This study aimed to examine brain metabolic patterns on [18F]Fluorodeoxyglucose ([18F]FDG) positron emission tomography (PET) in breast cancer (BC), comparing patients with tension-type headache (TTH), migraine (MiG), and those without headache. Further association with BC response to neoadjuvant chemotherapy (NAC) was explored. In this prospective study, BC patients eligible for NAC performed total-body [18F]FDG PET/CT with a dedicated brain scan. A voxel-wise analysis (two-samplet-test) and a multiple regression model were used to compare brain metabolic patterns among TTH, MiG, and no-headache patients and to correlate them with clinical covariates. A single-subject analysis compared each patient’s brain uptake before and after NAC with a healthy control group. Primary headache was diagnosed in 39/46 of BC patients (39% TTH and 46% MiG). TTH patients exhibited hypometabolism in specific brain regions before NAC. TTH patients with a pathological complete response (pCR) to NAC showed hypermetabolic brain regions in the anterior medial frontal cortex. The correlation between tumor uptake and brain metabolism varied before and after NAC, suggesting an inverse relationship. Additionally, the single-subject analysis revealed that hypometabolic brain regions were not present after NAC. Primary headache, especially MiG, was associated with a better response to NAC. These findings suggest complex interactions between BC, headache, and hormonal status, warranting further investigation in larger prospective cohorts.
本研究旨在探讨乳腺癌（BC）患者中，[¹⁸F]氟代脱氧葡萄糖（[¹⁸F]FDG）正电子发射断层扫描（PET）显示的脑代谢模式，比较紧张型头痛（TTH）、偏头痛（MiG）及无头痛患者的差异，并进一步分析其与新辅助化疗（NAC）疗效的关联。在这项前瞻性研究中，符合NAC条件的BC患者接受了全身[¹⁸F]FDG PET/CT检查及专项脑部扫描。研究采用体素水平分析（双样本t检验）和多元回归模型，比较TTH、MiG及无头痛患者的脑代谢模式，并将其与临床协变量进行关联分析。通过个体水平分析，将每位患者NAC前后的脑部摄取情况与健康对照组进行比较。46例BC患者中39例（85%）被诊断为原发性头痛（39%为TTH，46%为MiG）。TTH患者在NAC前特定脑区呈现代谢减低。对NAC达到病理完全缓解（pCR）的TTH患者，其前内侧额叶皮层出现代谢增高区域。肿瘤摄取与脑代谢的相关性在NAC前后发生变化，提示两者存在反向关系。此外，个体分析显示NAC后未再出现代谢减低脑区。原发性头痛（尤其是MiG）与更好的NAC疗效相关。这些发现提示BC、头痛与激素状态之间存在复杂的相互作用，需要在更大规模的前瞻性队列中进一步研究。
Imaging Correlates between Headache and Breast Cancer: An [18F]FDG PET Study
肿瘤(癌症)患者之家