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Review
. 2024 Jan 12;12(1):172.
doi: 10.3390/biomedicines12010172.

PET/MRI and Novel Targets for Breast Cancer

Hyun Woo Chung  1 , Kyoung Sik Park  2   3 , Ilhan Lim  4 , Woo Chul Noh  2 , Young Bum Yoo  2 , Sang Eun Nam  2 , Young So  1 , Eun Jeong Lee  5
Affiliations
Review

PET/MRI and Novel Targets for Breast Cancer

Hyun Woo Chung et al. Biomedicines. .

Abstract

Breast cancer, with its global prevalence and impact on women's health, necessitates effective early detection and accurate staging for optimal patient outcomes. Traditional imaging modalities such as mammography, ultrasound, and dynamic contrast-enhanced magnetic resonance imaging (MRI) play crucial roles in local-regional assessment, while bone scintigraphy and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) aid in evaluating distant metastasis. Despite the proven utility of 18F-FDG PET/CT in various cancers, its limitations in breast cancer, such as high false-negative rates for small and low-grade tumors, have driven exploration into novel targets for PET radiotracers, including estrogen receptor, human epidermal growth factor receptor-2, fibroblast activation protein, and hypoxia. The advent of PET/MRI, which combines metabolic PET information with high anatomical detail from MRI, has emerged as a promising tool for breast cancer diagnosis, staging, treatment response assessment, and restaging. Technical advancements including the integration of PET and MRI, considerations in patient preparation, and optimized imaging protocols contribute to the success of dedicated breast and whole-body PET/MRI. This comprehensive review offers the current technical aspects and clinical applications of PET/MRI for breast cancer. Additionally, novel targets in breast cancer for PET radiotracers beyond glucose metabolism are explored.

Keywords: FAPI; HER2; PET/MRI; breast cancer; estrogen receptor; hypoxia.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Breast and whole-body simultaneous PET/MRI acquisition protocol.
Figure 2
Figure 2
18F-FDG PET/MRI for initial N staging in a patient with breast cancer. (A) PET images revealed hypermetabolic right breast cancer with right axillary lymph node metastasis (red arrow). Additionally, inconclusive mild hypermetabolic uptake was found in the right interpectoral area (yellow arrow). (B) PET/MRI identified right interpectoral lymph node metastasis with gadolinium-contrast enhancement on T1-w MRI (yellow arrow).
Figure 3
Figure 3
18F-FDG PET/MRI for initial M staging in a patient with breast cancer. (A) PET images revealed hypermetabolic left breast cancer with left axillary lymph node metastases (red arrow). Additionally, inconclusive mild hypermetabolic uptake was observed in the sternum area (yellow arrow). (B) PET/MRI identified sternum metastasis with gadolinium-contrast enhancement on T1-w MRI (yellow arrow).
Figure 4
Figure 4
18F-FDG PET/MRI in a patient with previously treated breast cancer. (A) PET maximum intensity projection image revealed hepatic metastases. (B,C) Post-contrast MRI found an additional hepatic metastasis without hypermetabolism on PET (yellow arrow). (D,E) MRI ADC and PET images detected additional asymptomatic brain metastasis (red arrow). Reprinted through the Copyright Clearance Center’s RightsLink® service from Kwon et al. [49].
Figure 5
Figure 5
18F-FDG and 64Cu-DOTA-trastuzumab PET maximum intensity projection images in a patient with recurrent left breast cancer with pulmonary metastases. (A) 18F-FDG PET detected hypermetabolic recurrent left breast cancer (yellow arrow) and pulmonary metastases (red arrow). (B) 64Cu-DOTA-trastuzumab PET demonstrated increased uptake only in the recurrent left breast lesions (yellow arrow), not in the pulmonary metastases. (C) Following treatment with trastuzumab emtansine, the metabolic activity of the recurrent left breast lesions decreased (yellow arrow), while the pulmonary metastases worsened on 18F-FDG PET (red arrow).
See this image and copyright information in PMC

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