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Comparison of Whole-Body F FDG PET/MR Imaging and Whole-Body F FDG PET/CT in Terms of Lesion Detection and Radiation Dose in Patients with Breast Cancer

Melsaether, Amy N; Raad, Roy A; Pujara, Akshat C; Ponzo, Fabio D; Pysarenko, Kristine M; Jhaveri, Komal; Babb, James S; Sigmund, Eric E; Kim, Sungheon G; Moy, Linda A
Purpose To compare fluorine 18 (18F) fluorodeoxyglucose (FDG) combined positron emission tomography (PET) and magnetic resonance (MR) imaging with 18F FDG combined PET and computed tomography (CT) in terms of organ-specific metastatic lesion detection and radiation dose in patients with breast cancer. Materials and Methods From July 2012 to October 2013, this institutional review board-approved HIPAA-compliant prospective study included 51 patients with breast cancer (50 women; mean age, 56 years; range, 32-76 years; one man; aged 70 years) who completed PET/MR imaging with diffusion-weighted and contrast material-enhanced sequences after unenhanced PET/CT. Written informed consent for study participation was obtained. Two independent readers for each modality recorded site and number of lesions. Imaging and clinical follow-up, with consensus in two cases, served as the reference standard. Results There were 242 distant metastatic lesions in 30 patients, 18 breast cancers in 17 patients, and 19 positive axillary nodes in eight patients. On a per-patient basis, PET/MR imaging with diffusion-weighted and contrast-enhanced sequences depicted distant (30 of 30 [100%] for readers 1 and 2) and axillary (eight of eight [100%] for reader 1, seven of eight [88%] for reader 2) metastatic disease at rates similar to those of unenhanced PET/CT (distant metastatic disease: 28 of 29 [96%] for readers 3 and 4, P = .50; axillary metastatic disease: seven of eight [88%] for readers 3 and 4, P > .99) and outperformed PET/CT in the detection of breast cancer (17 of 17 [100%] for readers 1 and 2 vs 11 of 17 [65%] for reader 3 and 10 of 17 [59%] for reader 4; P < .001). PET/MR imaging showed increased sensitivity for liver (40 of 40 [100%] for reader 1 and 32 of 40 [80%] for reader 2 vs 30 of 40 [75%] for reader 3 and 28 of 40 [70%] for reader 4; P < .001) and bone (105 of 107 [98%] for reader 1 and 102 of 107 [95%] for reader 2 vs 106 of 107 [99%] for reader 3 and 93 of 107 [87%] for reader 4; P = .012) metastases and revealed brain metastases in five of 51 (10%) patients. PET/CT trended toward increased sensitivity for lung metastases (20 of 23 [87%] for reader 1 and 17 of 23 [74%] for reader 2 vs 23 of 23 [100%] for reader 3 and 22 of 23 [96%] for reader 4; P = .065). Dose reduction averaged 50% (P < .001). Conclusion In patients with breast cancer, PET/MR imaging may yield better sensitivity for liver and possibly bone metastases but not for pulmonary metastases, as compared with that attained with PET/CT, at about half the radiation dose. (c) RSNA, 2016 Online supplemental material is available for this article.
PMCID:5028256
PMID: 27023002
ISSN: 1527-1315
CID: 2059122

Evaluation of a known breast cancer using an abbreviated breast MRI protocol: Correlation of imaging characteristics and pathology with lesion detection and conspicuity

Heacock, Laura; Melsaether, Amy N; Heller, Samantha L; Gao, Yiming; Pysarenko, Kristine M; Babb, James S; Kim, Sungheon G; Moy, Linda
OBJECTIVE: This study evaluates use of an abbreviated magnetic resonance imaging protocol with T2-weighted imaging in detecting biopsy-proven unifocal breast cancer. MATERIALS AND METHODS: This is an institutional review board approved retrospective study of patients with biopsy-proven unifocal breast cancer (88% invasive; 12% in situ) undergoing magnetic resonance imaging. In three separate sessions, three breast imagers evaluated (1) T1-weighted non-contrast, post-contrast and post-contrast subtracted images, (2) T1-weighted images with clinical history and prior imaging, and (3) T1-weighted images and T2-weighted images with clinical history and prior imaging. Protocols were compared for cancer detection, reading time and lesion conspicuity. An independent breast radiologist retrospectively analyzed initial enhancement ratio of cancers and retrospectively reviewed lesion morphology and final pathology. RESULTS: All 107 cancers were identified at first protocol by at least one reader; five cancers were missed by either one or two readers. One cancer was missed by one reader at protocols two and three. Mean percentage detection for protocol one was 97.8%; protocol two, 99.4%, protocol three, 99.4%. T2-weighted images did not alter cancer detection but increased lesion conspicuity for 2/3 readers. 3/5 missed lesions were low grade cancers. Initial enhancement ratio was positively associated with increasing tumor grade (p=0.031) and pathology (p=0.002). Reader interpretation time decreased and lesion conspicuity increased as initial enhancement ratio increased. CONCLUSION: Abbreviated magnetic resonance imaging has high rate of detection for known breast cancer and short interpretation time. T2 weighted imaging increased lesion conspicuity without altering detection rate. Initial enhancement ratio correlated with invasive disease and tumor grade.
PMID: 26971429
ISSN: 1872-7727
CID: 2031312

The service encounter in radiology: acing the "moments of truth" to achieve patient-centered care

Rosenkrantz, Andrew B; Pysarenko, Kristine
Radiologists are increasingly recognizing their role as direct service providers to patients and seeking to offer an exceptional patient experience as part of high-quality service delivery. Patients' perceptions of service delivery are derived from the chain of numerous individual real-time encounters that occur throughout their visit. These so-called "moments of truth" define the overall experience and form the lasting impression of the given practice in their mind. Providing excellent service can be difficult to achieve in practice given its intangible nature as well as the heterogeneity and unpredictability of the large number of patients, frontline staff, and environmental circumstances that define the patient experience. Thus, broad commitment and team effort among all members of a radiology practice are required. This article explores important areas to be considered by a radiology practice to ensure positive and meaningful patient experiences. Specific ways in which every member within the practice, including schedulers, receptionists, technologists, nurses, and radiologists, can contribute to achieving high-quality patient service are discussed. Examples of patient-oriented language that may be useful in particular scenarios in radiology practice are given. The role of the practice's physical facility, including all aspects of its aesthetics and amenities, as well as of Internet services, in shaping the patient experience is also described. Throughout this work, a proactive approach to promoting a service-oriented organizational culture is provided. By improving the patient experience, these strategies may serve to enhance patients' perceptions of radiology and radiologists.
PMID: 25572928
ISSN: 1076-6332
CID: 1435832

Inter- and intrareader agreement for categorization of background parenchymal enhancement at baseline and after training

Melsaether, Amy; McDermott, Meredith; Gupta, Dipti; Pysarenko, Kristine; Shaylor, Sara D; Moy, Linda
OBJECTIVE. Background parenchymal enhancement (BPE) refers to enhancing fibroglandular tissue on initial contrast-enhanced MR images. BPE appears to impact the rate of abnormal MRI interpretation and may correlate with breast cancer risk. There are now minimal data as to the uniformity of radiologists' BPE assessments and no data as to whether training improves agreement. Therefore, for this study, we sought to assess interreader agreement for BPE at baseline and after dedicated training. MATERIALS AND METHODS. This study included 119 breast MRI examinations performed in 119 patients (mean age, 47 years; age range, 25-79 years) in 2008. One week before training, four fellowship-trained breast imagers with 2-12 years' experience independently recorded BPE on a 4-point scale as follows: 1 (minimal, 75%). The same 119 cases were reread in a new random order within 1 week and at least 3 weeks after training. Interreader agreement and intrareader agreement were assessed using kappa coefficients. RESULTS. With training, interreader agreement increased from fair (kappa = 0.36) to moderate (kappa = 0.48). Improvement was sustained at 3 weeks after training (kappa = 0.45). Intrareader agreement between time points 2 and 3 (kappa: mean, 0.79; range, 0.56-0.98) was greater than between time points 1 and 2 (kappa: mean, 0.62; range, 0.45-0.84), indicating readers learned and retained. CONCLUSION. Initial interreader agreement for BPE was fair among breast radiologists but achieved sustained improvement with training, highlighting the importance of education and inclusion of standardized BPE categories in a reference atlas.
PMID: 24951217
ISSN: 0361-803x
CID: 1050772