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Clinical Trial
. 2019 Apr;46(4):821-830.
doi: 10.1007/s00259-018-4223-9. Epub 2018 Dec 1.

Prediction of therapy response in bone-predominant metastatic breast cancer: comparison of [18F] fluorodeoxyglucose and [18F]-fluoride PET/CT with whole-body MRI with diffusion-weighted imaging

Gurdip K Azad  1 , Benjamin P Taylor  2 , Adrian Green  1 , Ines Sandri  2 , Angela Swampillai  2 , Mark Harries  2 , Hartmut Kristeleit  2 , Janine Mansi  2 , Vicky Goh  1 , Gary J R Cook  3   4
Affiliations
Clinical Trial

Prediction of therapy response in bone-predominant metastatic breast cancer: comparison of [18F] fluorodeoxyglucose and [18F]-fluoride PET/CT with whole-body MRI with diffusion-weighted imaging

Gurdip K Azad et al. Eur J Nucl Med Mol Imaging. 2019 Apr.

Abstract

Purpose: To compare [18F]-fluorodeoxyglucose (FDG) and [18F]-sodium fluoride (NaF) positron emission tomography/computed tomography (PET/CT) with whole-body magnetic resonance with diffusion-weighted imaging (WB-MRI), for endocrine therapy response prediction at 8 weeks in bone-predominant metastatic breast cancer.

Patients and methods: Thirty-one patients scheduled for endocrine therapy had up to five bone metastases measured [FDG, NaF PET/CT: maximum standardized uptake value (SUVmax); WB-MRI: median apparent diffusion coefficient (ADCmed)] at baseline and 8 weeks. To detect the flare phenomenon, a 12-week NaF PET/CT was also performed if 8-week SUVmax increased. A 25% parameter change differentiated imaging progressive disease (PD) from non-PD and was compared to a 24-week clinical reference standard and progression-free survival (PFS).

Results: Twenty-two patients (median age, 58.6 years, range, 40-79 years) completing baseline and 8-week imaging were included in the final analysis. Per-patient % change in NaF SUVmax predicted 24-week clinical PD with sensitivity, specificity and accuracy of 60, 73.3, and 70%, respectively. For FDG SUVmax the results were 0, 100, and 76.2% and for ADCmed, 0, 100 and 72.2%, respectively. PFS < 24 weeks was associated with % change in SUVmax (NaF: 41.7 vs. 0.7%, p = 0.039; FDG: - 4.8 vs. - 28.6%, p = 0.005) but not ADCmed (- 0.5 vs. 10.1%, p = 0.098). Interlesional response heterogeneity occurred in all modalities and NaF flare occurred in seven patients.

Conclusions: FDG PET/CT and WB-MRI best predicted clinical non-PD and both FDG and NaF PET/CT predicted PFS < 24 weeks. Lesional response heterogeneity occurs with all modalities and flare is common with NaF PET/CT.

Keywords: Bone metastases; Diffusion-weighted MRI; Positron emission tomography/computed tomography; Whole-body MRI; [18F]-fluorodeoxyglucose; [18F]-sodium fluoride.

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Conflict of interest statement

Conflict of interest

The authors declare they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Figures

Fig. 1
Fig. 1
Waterfall plots showing % change in ADCmed and SUVmax in a each patient and in b each lesion for (top) WB-MRI, (middle) FDG PET/CT, and (bottom) NaF PET/CT [clinical non-progressors (blue) and progressors (red)]. ADC, apparent diffusion coefficient; FDG, [18F]-fluorodeoxyglucose; NaF, [18F]-sodium fluoride
Fig. 2
Fig. 2
a NaF PET maximum intensity projection (MIP) and b corresponding transaxial images [PET (top), fused PET/CT (middle), and CT (bottom)] of a lesion in L5 at baseline (left) and 8 weeks (right) after commencing endocrine therapy in a patient who had a response by the clinical reference standard. SUVmax of the L5 vertebral lesion decreased from 42.7 to 32.5
Fig. 3
Fig. 3
a FDG PET MIP and b corresponding transaxial images [PET (top), fused PET/CT (middle), and CT (bottom)] of a lesion in L5 at baseline (left) and 8 weeks (right) in the same patient as Figs. 2 and 4. SUVmax of the L5 vertebral lesion decreased from 9.9 to 4.9
Fig. 4
Fig. 4
a b900 DWI MIP and b corresponding transaxial b900 DWI (top) and T1-W (bottom) images at baseline (left) and 8 weeks (right) of a L5 lesion in the same patient as Figs. 2 and 3. ADCmed of the L5 vertebral lesion increased from 1047 to 1150 mm2/s
See this image and copyright information in PMC

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