well as hilar metastases and diffuse bone metastases.
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Figure 8a. Detection of both lytic and sclerotic bone metastases with FDG PET/CT. Coronal CT (a), PET (b), and fusion (c) images show the complementary nature of CT (sclerotic foci) and PET (lytic foci) in detection of bone metastases.
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Figure 8b. Detection of both lytic and sclerotic bone metastases with FDG PET/CT. Coronal CT (a), PET (b), and fusion (c) images show the complementary nature of CT (sclerotic foci) and PET (lytic foci) in detection of bone metastases.
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Figure 8c. Detection of both lytic and sclerotic bone metastases with FDG PET/CT. Coronal CT (a), PET (b), and fusion (c) images show the complementary nature of CT (sclerotic foci) and PET (lytic foci) in detection of bone metastases.
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Figure 9. NST in women with LABC consists of preoperative systemic chemotherapy aimed at achieving long-term survival, assessing the response to systemic therapy, and improving surgical options. FDG PET has been evaluated at different time points along the course of neoadjuvant therapy (Rx), and its results have been shown to be an accurate predictor of tumor response.
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Figure 10a. Assessment of tumor response to NST. Coronal FDG PET images of a patient with right LABC (arrows in a), obtained before (a) and 2 months after (b) chemotherapy, show an excellent response. The tumor response was subsequently confirmed at posttherapy histopathologic analysis.
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Figure 10b. Assessment of tumor response to NST. Coronal FDG PET images of a patient with right LABC (arrows in a), obtained before (a) and 2 months after (b) chemotherapy, show an excellent response. The tumor response was subsequently confirmed at posttherapy histopathologic analysis.
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Figure 11a. Poor response to preoperative chemotherapy in a patient with left LABC. (a) Coronal FDG PET image obtained before therapy shows uptake in the breast primary tumor (double arrows) and myocardial uptake (single arrow), which is a normal variant. (b) Image obtained after 2 months of chemotherapy shows little qualitative change in the appearance of the breast tumor (arrows); there was only a small quantitative decline in uptake. The diffuse uptake in the marrow spaces is due to the effect of granulocyte colony-stimulating factor. The poor response to treatment was confirmed with multiple subsequent imaging studies and surgical histopathologic analysis.
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Figure 11b. Poor response to preoperative chemotherapy in a patient with left LABC. (a) Coronal FDG PET image obtained before therapy shows uptake in the breast primary tumor (double arrows) and myocardial uptake (single arrow), which is a normal variant. (b) Image obtained after 2 months of chemotherapy shows little qualitative change in the appearance of the breast tumor (arrows); there was only a small quantitative decline in uptake. The diffuse uptake in the marrow spaces is due to the effect of granulocyte colony-stimulating factor. The poor response to treatment was confirmed with multiple subsequent imaging studies and surgical histopathologic analysis.
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Figure 12a. Evaluation of the response of bone metastases to therapy. (a, b) FDG PET images obtained at baseline (a) and after 4 months of therapy with letrozole (b) show a significant response to treatment; the treatment response was confirmed by the subsequent clinical course. (c, d) Na18F images obtained at baseline (c) and after 4 months of letrozole therapy (d) show resolution of the abnormal uptake due to a pathologic right pelvic fracture but relatively modest change elsewhere. The nature of the information provided by FDG PET and fluoride PET is complementary; however, FDG PET allows measurement of response earlier than fluoride PET or bone scanning.
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Figure 12b. Evaluation of the response of bone metastases to therapy. (a, b) FDG PET images obtained at baseline (a) and after 4 months of therapy with letrozole (b) show a significant response to treatment; the treatment response was confirmed by the subsequent clinical course. (c, d) Na18F images obtained at baseline (c) and after 4 months of letrozole therapy (d) show resolution of the abnormal uptake due to a pathologic right pelvic fracture but relatively modest change elsewhere. The nature of the information provided by FDG PET and fluoride PET is complementary; however, FDG PET allows measurement of response earlier than fluoride PET or bone scanning.
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Figure 12c. Evaluation of the response of bone metastases to therapy. (a, b) FDG PET images obtained at baseline (a) and after 4 months of therapy with letrozole (b) show a significant response to treatment; the treatment response was confirmed by the subsequent clinical course. (c, d) Na18F images obtained at baseline (c) and after 4 months of letrozole therapy (d) show resolution of the abnormal uptake due to a pathologic right pelvic fracture but relatively modest change elsewhere. The nature of the information provided by FDG PET and fluoride PET is complementary; however, FDG PET allows measurement of response earlier than fluoride PET or bone scanning.
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Figure 12d. Evaluation of the response of bone metastases to therapy. (a, b) FDG PET images obtained at baseline (a) and after 4 months of therapy with letrozole (b) show a significant response to treatment; the treatment response was confirmed by the subsequent clinical course. (c, d) Na18F images obtained at baseline (c) and after 4 months of letrozole therapy (d) show resolution of the abnormal uptake due to a pathologic right pelvic fracture but relatively modest change elsewhere. The nature of the information provided by FDG PET and fluoride PET is complementary; however, FDG PET allows measurement of response earlier than fluoride PET or bone scanning.
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Copyright © 2007 by the Radiological Society of North America.
