Breast Cancer Case

Multiparametric PET/MRI for Breast Evaluation has provided benefits under the following indications:

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Primary Staging Evaluation

 Accurate initial staging is important in decision-making for women with primary breast cancer both for optimal treatment planning and establishing the likely prognosis. Mammography with or without correlative ultrasound are still the most widely utilized modality for initial local assessment of breast cancer. Over the past decade, dedicated dynamic contrast-enhanced breast MRI (DCE-MRI) has emerged as an important tool in the pre-operative evaluation of breast cancer in patients contemplating BCS, owing to its high sensitivity for detection of small multifocal/multicentric and synchronous contralateral disease unrecognized on conventional assessment, as well as in patients with locally advanced disease to assess response to therapy. Whole-body 18F-FDG PET/CT has been predominantly used for distant metastatic staging in patients with breast cancer and has also been found to be useful for staging early breast cancer and for monitoring therapy in breast cancer patients.

 Simultaneous PET/MRI brings the potential to combine the specificity obtained by the functional imaging modality i.e., PET with the superior sensitivity of MRI, to provide relevant information of higher diagnostic accuracy in one single session, besides significant reduction in radiation exposure.

Response Assessment to NACT

 The other area where PET MRI can make a difference in response evaluation in patients undergoing chemotherapy where DCE MRI alone and /or in combination with PET has been increasingly used in assessing the response and early phase clinical trial settings to measure and, importantly, predict tumor response to treatment. Simultaneous PET/MRI, in a single time frame, accommodates the tissue characterization through MRI for evaluation of local disease along with functional and molecular information of the whole body provided by PET, thereby providing distinct clinical advantages over other imaging modalities.

 

Unsuspected contralateral synchronous cancer in the left breast on Multiparametric evaluation

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Case History:

44 year old female with a palpable nodule in the right breast. XRM, MLO(A) and CC (B) :heterogeneously dense breasts. USG: right breast suspicious lesion; left breast was reported normal. FNAC right breast lesion: reported Malignant. Underwent staging PET/MR.

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Findings:

Breast MR as a part of WB PET/MR revealed an enhancing FDG avid lesion in the right breast in 1 min Sub MIP axial image (C, arrow) right breast oblique sagittal (E, arrow) and PET/MR fused image (D, arrow) with non-avid enhancing lesion anterior to it suggesting multifocality ( arrowhead in D and E).

Unsuspected contralateral two adjacently placed enhancing lesions were seen at posterior depth (red arrows in D and F ) which showed increased FDG uptake (red arrow in C) and wash out kinetics appearing red on the WIWO parametric map( red arrow in G).

Another discrete circumscribed mass is seen at anterior mid-depth (arrowhead in D and F) with no FDG uptake (arrowhead in C) and persistent kinetics in WIWO parametric map ( arrowhead in G)

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Case Study Prepared by:

This short PET-MRI Scan case was compiled by Dr. Sangeeta Taneja and Dr. Amarnath Jena (Nuclear Medicine Physician at PET-Suite @ Indraprastha Apollo Hospital, Sarita Vihar).

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Read More about PET-MRI Scan at House Of Diagnostics in Delhi and NCR.

The Simultaneous PET-MRI Scan is currently offered at PET-Suite at Apollo Hospital, Sarita Vihar.

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