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Improving Specificity of Breast MRI Using Prone PET and Fused MRI and PET 3D Volume Datasets

¹ Department of Radiology, School of Medicine, New York University, New York, New York; and ² School of Information and Communication Technology, Royal Institute of Technology, Kista, Sweden

View larger version (110K): [in this window] [in a new window]   FIGURE 1.  Breast apparatus used to position patient for prone 18F-FDG PET study is shown positioned on scanner couch. Patient's shoulders, arms, and head rest comfortably on pillows provided.

View larger version (96K): [in this window] [in a new window]   FIGURE 2.  Patient 1, a 25-y-old woman, presented with 1 mass in each breast. Axial (top), coronal (middle), and sagittal (bottom) slices are shown at level of 1-cm enhancing mass (arrows) detected only on MRI scan, evaluated as a probably benign finding and found to be benign after 17 mo of follow-up. (A) Unregistered PET scan. (B) Original MRI scan. (C) Registered PET scan superimposed on original MRI scan. No increased uptake was seen on PET scan.

View larger version (107K): [in this window] [in a new window]   FIGURE 3.  Patient 2, a 44-y-old woman, presented with 3 masses in left breast. Axial (top), coronal (middle), and sagittal (bottom) slices are shown at level of 2-cm enhancing mass (arrows) detected on both MRI and PET scans and confirmed by pathology to be moderately differentiated IDC. (A) Unregistered PET scan. (B) Original MRI scan. (C) Registered PET scan superimposed on original MRI scan.

View larger version (64K): [in this window] [in a new window]   FIGURE 4.  Patient 2 shown in 3D with arrow indicating 2-cm lesion confirmed as moderately differentiated IDC. Yellow, shown transparent, is MRI scan with fused PET lesion and other high-activity regions (liver and spine) superimposed in red. Lesion is inside left breast, whereas liver and spine are in front of and beneath MRI scan. (A) 3D view from 1 angle with level of PET activity set at 1 particular level. (B) 3D view from a different angle with level of PET activity set at a higher level than in A.

View larger version (103K): [in this window] [in a new window]   FIGURE 5.  Patient 2 shown with axial (top), coronal (middle), and sagittal (bottom) slices now at level of a 0.6-cm enhancing mass (upper arrows) detected only on MRI scan and evaluated as a BIRADS 3, probably benign finding. (A) Unregistered PET scan. (B) Original MRI scan. (C) Registered PET scan superimposed on original MRI scan. The 2-cm mass shown in Figure 3 is just visible in bottom right of axial view (lower arrow).

View larger version (106K): [in this window] [in a new window]   FIGURE 6.  Patient 3, a 27-y-old woman, presented with 1 enhancing mass in each breast. Axial (top), coronal (middle), and sagittal (bottom) slices are shown at level of a 2.2-cm mass detected in left breast (arrows) on both MRI and PET scans and found to be poorly differentiated DCIS at mastectomy. (A) Unregistered PET scan. (B) Original MRI scan. (C) Registered PET scan superimposed on original MRI scan. As can be seen in A on axial and coronal views, mass in right breast was correctly not seen on PET scan as determined also by mastectomy.