The Functional Imageology Evaluation Of Metabolism And Blood Supply In Breast Tumors

Objective:Using CT perfusion,¹⁸F-FDG and ¹¹C-CH PET/CT to investigate the blood supply and metabolism change of breast tumors and their clinical value.Material and Methods:44 females with suspicious breast masses were included from July,2003 to December,2007,with an age range of 20～75 years old(mean 54.5).All the patients were divided into two groups according to visiting time,A and B.Group A with 32 patients were underwent CT perfusion and ¹⁸F-FDG PET/CT at the same day separately.Group B with 12 patients were underwent ¹¹C-CH PET/CT. CT perfusion scan were acquired by 16 slices CT(Light Speed,GE Medical, Milwaukee,Wis).The data were transmitted to Advantage Workstation 4.1,the parameters of hemoperfusion such as BF(blood flow),BV(blood volume),MTT (mean transit time)and PS(permeability surface area product)in tumor peripheral zone,central portions,and contralateral normal breast tissue,,were acquired by a software package perfusion 3 within the Workstation.The average of 3 ROI was considered as objective perfusion value which were obtained separately in tumor peripheral zone,central portions,and contralateral normal breast tissue.Tumor peripheral zone perfusion value was the same as tumor's.PET/CT scans were acquired by GE Discovery LS⁴ PET/CT system and the data were transferred to the workstation(GE Xeleris)through reconstruction obtained CT,PET,fused PET/CT images.3 PET/CT doctors interpreted the images semi-quantitatively and visually,and made diagnostic and staging conclusions together.SUVs(standardized uptake values)of tumor peripheral zone,central portions,and contralateral normal breast tissue were got in ¹⁸F-FDG PET/CT;SUVs of tumor and contralateral normal breast tissue were got in ¹¹C-CH PET/CT.At the same time T/NT(target-to-nontarget) ratios were obtained.43 patients were underwent surgery;1 patient was underwent fine needle aspiration.All the lesions were confirmed histopathologically.All data were analyzed for significance by using the t-test with SPSS10.0.Values of P＜0.05 were accepted as significance.Results:In group A there were 27 malignant(18 infiltrating ductal carcinoma;5 infiltrating lobular carcinoma;3 intraductal carcinoma;1 medullary carcinoma)and 5 benign(2 adenoma fibrosum;1 adenoma fibrosum with hyperplasia;1 inflammatory hyperplasia;1 sclerosing adenosis)breast lesions of 32 patients proven histologically. Masses diameter ranged from 0.9 cm to 7.8 cm.The mean difference BF,BV,and PS between breast cancer and normal breast tissue,between peripheral zone and central portions of tumor were statistically significant(p＜0.05).The mean difference MTT between breast cancer and normal breast tissue,between peripheral zone and central portions of tumor were not statistically significant(p＞0.05).For detecting primary breast cancer semi-quantitatively the sensitivity,specificity,positive predictive value, negative predictive value and accuracy of ¹⁸F-FDG PET/CT were 88.89%(24/27),80.00%(4/5),96.00%(24/25),57.14%(4/7)and 87.50%(28/32),respectively. There was statistic difference in mean SUV and T/NT between benign and malignant masses(p＜0.01).The mean difference SUVs between infiltrating ductal carcinoma and infiltrating lobular carcinoma was statistically significant(p＜0.05).The false negative of the former was lower than that of the latter.Differences of SUVs between the center and periphery of breast masses were significant too.In addition,SUVs of central portions were higher than those of peripheral portions while both of them in blood supply were opposite.For detecting primary breast cancer visually the sensitivity,specificity,positive predictive value,negative predictive value and accuracy of ¹⁸F-FDG PET/CT were 92.59%(25/27),80.00%(4/5),96.15 %(25/26),66.67%(4/6)and 90.63%(29/32),respectively.In group B there were 9 malignant(infiltrating ductal carcinoma7;Intraductal carcinoma 1;atypical hyperplasia with minor duet carcinoma in suit 1)and 3 benign(adenoma fibrosum with hyperplasia 2;hyperplasia with fat necrosis 1)breast lesions of 12 patients proven histologically.Masses diameter ranged from 1.0 cm to 4.5 cm.8 of 9 malignant lesions and 2 of 3 benign lesions were diagnosed correctly through ¹¹C-CH PET/CT.Additionally;there was 1 false positive and 1 false negative.Conclusion:CT perfusion can evaluate blood supply and offer the hypoxia information of breast tumors.Blood flow is abundant and surface area permeability is higher in breast carcinoma.Blood flow in peripheral zone is more plentiful than the central portions of carcinoma.Sensitivity and specificity are higher using ¹⁸FPET/CT to diagnose primary breast carcinoma.The uptake of FDG in carcinoma is concerned with pathology types.SUV and T/NT are benefit for the diagnosis and differential diagnosis.Visual assement is superior to semiquantitative assement.The center of carcinoma has more FDG than the peripheral zone.Meanwhile the state of blood perfusion is opposite.The data in group of ¹¹C-Choline PET/CT show that SUV is less helpful in diagnosis.The uptake of infiltrating duetal carcinoma is higher than others.False negative in PET/CT is mainly attributed to smaller size(diameter＜1 cm)and infiltrating lobular carcinoma.