TY - JOUR
T1 - Comparison of contrast-enhanced CT, dual-layer detector spectral CT, and whole-body MRI in suspected metastatic breast cancer
T2 - a prospective diagnostic accuracy study
AU - Buus, Thomas Winther
AU - Rasmussen, Finn
AU - Nellemann, Hanne Marie
AU - Løgager, Vibeke
AU - Jensen, Anders Bonde
AU - Hauerslev, Katrine Rye
AU - Christiansen, Peer
AU - Pedersen, Erik Morre
N1 - Publisher Copyright:
© 2021, European Society of Radiology.
PY - 2021/12
Y1 - 2021/12
N2 - OBJECTIVES: To compare diagnostic accuracy of contrast-enhanced CT, dual-layer detector spectral CT (DL-CT), and whole-body MRI (WB-MRI) for diagnosing metastatic breast cancer.METHODS: One hundred eighty-two biopsy-verified breast cancer patients suspected of metastatic disease prospectively underwent contrast-enhanced DL-CT and WB-MRI. Two radiologists read the CT examinations with and without spectral data in consensus with 3-month washout between readings. Two other radiologists read the WB-MRI examinations in consensus. Lymph nodes, visceral lesions, and bone lesions were assessed. Readers were blinded to other test results. Reference standard was histopathology, previous or follow-up imaging, and clinical follow-up.RESULTS: Per-lesion AUC was 0.80, 0.84, and 0.82 (CT, DL-CT, and WB-MRI, respectively). DL-CT showed significantly higher AUC than CT (p = 0.001) and WB-MRI (p = 0.02). Sensitivity and specificity of CT, DL-CT, and WB-MRI were 0.66 and 0.94, 0.75 and 0.95, and 0.65 and 0.98, respectively. DL-CT significantly improved sensitivity compared to CT (p < 0.0001) and WB-MRI (p = 0.002). Per-patient AUC was 0.85, 0.90, and 0.92 (CT, DL-CT, and WB-MRI, respectively). DL-CT and WB-MRI had significantly higher AUC than CT (p = 0.04 and p = 0.03). DL-CT significantly increased sensitivity compared to CT (0.89 vs. 0.79, p = 0.04). WB-MRI had significantly higher specificity than CT (0.84 vs. 0.96, p = 0.001) and DL-CT (0.87 vs. 0.96, p = 0.02).CONCLUSIONS: DL-CT showed significantly higher per-lesion diagnostic performance and sensitivity than CT and WB-MRI. On a per-patient basis, DL-CT and WB-MRI had equal diagnostic performance superior to CT.KEY POINTS: • Spectral CT has higher diagnostic performance for diagnosing breast cancer metastases compared to conventional CT and whole-body MRI on a per-lesion basis. • Spectral CT and whole-body MRI are superior to conventional CT for diagnosing patients with metastatic breast cancer. • Whole-body MRI is superior to conventional CT and spectral CT for diagnosing bone metastases.
AB - OBJECTIVES: To compare diagnostic accuracy of contrast-enhanced CT, dual-layer detector spectral CT (DL-CT), and whole-body MRI (WB-MRI) for diagnosing metastatic breast cancer.METHODS: One hundred eighty-two biopsy-verified breast cancer patients suspected of metastatic disease prospectively underwent contrast-enhanced DL-CT and WB-MRI. Two radiologists read the CT examinations with and without spectral data in consensus with 3-month washout between readings. Two other radiologists read the WB-MRI examinations in consensus. Lymph nodes, visceral lesions, and bone lesions were assessed. Readers were blinded to other test results. Reference standard was histopathology, previous or follow-up imaging, and clinical follow-up.RESULTS: Per-lesion AUC was 0.80, 0.84, and 0.82 (CT, DL-CT, and WB-MRI, respectively). DL-CT showed significantly higher AUC than CT (p = 0.001) and WB-MRI (p = 0.02). Sensitivity and specificity of CT, DL-CT, and WB-MRI were 0.66 and 0.94, 0.75 and 0.95, and 0.65 and 0.98, respectively. DL-CT significantly improved sensitivity compared to CT (p < 0.0001) and WB-MRI (p = 0.002). Per-patient AUC was 0.85, 0.90, and 0.92 (CT, DL-CT, and WB-MRI, respectively). DL-CT and WB-MRI had significantly higher AUC than CT (p = 0.04 and p = 0.03). DL-CT significantly increased sensitivity compared to CT (0.89 vs. 0.79, p = 0.04). WB-MRI had significantly higher specificity than CT (0.84 vs. 0.96, p = 0.001) and DL-CT (0.87 vs. 0.96, p = 0.02).CONCLUSIONS: DL-CT showed significantly higher per-lesion diagnostic performance and sensitivity than CT and WB-MRI. On a per-patient basis, DL-CT and WB-MRI had equal diagnostic performance superior to CT.KEY POINTS: • Spectral CT has higher diagnostic performance for diagnosing breast cancer metastases compared to conventional CT and whole-body MRI on a per-lesion basis. • Spectral CT and whole-body MRI are superior to conventional CT for diagnosing patients with metastatic breast cancer. • Whole-body MRI is superior to conventional CT and spectral CT for diagnosing bone metastases.
KW - Breast neoplasms
KW - Diffusion magnetic resonance imaging
KW - Neoplasm staging
KW - Tomography, X-ray computed
KW - Whole-body imaging
UR - http://www.scopus.com/inward/record.url?scp=85106253372&partnerID=8YFLogxK
U2 - 10.1007/s00330-021-08041-2
DO - 10.1007/s00330-021-08041-2
M3 - Journal article
C2 - 34008104
AN - SCOPUS:85106253372
VL - 31
SP - 8838
EP - 8849
JO - European Radiology
JF - European Radiology
SN - 0938-7994
IS - 12
ER -