radiologyРадиология — практикаRadiology - Practice2713-0118Центральный научно-исследовательский институт лучевой диагностикиradiology-74Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL RESEARCHСравнение диагностической ценности диффузионно-взвешенной магнитно-резонансной томографии, позитронно-эмиссионной томографии с 18F-ФДГ и компьютерной томографии всего тела при метастатическом раке молочной железыComparison of the Diagnostic Value of Whole-body MRI with Diffusion-weighted Images, 18F-FDG Positron Emission Tomography Combined with Computer Tomography and Whole Body Computer Tomography in Metastatic Breast Cancerhttps://orcid.org/0000-0003-1072-2202ГележеП. Б.GelezheP. B.gelezhe.pavel@gmail.comhttps://orcid.org/0000-0001-6545-6170МорозовС. П.MorozovS. P.npcmr@zdrav.mos.ruГБУЗ «Научно-практический клинический центр диагностики и телемедицинских технологий Департамента здравоохранения города Москвы»РоссияResearch and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Department of Healthcare of MoscowRussian Federation20192812201906820Copyright © Гележе П.Б., Морозов С.П., 20192019Гележе 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/74

Рак молочной железы занимает лидирующие позиции в онкологической заболеваемости и смертности. Точное стадирование заболевания повышает шансы на высокую безрецидивную выживаемость. Позитронно-эмиссионная томография с 18F-фтордезоксиглюкозой (18F-ФДГ ПЭТ/КТ) считается «золотым стандартом» диагностики метастатического поражения при ряде онкологических заболеваний, в том числе и при раке молочной железы. Диффузионно-взвешенные изображения (ДВИ) являются специфической импульсной последовательностью, позволяющей дифференцировать злокачественный процесс за счет повышения сигнала. Место ДВИ всего тела в диагностическом алгоритме при раке молочной железы не определено. Целью работы являлась оценка возможностей ДВИ всего тела в сравнении с 18F-ФДГ ПЭТ/КТ и компьютерной томографией (КТ) всего тела в отношении местного и отдаленного распространения рака молочной железы. Было произведено сравнение диагностических показателей, включающих чувствительность, специфичность, положительное и отрицательное прогностическое значение, точность, для 18F-ФДГ ПЭТ/КТ, МРТ с ДВИ и КТ всего тела. МРТ всего тела с ДВИ продемонстрировала преимущество в диагностике метастатического поражения печени и скелета. Использование исключительно МРТ всего тела с ДВИ для стадирования и рестадирования рака молочной железы не является оправданным по причине низкой специфичности выявления метастазов регионарных и отдаленных лимфатических узлов. МРТ всего тела с ДВИ может быть рекомендована в качестве уточняющего метода после выполнения 18F-ФДГ ПЭТ/КТ или КТ всего тела.

Breast cancer occupies a leading position in cancer morbidity and mortality. Accurate staging of the disease increases the chances of a high relapse-free survival. 18F-FDG PET/CT is considered the «gold standard» for diagnosing metastatic lesions in a number of cancers, including breast cancer. Diffusion-weighted imaging (DWI) is a specific pulse sequence that allows differentiation of the malignant process. The place of whole body DWI in the diagnostic algorithm for breast cancer is not defined. The aim of the work was to evaluate the possibilities of whole body DWI in comparison with 18F-FDG PET/CT and whole body CT for the local and distant spread of breast cancer. A comparison was made of diagnostic indicators, including sensitivity, specificity, positive and negative predictive value, accuracy. A whole body MRI with DWI demonstrated an advantage in diagnosing metastatic lesions of the liver and skeleton. The use of exclusively whole body MRI with DWI for staging and restaging of breast cancer is not justified due to the low specificity of detection of metastases of regional and distant lymph nodes. A whole body MRI with DWI may be recommended as a clarifying method after performing 18F-FDG PET/CT or whole body CT.

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