Magnetic resonance imaging of bone marrow versus bone marrow biopsy in malignant lymphoma

Bone marrow involvement is a frequent finding in malignant lymphoma. Bone marrow biopsy of the posterior iliac crest is routinely performed for staging. Abnormal magnetic resonance imaging (MRI) signals of bone marrow was also reported to be indicative of bone marrow involvement. This study included 60 patients with malignant lymphoma. Unilateral bone marrow biopsy of the posterior iliac crest was performed. MRI of lumbar spine was studied within 24 hours of bone marrow biopsy. 22 healthy controls were used for the detection of MRI objectivity during visual evaluation. In 83% of patients (50/60), biopsy and MRI results agreed completely. In two patients, histologic sections failed to show any evidence of bone marrow involvement despite abnormal MRI signals suggestive of involvement. In three patients, MRI was completely normal despite biopsy proven bone marrow infiltration. False negativity (3/60) and false positivity (2/60) rates were very low. Negative biopsy findings with positive or equivocal MRI results should not exclude bone marrow involvement and needs further evaluation with bilateral or guided biopsy. Thus, we conclude that MRI of bone marrow is a fairly sensitive, noninvasive modality and might be of potential value in detecting bone marrow infiltration in malignant lymphoid neoplasms which can be utilized as a useful adjunct to standard staging procedures.     

Effect on prognosis of bone marrow infiltration detected by magnetic resonance imaging in small cell lung cancer

The staging system of limited disease (LD) and extensive disease (ED) is widely used and has been shown to provide useful prognostic information in cases of small cell lung cancer (SCLC). However, accurate examinations are necessary for correct staging. In this report, we evaluated the clinical usefulness of magnetic resonance imaging (MRI) of bone marrow in SCLC. 37 patients with LD by standard staging and 41 with ED were examined with bone marrow MRI. Results of bone marrow MRI did not influence the choice of treatment in patients with LD. For subsequent analysis, patients with LD were divided into two groups: patients in whom bone marrow infiltration was detected with MRI (MRI-positive LD group) and those in whom it was not (MRI-negative LD group). Focal or diffuse metastases to bone marrow were detected with MRI in 46% (36/78) of all patients and 35% (13/37) of LD patients. The response rates to treatment in patients with MRI-positive LD were lower than those in patients with MRI-negative LD (P=0.006). The survival of patients with MRI-positive LD was worse than that of MRI-negative LD (generalised Wilcoxon test: P=0.0157), and closer to that of ED. Multivariate analyses using a Cox model that included the result of bone marrow MRI, performance status, chemotherapy regimen, radiotherapy and serum lactose dehydrogenase (LDH) level showed that the result of bone marrow MRI remained a prognostic factor in SCLC patients with limited disease. Bone marrow examination with MRI is useful for better staging of SCLC. According to our analysis of response rates and survival, MRI-positive LD should be considered a type of ED.     

Extent of disease burden determined with magnetic resonance imaging of the bone marrow is predictive of survival outcome in patients with multiple myeloma

BACKGROUND:

Multiple myeloma (MM) remains an incurable cancer. Treatment often is initiated at the time patients experience a progressive increase in tumor burden. The authors of this report investigated magnetic resonance imaging of the bone marrow (BM‐MRI) as a novel approach to quantify disease burden and validated a staging system by correlating BM‐MRI with common clinical and laboratory parameters.

METHODS:

The extent of bone marrow involvement was evaluated by BM‐MRI. Clinical and laboratory parameters were assessed in patients with active MM, and correlations between variables were assessed statistically. Bone marrow involvement by BM‐MRI was defined as stage A (0%), stage B (<10%), stage C (10%‐50%), and stage D (>50%).

RESULTS:

In total, 170 consecutive patients were evaluated (77 women and 93 men), including 144 patients who had active MM. The median age was 61 years (age range, 35‐83 years). Advance stage disease (stage >I) based on Durie‐Salmon (DS) staging or International Staging System (ISS) criteria was observed in 122 patients (84%) and 77 patients (53%), respectively. Lytic bone disease was noted in 120 patients (83%). There was a significant association between BM‐MRI involvement and DS stage (P = .0006), ISS stage (P = .0001), the presence of lytic bone disease (P < .0001) and mean β‐2 microglobulin levels (P < .0001). Among the patients with previously untreated MM, there was a significant association between BM‐MRI stage and overall survival (OS) (univariate P = .013; multivariate P = .045). Plasmacytosis on bone marrow biopsy at diagnosis was not predictive of OS (P = .91).

CONCLUSIONS:

BM‐MRI is a novel approach for quantifying disease burden in patients with MM. The current investigation in a large cohort of nontransplantion MM patients demonstrated that the extent of bone marrow involvement determined by BM‐MRI correlates accurately with other conventional parameters of disease burden and can independently predict survival in patients with MM at the time of initial diagnosis. Cancer 2010. © 2010 American Cancer Society.     

全身弥散加权成像在恶性肿瘤骨转移诊断中的应用

 目的　探讨全身弥散加权成像（WB-DWI）在恶性肿瘤骨转移诊断中的应用价值。方法　对118例恶性肿瘤患者行WB-DWI检查,并于扫描后1周内对可疑骨转移部位行常规磁共振成像（MRI）／CT检查。对资料进行统计学分析,比较单独应用WB-DWI、MRI／CT及二者联合应用（WB-DWI＋MRI／CT）对恶性肿瘤骨转移的诊断价值。分别测定骨转移组及良性骨病变组的表观弥散系数（ADC）值,探讨其在良恶性病变诊断中的价值。结果　受试工作者曲线（ROC）分析结果显示,WB-DWI＋MRI／CT诊断骨转移瘤的ROC曲线下面积、特异度、正确诊断指数及阳性预测值最高（0.999、100.0 %、97.4 %、100.0 %）,诊断效果最好;骨转移组平均ADC值[（0.71±0.15）×10-3 mm2／s]明显低于良性骨病变组[（1.50±0.23）×10-3 mm2／s],差异具有统计学意义（F＝261.587,P＜0.001）。结论　WB-DWI是常规MRI／CT的有益补充,结合ADC值测定,在恶性肿瘤骨转移诊断与鉴别诊断方面具有一定价值。     

MRI对乳腺含粘液良、恶性肿瘤的鉴别诊断价值

目的:探讨磁共振成像对乳腺含黏液良、恶性肿瘤鉴别诊断价值。方法:回顾性分析2018年12月至2021年02月经我院病理证实的乳腺含黏液肿瘤25例共26个病灶的术前MRI图像及临床病理资料,依据病理分为良性组及恶性组,比较良、恶性组的临床及MRI表现差异性。结果:25例患者共26个病灶纳入研究,良性肿瘤10例共10个病灶,恶性肿瘤15例共16个病灶。恶性组发病年龄高于良性组（P＜0.01）;病变的边缘多不规则,与良性组比较差异具有统计学意义（P＜0.01）;而两组间肿块大小、形态、动态增强曲线类型及ADC值无统计学差异（P＞0.05）。恶性组出现由周围向中央填充式渐进性强化,而良性组未出现,差异具有统计学意义（P＜0.01）。恶性组T2WI上的低信号分隔纤细并在增强后图像显示不清（31.25%,5/16）,良性组T2WI上的低信号分隔增强后显示清晰（30.00%,3/10）,差异具有统计学意义（P＜0.05）。结论:乳腺含黏液的恶性肿瘤患者发病年龄较良性肿瘤大,边缘多不规则,以不均匀强化为主,出现由周围向中央填充渐进性强化方式,T2WI序列的低信号分隔于增强后显示不清为较特征性表现。     

Bone marrow microcirculation analysis in multiple myeloma by contrast-enhanced dynamic magnetic resonance imaging

The aim of our study was to investigate the quantitative microcirculation parameters amplitude A (hypothetical intravascular volume) and exchange rate constant k(21) (hypothetical vascular permeability) by contrast-enhanced dynamic magnetic resonance imaging (dMRI) as markers of angiogenesis in multiple myeloma (MM). Therefore lumbar spine and spina iliaca superior posterior of 16 normal controls and 41 patients with active MM were assessed using a dMRI protocol with a pump controlled bolus infusion of Gadolinium-DTPA. Pharmacokinetic parameters, amplitude A and exchange rate constant k(21) were calculated according to a 2-compartment model. Color-coded parameter images were generated from pharmacokinetic data analysis and superimposed onto the conventional MR images. Amplitude A and k(21) parameters were significantly increased in patients with MM compared with controls (p = 0.001; median A(ctr), 0.2 [range, 0.09-0.4]; median A(MM), 0.93 [range, 0.2-2.2]; median k(21ctr), 0.09 min(-1) [range, 0.03-0.9]; median k(21MM), 4.58 [range, 0.22-23.8]). Within the group of MM patients the pattern of color-coded parameter images were found to be either of "diffuse" (n = 13, 31%) or "focal" (n = 28, 69%) type of distribution of microcirculation. Comparison of amplitude A in patients with "focal" vs. "diffuse" pattern of the pharmacokinetic maps revealed a significant increase in the median of amplitude A in the "focal" group. Amplitude A values allowed a classification of patients according to severe osteolytic bone involvement (p = 0.023) with the best cutoff value of 0.7 for amplitude A. Downmodulation of amplitude A was observed in a MM patient treated with standard VAD chemotherapy. Our data demonstrate that dMRI is a novel imaging technique for the detection and monitoring of MM bone lesions. It provides independent evidence for angiogenesis in MM.     

Two Different Methods of Region-of-Interest Placement for Differentiation of Benign and Malignant Breast Lesions by Apparent Diffusion Coefficient Value

Purpose: We aimed to investigate the influence of different methods of region-of-interest (ROI) placement onapparent diffusion coefficient (ADC) values in breast tumours and their accuracy in differentiating benign versusmalignant tumors in mass and nonmass lesions. Methods and Materials: In this prospective study, 79 patients with98 breast lesions, from 2015 until 2017, were investigated by 1.5-T breast MRI. Histopathology evaluation were donefor all malignant lesions and most of the benign ones. ADC values were measured in normal breast tissue and by twoways of ROI placement in the breast lesions (mass and non-mass): 1- ROI covering the whole lesion, 2- ROI in thehighest part (most restricted area) of the lesion in DWI images. The accuracy of these two approaches were compared.Results: The age range was 17-68 years with mean age 43.3 ± 9.9 years. 49% of the lesions were benign and 51% oftumors were malignant. Our results revealed that the measured ADC values in normal breast tissue were higher thanbreast lesions (P≤0.01). Appropriate cut off determination in non-mass was not valid by both methods, but in mass inthe first way was 1.45×10 -³mm²/s and in the most restricted part was 1.16×10-³ mm²/s. ADC values differed significantlybetween the two ways of ROI placement in mass lesions (P<.001). Most restricted part ADC showed the best diagnosticperformance in mass lesions with area under curve 0.88 versus 0.82. Conclusion: ROI placement has significant impacton the meseaured ADC values of breast lesions and ROIs in most restricted parts were more accurate than whole-lesionROIs. Cut-off values differed significantly based on the methods of measurement.     

Magnetic Resonance Imaging in Patients with Bone Marrow Disorders

Magnetic resonance imaging (MRI) provides a non-invasive means to evaluate a large fraction of marrow in less than one hour. Marrow disorders produce non-specific changes in marrow signal intensities which primarily reflect changes in proportions of fat and cellular elements. The pattern of these signal changes narrows the differential diagnosis, and the combination of these features with the clinical context allows interpretations which are clinically useful in many ways. These include: I) the diagnosis of avascular necrosis (and its distinction from other causes of joint pain), 2) detection of osteomyelitis, 3) differential diagnosis of hypo-plastic disorders, 4) staging of lymphomas and myeloma, 5) selection of patients for autolo-gous bone marrow transplant, 6) objective measures of marrow response to therapy, 7) detection of leukemic transformation, and 8) improved detection of marrow disease (primary or secondary) in patients with otherwise unexplained bone pain.     

骨髓异常的磁共振成像及其临床应用研究

目的：探讨磁共振成像（magnetic reconance imaging,MRI) 在评价骨髓病变中的作用。方法：定性定量分析78例正常人群、44例骨髓病变患者（15例白血病、13例非霍奇金氏淋巴瘤、16例增生性贫血）的脊柱MRI汲骨髓穿刺、外周血检查资料，并将MRI定量资料与临床实验室检查资料进行相关性分析。全部病例均经骨髓穿刺或活检证实。结果：①白血病及淋巴瘤T1加权像（T1-weigted imaging,T1WI)低信号多于增生性贫血及正常人群（P＜0．05），T2加权像（T2-weigted imaging,T2WI)高信号多于增生性贫血及正常人群（P＜0．05）；正常人群、白血病、淋巴瘤强化无差异（P＞0．05）；白血病弥漫性浸润多于淋巴瘤（P＝0．000）。②T1WI白血病及淋巴瘤骨髓肌肉信号强度比（signal intensity ratio on T1WI,SIR1)低于增生性贫血及正常人群（P＜0．05）。③增生性贫血SIR1与粒细胞和红细胞之比呈正相关（P＝0．006），与骨髓中红细胞比例负相关（P＝0．008）；白血病SIR1与骨髓幼稚细胞比例负相关（P＝0．048）。结论：MRI可显示脊柱红骨髓的分布；MRI定性分析可区分良、恶性骨髓病变；定量分析SIR1诊断价值有限；SIR1可评价增生性贫血的贫血程度，粗略预测白血病的瘤负荷。     

Bone Marrow Involvement in Lymphoma: The Importance of Marrow Magnetic Resonance Imaging

Detection of bone marrow involvement is important for staging and treatment decisions in patients with lymphoma. Although routine bone marrow evaluation is based on aspirates and bone marrow biopsies, new diagnostic tools are required to improve diagnostic accuracy. Visual and quantitative assessment of the bone marrow by magnetic resonance (MR) imaging is useful for the detection of occult lymphomatous marrow involvement. MRI is also suitable for the evaluation of disease extent in the bone marrow. Furthermore, abnormal images on marrow MRI may be associated with a significantly poorer survival in patients with lymphoma, regardless of histologic findings in the marrow. Evaluation of the bone marrow by MRI is essential to assess disease status in patients with lymphoma.     

乳腺癌的影像学表现与诊断

目的：探讨影像学对乳腺癌的诊断价值。方法：搜集经钼靶X线，CT，超声，MRI等影像学检查、手术或穿刺病理证实的乳腺癌56例进行回顾性分析。结果：56例乳腺癌中，单发病灶40例，多发病灶16例。X线和CT多表现为不规则肿块（34／46例），伴有毛刺32例，与导管形态一致的密集钙化30例。CT对肿块或结节的边缘毛刺，尖角状或触须状突起及邻近皮肤局限增厚或凹陷，脂肪间隙与胸肌受侵，腋窝淋巴结肿大等恶性征象的显示比钼靶更清晰，彩超能初步筛查有无乳腺包块存在，并能根据乳腺肿块的形态特点、内部回声及血流情况判断乳腺肿快的性质，磁共振不但可以显示肿瘤的部位大小和边缘及腋窝淋巴结肿大，皮肤和胸壁侵犯。还可显示肿瘤内部的坏死（52／56例）和多中心病灶（16／56例）。结论：MRI动态增强扫描对乳腺癌的判定有重要意义；多种影像结合及影像与临床结合对乳腺癌的诊断有较大帮助。     

Whole‐body magnetic resonance imaging in the detection of skeletal metastases in patients with prostate cancer

Whole‐body MRI is an effective method for evaluating the entire skeletal system in patients with metastatic disease. This study aimed to compare whole‐body MRI and radionuclide bone scintigraph in the detection of skeletal metastases in patients with prostate cancer. Patients with prostate cancer at high risk of skeletal metastasis with (i) prostate‐specific antigen of ≥50 ng/mL; (ii) composite Gleason score of ≥8 with prostate‐specific antigen of >20 ng/mL; or (iii) node‐positive disease were enrolled in this prospective study before systemic treatment was initiated. Whole‐body MR images and bone scans of 39 patients were analysed. Seven patients had bone metastases on bone scans, while seven patients had skeletal metastases by whole‐body MRI, with concordant findings only in four patients. Compared with the ‘gold standard’, derived from clinical and radiological follow‐up, the sensitivity for both bone scans and MRI was 70%, and the specificity for both was 100%. Magnetic resonance imaging detected 26 individual lesions compared with 18 lesions on bone scans. Only eight lesions were positive on both. Bone scans detected more rib metastases, while MRI identified more metastatic lesions in the spine. Whole‐body MRI and radionuclide bone scintigraphy have similar specificity and sensitivity and may be used as complementary investigations to detect skeletal metastases from prostate cancer.     

Estimation of error in maximal intensity projection-based internal target volume of lung tumors: a simulation and comparison study using dynamic magnetic resonance imaging

PURPOSE: To evaluate the error in four-dimensional computed tomography (4D-CT) maximal intensity projection (MIP)-based lung tumor internal target volume determination using a simulation method based on dynamic magnetic resonance imaging (dMRI). METHODS AND MATERIALS: Eight healthy volunteers and six lung tumor patients underwent a 5-min MRI scan in the sagittal plane to acquire dynamic images of lung motion. A MATLAB program was written to generate re-sorted dMRI using 4D-CT acquisition methods (RedCAM) by segmenting and rebinning the MRI scans. The maximal intensity projection images were generated from RedCAM and dMRI, and the errors in the MIP-based internal target area (ITA) from RedCAM (epsilon), compared with those from dMRI, were determined and correlated with the subjects' respiratory variability (nu). RESULTS: Maximal intensity projection-based ITAs from RedCAM were comparatively smaller than those from dMRI in both phantom studies (epsilon = -21.64% +/- 8.23%) and lung tumor patient studies (epsilon = -20.31% +/- 11.36%). The errors in MIP-based ITA from RedCAM correlated linearly (epsilon = -5.13nu - 6.71, r(2) = 0.76) with the subjects' respiratory variability. CONCLUSIONS: Because of the low temporal resolution and retrospective re-sorting, 4D-CT might not accurately depict the excursion of a moving tumor. Using a 4D-CT MIP image to define the internal target volume might therefore cause underdosing and an increased risk of subsequent treatment failure. Patient-specific respiratory variability might also be a useful predictor of the 4D-CT-induced error in MIP-based internal target volume determination.     

Low field strength magnetic resonance imaging of bone marrow in acute leukaemia

The accuracy of low field strength (0.08 Tesla) magnetic resonance imaging (MRI) of bone marrow for the detection of acute leukaemia in adults has been assessed by comparison with bone marrow biopsy results. Spin lattice relaxation time (T1) measurements from patients were compared with those from 90 volunteers. Eighteen patients were studied at the time of diagnosis of leukaemia. Bone marrow T1 was prolonged in all cases. One of two patients with refractory anaemia with excess of blasts in transformation (RAEBt) had prolonged bone marrow T1, the other had normal T1. T1 at the time of diagnosis for patients with acute leukaemia or RAEBt correlated with the cellularity and blast cell count in the marrow. None of the 17 patients who were studied when in long-term remission of leukaemia had prolonged marrow T1. Serial studies were undertaken in five of the newly diagnosed patients. An increase in bone marrow T1 was observed in each of four patients studied seven days after the start of treatment, at a time when they showed a decrease in leukaemic cells on peripheral blood examination. T1 measurements made 3 weeks after the commencement of chemotherapy were similar to pretreatment values and did not reflect the reduction in leukaemic infiltration observed on bone marrow needle aspirate. The implications and possible explanations for these findings are discussed.     

Magnetic resonance imaging of the wrist in early rheumatoid arthritis: A pictorial essay

This pictorial essay describes the changes seen in the wrist in early rheumatoid arthritis (RA) on MRI. Magnetic resonance imaging can demonstrate bone erosions, bone marrow signal changes, synovitis and tenosynovitis in early rheumatoid arthritis. Magnetic resonance imaging of the wrist can identify erosions in RA earlier than plain radiographs and can detect more erosions. Common sites include the capitate, lunate and scaphoid. Bone marrow signal changes occur frequently and are most common in the capitate, lunate and triquetrum. Synovial thickening and enhancement are clearly demonstrated with MRI and are most commonly seen in the radiocarpal joint (RCJ). Tenosynovitis can be seen in the wrist in more than half of patients presenting with RA. This most commonly involves the extensor carpi ulnaris tendon and is seen as sheath fluid, thickening and enhancement.     

The Role of Magnetic Resonance Imaging in the Diagnosis and Monitoring of Myelodysplastic Syndromes or Leukemia

Magnetic resonance imaging (MRI) can provide valuable information about regions of the bone marrow which are inaccessible to biopsy. MRI also is unique in characterizing normal and abnormal bone marrow because of its ability to distinguish fat from other tissues. In patients with myelodysplastic syndromes (MDS) or leukemia, marrow MRI is an important tool for accurate diagnosis and monitoring and may function as an adjunct to bone marrow aspiration and biopsy. In clinical practice, defining the anatomic distribution and extent of marrow involvement by MRI is of advantage in the management of patients with MDS or leukemia.     

淋巴瘤骨髓浸润的磁共振成像定性和定量诊断价值

 【摘要】　目的　探讨磁共振成像（MRI）对淋巴瘤患者骨髓浸润的定性及定量诊断价值。方法　回顾性分析28例确诊淋巴瘤骨髓浸润的患者,MRI定性分析脊柱骨髓浸润的影像特征,定量测量病变骨髓与脑脊液在T1加权图像上的信号强度比（SIR1）。以31例正常脊柱骨髓为对照组。结果　定性诊断：27例患者脊柱骨髓MRI见异常信号,1例假阴性,MRI诊断的敏感度为96.4 %;淋巴瘤骨髓浸润的脊柱MRI表现主要有4种类型,分别为局灶型21.4 %（6／28）,多灶型53.6 %（15／28）,斑驳型14.3 %（4／28）,弥漫型7.1 %（2／28）。定量诊断：淋巴瘤组骨髓的SIR1（1.251±0.253）明显低于对照组（2.625±0.434）,两组差异有统计学意义（t＝15.022,P＜0.001）;轻、中、重度骨髓浸润SIR1值（分别为1.390±0.172、0.982±0.790、0.908±0.122）与对照组比较,差异均有统计学意义（均P＝0.000）,骨髓浸润轻度与中度组间、轻度与重度组间SIR1值差异有统计学意义（LSD法,P＝0.012,P＝0.025）,中度与重度组间的SIR1值的差异无统计学意义（LSD法,P＝0.757）;淋巴瘤骨髓浸润的骨髓SIR1值与骨髓中浸润的瘤细胞百分比呈负相关（r＝-0.765,P＜0.001）。结论　MRI无创、直观,能够展示骨髓全貌,对淋巴瘤骨髓浸润诊断敏感度高,定量分析能一定程度区分骨髓浸润程度,并反映骨髓中瘤细胞负荷量。     

骨肿瘤影像学与病理学的相关性研究

目的 探讨骨肿瘤诊疗过程中病理学与影像学的相关性.方法 回顾性分析骨肿瘤120例患者的病理学与影像学资料,所有患者均进行了X线检查,其中49例行MRI检查,46例行CT检查.分别比较肿瘤的影像学特征与病理诊断结果的关系,判断良恶性肿瘤的影像学诊断正确率.结果 X线检查与CT检查在对相关骨肿瘤周围骨质增生、硬化、破坏、病灶边界等方面表现相似,但在脊柱、骨盆病灶、头颅、软组织阴影、细微病灶等特殊部位其显像CT更为清晰,而X线在骨膜方面表现良好,对于软组织、骨髓水肿的显像方面MRI表现更为优秀.与术后病理学诊断结果为标准:X线诊断正确率为86.67%,CT诊断正确率为93.47%;MRI诊断正确率为93.88%,3种影像学检查对骨肿瘤良恶性的诊断正确率方面比较差异无统计学意义(P>0.05).结论 X线由于方便、快捷的优势可作为骨肿瘤诊断的首选诊断,CT对于细微病灶、肿瘤的范围具有一定优势,MRI对于软组织、骨髓水肿显像优势明显,3种检查方法可作为骨肿瘤诊断的互补检查,提高诊断的准确性.     

Preoperative taxane-based chemotherapy in a standardized protocol for locally advanced breast cancer

Aims: To assess the feasibility of a standardized multidisciplinary protocol for the management of locally advanced breast cancer (LABC). We also evaluated the accuracy of magnetic resonance imaging (MRI) and positron emission tomography (PET) in predicting the extent of residual disease. Methods: Patients with LABC were offered preoperative chemotherapy of docetaxel 75 mg/m², doxorubicin 50 mg/m², cyclophosphamide 500 mg/m² (TAC), every 21 days for six cycles, until progression or intolerable toxicity. MRI and PET were performed at baseline and six cycles. Patients underwent a mastectomy or complete local excision, followed by radiotherapy. Trastuzumab and endocrine treatment were recommended where appropriate. Results: Between April 2005 and October 2006, 51 patients were included from three institutions, and 50 received TAC (90% commenced within 35 days of diagnosis), with 44 patients completing six cycles (88%). Pathological complete response was seen in 10 patients (19.6%); all had invasive ductal carcinoma. No patient with invasive lobular carcinoma achieved pathological complete response. MRI was the most accurate method of assessing the extent of residual cancer. In total, 45 (88%) patients underwent surgery within the protocol‐specified time and 12 (23%) patients had breast conservation surgery. At a median follow‐up of 41.3 months, there were three local recurrences. Ten patients (19.6%) developed distant metastases, resulting in an 80% actuarial disease‐free survival. Conclusion: This regimen of TAC is effective and well‐tolerated and is likely to result in improved outcomes since patients can receive optimal multimodality treatments.     

Dynamic-enhanced MRI predicts metastatic potential of invasive ductal breast cancer

BACKGROUND: Dynamic magnetic resonance imaging (MRI) has improved the detection of breast malignancies. The method is based on estimating the velocity of contrast enhancement taking into account increased angiogenesis in tumor. Microvessel density correlates with breast carcinoma metastasis. Thus, we hypothesized that contrast enhancement on MRI correlates with metastasis in breast cancer patients. The present study attempts to clarify the quantitative assessment of dynamic data, and examines the correlation between MRI enhancement and breast carcinoma metastasis. METHODS: The subjects consisted of 31 patients with invasive ductal breast cancer. Twenty patients were disease free for five years (group A), and eleven patients suffered from metastatic disease at distant sites concurrently or postoperatively (group B). Dynamic MRI was performed preoperatively using a 1.5T system in all cases. Using the dynamic data, the signal intensity (SI)ratio and SI index were determined and analyzed retrospectively taking into account the presence of distant metastases. RESULTS: The values of the SI ratio were 2.2+/-0.7 in group A and 2.3+/-0.4 in group B, respectively, with no significant difference seen between the groups. The SI index value was significantly higher in group B (28.5+/-32.8) than in group A (10.3+/-5.5, p<0.05). CONCLUSIONS: The current series suggests that the SI index could distinguish patients with high risk of distant metastasis from disease free patients, preoperatively. If a suitable borderline value were established, the quantitative dynamic parameter determined by MRI may be useful for predicting the prognosis of breast cancer patients.