radiologyРадиология — практикаRadiology - Practice2713-0118Центральный научно-исследовательский институт лучевой диагностикиradiology-38Research ArticleПРОДОЛЖЕННОЕ МЕДИЦИНСКОЕ ОБРАЗОВАНИЕCONTINUING MEDICAL EDUCATIONВозможности применения магнитно-резонансной томографии и позитронно-эмиссионной томографии с 18F-фтордезоксиглюкозой для диагностики рака молочной железы (обзор литературы и собственные клинические наблюдения)Magnetic Resonance Imaging and Positron-Emission Tomography with 18F-Fluorodeoxyglucose Application for Breast Cancer Diagnosis (Literature Review with Case Reports)ГележеП. Б.GelezheP. B.Gelezhe.pavel@gmail.comМорозовС. П.MorozovS. P.npcmr@zdrav.mos.ruГБУЗ «Научно-практический центр медицинской радиологии Департамента здравоохранения города Москвы»РоссияResearch and Practical Center of Medical Radiology of Moscow Healthcare DepartmentRussian Federation201828122018062234Copyright © Гележе П.Б., Морозов С.П., 20182018Гележе П.Б., Морозов С.П.Gelezhe P.B., Morozov S.P.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.radp.ru/jour/article/view/38

Рак молочной железы является социально значимой медицинской проблемой во всем мире. Назначение оптимального плана лечения требует точного стадирования. Магнитно-резонансная томография (МРТ) и позитронно-эмиссионная томография (ПЭТ) достигли значительного прогресса в последние десятилетия, являясь клинически значимыми для различных стадий онкологического процесса. МРТ молочных желез обеспечивает высокую диагностическую точность для оценки местного распространения опухолевого процесса, МРТ всего тела с протоколом ДВИ позволяет выявить отдаленные метастазы. С другой стороны, ПЭТ с 18F-ФДГ, совмещенная с компьютерной томографией (КТ), также обладает высокими диагностическими качествами в обнаружении отдаленных метастазов. ПЭТ/МРТ является быстро развивающейся технологией, применение которой оправдано при необходимости одновременного получения данных о локальном статусе опухоли и ее метаболической активности. Тем не менее в настоящее время требуется больше клинических данных для демонстрации преимущества одновременного сбора данных. Продолжается оптимизация протоколов ПЭТ/МРТ, которая позволит повысить диагностическую точность при раке молочной железы. Данный обзор посвящен текущему состоянию вопроса применения МРТ и ПЭТ с 18F-ФДГ в диагностике рака молочной железы, путям развития методов и потенциальным областям применения в будущем.

Breast cancer is a socially significant medical problem all over the world. Optimal treatment plan requires precise staging. Magnetic resonance imaging (MRI) and positron emission tomography (PET) have made significant progress in recent decades, being clinically significant for various stages of the oncological process. MRI of the breast provides high diagnostic accuracy for local tumor evaluation. Whole-body DWI allows to identify distant metastases. On the other hand, PET with 18F-FDG, combined with computed tomography (CT), also has high diagnostic properties in the detection of distant metastases. PET/MRI is a rapidly developing technology, the use of which is justified when it is necessary to simultaneously obtain data on the local status of the tumor and its metabolic activity. However, more clinical data is now required to demonstrate the benefits of simultaneous data collection. The optimization of the PET/MRI protocols in breast cancer continues, which will increase the diagnostic accuracy. This review focuses on the current state of art in the field of using MRI and 18F-FDG PET in the diagnosis of breast cancer, ways to develop the method and potential applications in the future.

рак молочной железымагнитно-резонансная томография молочных железпозитронно-эмиссионная томографиясовмещенная с компьютерной томографиейпозитронно-эмиссионная томографиясовмещенная с магнитно-резонансной томографией18F-фтордезоксиглюкозаBreast CancerBreast Magnetic Resonance ImagingPositron-Emission TomographyCombined with Computer Tomography18F-fluorodeoxyglucosePositron-Emission TomographyCombined with Magnetic Resonance ImagingReferencesAppenzeller P., Mader C., Huellner M. et al. PET/CT versus body coil PET/MRI: How low can you go? // Insights Imaging. 2013. V. 4. № 4. P. 481-490.Appenzeller P., Mader C., Huellner M. et al. PET/CT versus body coil PET/MRI: How low can you go? // Insights Imaging. 2013. V. 4. № 4. P. 481-490.Baba S., Isoda T., Maruoka Y. et al. Diagnostic and prognostic value of pretreatment SUV in 18F-FDG/PET in breast cancer: comparison with apparent diffusion coefficient from diffusion-weighted MR imaging // J. Nucl. Med. 2014. V. 55. № 5. P. 736-742.Baba S., Isoda T., Maruoka Y. et al. Diagnostic and prognostic value of pretreatment SUV in 18F-FDG/PET in breast cancer: comparison with apparent diffusion coefficient from diffusion-weighted MR imaging // J. Nucl. Med. 2014. V. 55. № 5. P. 736-742.Bellevre D., Blanc Fournier C., Switsers O. et al. Staging the axilla in breast cancer patients with 18F-FDG/PET: How small are the metastases that we can detect with new generation clinical PET systems? // Eur. J. Nucl. Med. Mol. Imag. 2014. V. 41. № 6. P. 1103-1112.Bellevre D., Blanc Fournier C., Switsers O. et al. Staging the axilla in breast cancer patients with 18F-FDG/PET: How small are the metastases that we can detect with new generation clinical PET systems? // Eur. J. Nucl. Med. Mol. Imag. 2014. V. 41. № 6. P. 1103-1112.Chandarana H., Heacock L., Rakheja R. et al. Pulmonary nodules in patients with primary malignancy: Comparison of hybrid PET/MR and PET/CT imaging // Radiol. 2013. V. 268. № 3. P. 874-881.Chandarana H., Heacock L., Rakheja R. et al. Pulmonary nodules in patients with primary malignancy: Comparison of hybrid PET/MR and PET/CT imaging // Radiol. 2013. V. 268. № 3. P. 874-881.Dregely I., Lanz T., Metz S. et al. A 16-channel MR coil for simultaneous PET/MR imaging in breast cancer // Eur. Radiol. 2015. № 25. P. 1154-1161.Dregely I., Lanz T., Metz S. et al. A 16-channel MR coil for simultaneous PET/MR imaging in breast cancer // Eur. Radiol. 2015. № 25. P. 1154-1161.Duch J., Fuster D., Munoz M. et al. PET/CT with [18F]-fluorodeoxyglucose in the assessment of metabolic response to neoadjuvant chemotherapy in locally advanced breast cancer // Q. J. Nucl. Med. Mol. Imag. 2012. V. 56. № 3. P. 291-298.Duch J., Fuster D., Munoz M. et al. PET/CT with [18F]-fluorodeoxyglucose in the assessment of metabolic response to neoadjuvant chemotherapy in locally advanced breast cancer // Q. J. Nucl. Med. Mol. Imag. 2012. V. 56. № 3. P. 291-298.Garami Z., Hascsi Z., Varga J. et al. The value of 18F-FDG PET/CT in early-stage breast cancer compared to traditional diagnostic modalities with an emphasis on changes in disease stage designation and treatment plan // Eur. J. Surg. Oncol. 2012. V. 38. № 1. P. 31-37.Garami Z., Hascsi Z., Varga J. et al. The value of 18F-FDG PET/CT in early-stage breast cancer compared to traditional diagnostic modalities with an emphasis on changes in disease stage designation and treatment plan // Eur. J. Surg. Oncol. 2012. V. 38. № 1. P. 31-37.Gradishar W., Anderson B., Blair S. et al. Breast cancer version 3.2014 // J. Natl. Compr. Canc. Netw. 2014. V. 12. № 4. P. 542-590.Gradishar W., Anderson B., Blair S. et al. Breast cancer version 3.2014 // J. Natl. Compr. Canc. Netw. 2014. V. 12. № 4. P. 542-590.Groheux D., Espie M., Giacchetti S. et al. Performance of FDG PET/CT in the clinical management of breast cancer // Radiol. 2013. V. 266. № 2. P. 388-405.Groheux D., Espie M., Giacchetti S. et al. Performance of FDG PET/CT in the clinical management of breast cancer // Radiol. 2013. V. 266. № 2. P. 388-405.He N., Xie C., Wei W. et al. A new, preoperative, MRI-based scoring system for diagnosing malignant axillary lymph nodes in women evaluated for breast cancer // Eur. J. Radiol. 2012. V. 81. № 10. P. 2602-2612.He N., Xie C., Wei W. et al. A new, preoperative, MRI-based scoring system for diagnosing malignant axillary lymph nodes in women evaluated for breast cancer // Eur. J. Radiol. 2012. V. 81. № 10. P. 2602-2612.Huellner M., Appenzeller P., Kuhn F. et al. Whole-body nonenhanced PET/MR versus PET/CT in the staging and restaging of cancers: Preliminary observations // Radiol. 2014. V. 273. № 3. P. 859-869.Huellner M., Appenzeller P., Kuhn F. et al. Whole-body nonenhanced PET/MR versus PET/CT in the staging and restaging of cancers: Preliminary observations // Radiol. 2014. V. 273. № 3. P. 859-869.Jambor I., Kuisma A., Ramadan S. et al. Prospective evaluation of planar bone scintigraphy, SPECT, SPECT/CT, 18F-NaF PET/CT and whole body 1,5 T MRI, including DWI, for the detection of bone metastases in high risk breast and prostate cancer patients: SKELETA clinical trial // Acta Oncol. 2015. Early Online. P. 1-9.Jambor I., Kuisma A., Ramadan S. et al. Prospective evaluation of planar bone scintigraphy, SPECT, SPECT/CT, 18F-NaF PET/CT and whole body 1,5 T MRI, including DWI, for the detection of bone metastases in high risk breast and prostate cancer patients: SKELETA clinical trial // Acta Oncol. 2015. Early Online. P. 1-9.Knuttel F., Menezes G., van den Bosch M. et al. Current clinical indications for magnetic resonance imaging of the breast // J. Surg. Oncol. 2014. V. 110. № 1. P. 26-31.Knuttel F., Menezes G., van den Bosch M. et al. Current clinical indications for magnetic resonance imaging of the breast // J. Surg. Oncol. 2014. V. 110. № 1. P. 26-31.Mainiero M., Lourenco A., Mahoney M. et al. ACR appropriateness criteria breast cancer screening // J. Am. Coll. Radiol. 2013. V. 10. № 1. P. 11-14.Mainiero M., Lourenco A., Mahoney M. et al. ACR appropriateness criteria breast cancer screening // J. Am. Coll. Radiol. 2013. V. 10. № 1. P. 11-14.Marinovich M., Houssami N., Macaskill P. et al. Meta-analysis of magnetic resonance imaging in detecting residual breast cancer after neoadjuvant therapy // J. Natl. Cancer. Inst. 2013. V. 105. № 5. P. 321-333.Marinovich M., Houssami N., Macaskill P. et al. Meta-analysis of magnetic resonance imaging in detecting residual breast cancer after neoadjuvant therapy // J. Natl. Cancer. Inst. 2013. V. 105. № 5. P. 321-333.Menezes G., Knuttel F., Stehouwer B. et al. Magnetic resonance imaging in breast cancer: A literature review and future perspectives // World J. Clin. Oncol. 2014. V. 5. № 2. P. 61-70.Menezes G., Knuttel F., Stehouwer B. et al. Magnetic resonance imaging in breast cancer: A literature review and future perspectives // World J. Clin. Oncol. 2014. V. 5. № 2. P. 61-70.Moy L., Noz M., Maguire G. Jr. et al. Role of fusion of prone FDG-PET and magnetic resonance imaging of the breasts in the evaluation of breast cancer // Breast J. 2010. V. 16. № 4. P. 369-376.Moy L., Noz M., Maguire G. Jr. et al. Role of fusion of prone FDG-PET and magnetic resonance imaging of the breasts in the evaluation of breast cancer // Breast J. 2010. V. 16. № 4. P. 369-376.Pace L., Nicolai E., Luongo A. et al. Comparison of whole-body PET/CT and PET/MRI in breast cancer patients: Lesion detection and quantitation of 18F-deoxyglucose uptake in lesions and in normal organ tissues // Eur. J. Radiol. 2014. V. 83. № 2. P. 289-296.Pace L., Nicolai E., Luongo A. et al. Comparison of whole-body PET/CT and PET/MRI in breast cancer patients: Lesion detection and quantitation of 18F-deoxyglucose uptake in lesions and in normal organ tissues // Eur. J. Radiol. 2014. V. 83. № 2. P. 289-296.Reiner C., Stolzmann P., Husmann L. et al. Protocol requirements and diagnostic value of PET/MR imaging for liver metastasis detection // Eur. J. Nucl. Med. Mol. Imag. 2014. V. 41. № 4. P. 649- 658.Reiner C., Stolzmann P., Husmann L. et al. Protocol requirements and diagnostic value of PET/MR imaging for liver metastasis detection // Eur. J. Nucl. Med. Mol. Imag. 2014. V. 41. № 4. P. 649- 658.Stolzmann P., Veit-Haibach P., Chuck N. et al. Detection rate, location, and size of pulmonary nodules in trimodality PET/CT-MR: Comparison of low-dose CT and Dixon-based MR imaging // Invest. Radiol. 2013. V. 48. № 5. P. 241-246.Stolzmann P., Veit-Haibach P., Chuck N. et al. Detection rate, location, and size of pulmonary nodules in trimodality PET/CT-MR: Comparison of low-dose CT and Dixon-based MR imaging // Invest. Radiol. 2013. V. 48. № 5. P. 241-246.Taneja S., Jena A., Goel R. et al. Simultaneous whole-body 18F-FDG PET-MRI in primary staging of breast cancer: A pilot study // Eur. J. Radiol. 2014. V. 83. P. 2231-2239.Taneja S., Jena A., Goel R. et al. Simultaneous whole-body 18F-FDG PET-MRI in primary staging of breast cancer: A pilot study // Eur. J. Radiol. 2014. V. 83. P. 2231-2239.

The authors declare that there are no conflicts of interest present.