Evaluation of neoadjuvant chemotherapeutic response of breast cancer using dynamic MRI with high temporal resolution

The aim of this study was to evaluate changes in both size and contrast enhancement of breast tumors during neoadjuvant chemotherapy, using dynamic MRI with high temporal resolution. Patients with advanced breast cancer (n=21) underwent a 1.5-T MRI scan prior to and following neoadjuvant chemotherapy with four cycles. Dynamic contrast enhancement was measured using a fast turbo-FLASH sequence and quantified using a two-compartment model with the parameters k_ep and amplitude. Image analysis was done on images overlayed with a color map of parameters. The correlation between tumor diameter measured by histopathology and MRI was 0.7 (p<0.003). A reduction of tumor size after chemotherapy of more than 25% was associated with a decrease of both analyzed contrast enhancement parameters (k_ep: p<0.002; amplitude: p<0.006), where k_ep began to drop already after the first cycle of chemotherapy (p<0.008). A clear reduction of tumor size was only noted after the third cycle (p<0.008). In patients without tumor regression there was also a trend towards an early reduction of contrast enhancement. We assume that MRI with high temporal resolution and color mapping is a novel tool to assess therapeutic effects of neoadjuvant chemotherapy in breast tumors, which deserves further prospective evaluation. Electronic Publication     

Relationship between hormonal receptors, HER-2, p53 protein, Bcl-2, and MIB-1 status and the antitumor effects of neoadjuvant anthracycline-based chemotherapy in invasive breast cancer patients

PURPOSE: The purpose of this study was to evaluate the predictive value of six different biological factors for neoadjuvant chemotherapy (NAC) in breast conservation treatment (BCT) for invasive breast cancer. MATERIALS AND METHODS: Thirty invasive breast cancer patients (31 breasts) who received NAC as BCT and needle biopsy before chemotherapy were included in this study. Breast cancer tissue was obtained with an 18G core needle with ultrasound guidance. Patients received two to five courses of CAF (cyclophosphamide 600 mg/m(2), pirarubicin 20-40 mg, 5-fluorouracil 600 mg/m(2)). Tissue sections from formalin-fixed paraffin-embedded blocks were stained for the presence of estrogen receptor (ER), progesterone receptor (PgR), HER (human epidermal growth factor receptor)-2, p53 protein, Bcl-2, and MIB-1 (Ki-67). Tumor reduction rate was assessed by MRI before and after chemotherapy. RESULTS: The tumor reduction rate did not differ according to the number of courses of chemotherapy administered. In both the univariate and multivariate analyses, HER-2-negative status was the only significant predictive factor of response (P<0.05). There was no correlation between response and hormone receptors, MIB-1, p53 protein, or Bcl-2 expression. CONCLUSION: This study suggests that breast cancer cells that overexpress HER-2 may be resistant to low-doses of anthracycline-based chemotherapy.     

Accuracy of MRI in the detection of residual breast cancer after neoadjuvant chemotherapy

OBJECTIVE: This study was undertaken to evaluate the ability of MRI to accurately show residual primary breast malignancy in women treated with neoadjuvant chemotherapy. MATERIALS AND METHODS: Twenty-one patients with locally advanced primary breast carcinoma underwent contrast-enhanced MRI before and after treatment with neoadjuvant anthracycline-based chemotherapy. For each patient, the maximum extent of the MRI abnormality was measured both before and after treatment. These measurements were subsequently compared with physical examination findings and histologic results to determine the ability of MRI to accurately reveal tumor extent after neoadjuvant chemotherapy. RESULTS: MRI after chemotherapy showed a correlation coefficient of 0.75 with histology, which was better than physical examination (r = 0.61). MRI underestimated the extent of residual tumor in two patients by more than 1 cm (including one false-negative examination), was within 1 cm in 12 of 21 patients, and overestimated tumor extent by more than 1 cm in seven of 21 patients. CONCLUSION: MRI can show residual malignancy after neoadjuvant chemotherapy better than physical examination, particularly in patients who have not had a complete clinical response to therapy.     

MRI vs. histologic measurement of breast cancer following chemotherapy: comparison with x-ray mammography and palpation

Twenty consecutive patients with breast cancer were evaluated following chemotherapy using MRI to assess the size of cancer residua and compare these data with subsequent histologic measurements of the viable tumor. This retrospective study also involved assessment of the preoperative size of the malignancy as determined by physical exam and x-ray mammogram. These values were later compared with the histology. The tumor size correlation coefficient between MRI and pathologic analysis was the highest, at 0.93. Physical exam and x-ray mammography (available for 17 patients) produced correlation coefficients of 0.72 and 0.63, respectively, compared to histologic measurement. The accuracy of MRI did not vary with the size of cancer residua. MRI is an accurate method for preoperative assessment of breast cancer residua following chemotherapy. J. Magn. Reson. Imaging 2001;13:868-875.     

Accuracy of tumor size measurement in breast cancer using MRI is influenced by histological regression induced by neoadjuvant chemotherapy

The aim of this study was to evaluate whether regressive changes after neoadjuvant chemotherapy for breast cancer affect the accuracy of preoperative MRI measurements of tumor size. Thirty-one patients with breast cancer underwent MRI before and after neoadjuvant treatment. Besides pre- and post-contrast T1-weighted MRI, dynamic MRI with high temporal resolution (turbo-FLASH) was performed. Contrast enhancement in dynamic MRI was quantified using a pharmacokinetic two-compartment model, where two parameters, amplitude and k_ep, were calculated and color coded on transversal parameter maps. Considering the conventional MR images, tumor diameters were measured on the color maps and compared with histological tumor size. Histological regression was scored on a five-point scale regarding cytopathic effects, reactive changes, and tumor cell reduction. The correlation between tumor sizes measured by MRI and histopathology was 0.83 (p<0.0007) in 12 tumors without regressive changes (score 0), and 0.48 (p<0.051) in 17 tumors with regressive changes scored 1 or 2, without any tendency for systematic over- or underestimation. In two cases without residual tumor (score 4), MRI likewise showed no signs of persistent tumor. The decrease of the contrast enhancement parameters was significantly more marked in tumors with signs of histological regression than in those without. Whenever MRI is used to judge the response of breast cancer to chemotherapy, the reader must be aware that therapy-induced changes may cause significant over- or underestimation of tumor size. We saw a high precision only when there was either no response – according to histological criteria – or when the tumor had regressed completely. Electronic Publication     

MR quantification of the washout changes in breast tumors under preoperative chemotherapy: feasibility and preliminary results

OBJECTIVE: The objective of our study was to describe and determine the feasibility of an MR washout quantification method in patients with breast cancer under preoperative chemotherapy. MATERIALS AND METHODS: Nineteen patients with breast T2 or T3 tumors were enrolled in a previous study for tumor response evaluation during chemotherapy based on dynamic contrast-enhanced MRI. We retrospectively used the dynamic acquisition data to produce parametric images representing the washout pattern. Two radiologists unaware of the final pathologic results measured the volume of pixels exhibiting washout within the tumor before chemotherapy (volume 1), after two courses of chemotherapy (volume 2), and before surgery after four courses of chemotherapy (volume 3). The interobserver variability and intraobserver variability were calculated to evaluate the reproducibility of our method with the Pearson's correlation coefficient and the concordance correlation coefficient. We correlated the washout changes by means of a Student's t test and noted the histopathologic final outcome. RESULTS: A washout pattern was present in all patients on the initial MR study. The quantification method of the washout changes was reproducible with good interobserver agreement (r = 0.85, p < 10(-5)) and an excellent intraobserver agreement (r = 0.94, p < 10(-5)). A significant decrease of the washout volume was observed after two courses of chemotherapy (p = 0.004), whereas no significant modification was observed between two and four courses of chemotherapy (p = 0.52). CONCLUSION: Quantification of the washout variation in breast tumor based on the use of parametric images is feasible and reproducible. It may add information to the evaluation of tumor response to preoperative therapy.     

Prospective comparison of mammography, sonography, and MRI in patients undergoing neoadjuvant chemotherapy for palpable breast cancer

OBJECTIVE: The objective of our study was to determine the relative accuracy of mammography, sonography, and MRI in predicting residual tumor after neoadjuvant chemotherapy for breast cancer as compared with the gold standards of physical examination and pathology. SUBJECTS AND METHODS: Forty-one women with stage IIB-III palpable breast cancer were prospectively enrolled in a study investigating the effects of sequential single-agent chemotherapy (doxorubicin followed by paclitaxel or vice versa) on tumor imaging. The study cohort consisted of the first 31 patients (age range, 31-65 years; mean, 45 years) who completed the protocol. All underwent physical examination, mammography, sonography, and MRI before and after receiving each neoadjuvant chemotherapeutic drug. Imaging studies were reviewed by two radiologists using conventional lexicons for lesion analysis, and the findings were compared with clinical response and pathology results. RESULTS: Complete, partial, and stable clinical response as defined by clinical examination was seen in 15, 14, and two of the 31 patients, respectively. Agreement rates about the degree of response were 32%, 48%, and 55%, respectively, for mammography, sonography, and MRI compared with clinical evaluation and did not differ statistically. Agreement about the rate of response as measured by clinical examination, mammography, sonography, and MRI compared with the gold standard (pathology) was 19%, 26%, 35%, and 71%, respectively. Of the four, MRI agreed with the gold standard significantly more often (p < 0.002 for all three paired comparisons with MRI). When there was disagreement with the gold standard, none of the four exhibited a significant tendency to either under- or overestimate. CONCLUSION: MRI appears to provide the best correlation with pathology-better than physical examination, mammography, and sonography-in patients undergoing neoadjuvant chemotherapy. However, MRI may overestimate (6%) or underestimate (23%) residual disease in approximately 29% of the patients (95% confidence interval, 14-48%).     

Blood oxygenation level‐dependent (BOLD) contrast magnetic resonance imaging (MRI) for prediction of breast cancer chemotherapy response: A pilot study

Purpose:

To determine whether a simple noninvasive method of assessing tumor oxygenation is feasible in the clinical setting and can provide useful, potentially predictive information. Tumor microcirculation and oxygenation play critical roles in tumor growth and responsiveness to cytotoxic treatment and may provide prognostic indicators for cancer therapy. Deoxyhemoglobin is paramagnetic and can serve as an endogenous contrast agent causing signal loss in echo planar magnetic resonance imaging (MRI) (blood oxygenation level‐dependent [BOLD]‐MRI). We used BOLD‐MRI to provide early evaluation of response to neoadjuvant chemotherapy in patients with locally advanced breast cancer.

Materials and Methods:

MRI was performed on 11 patients with biopsy‐proven malignancy. MRI exams were scheduled before, during, and after chemotherapy. The BOLD study applied a 6‐minute oxygen breathing challenge.

Results:

Seven patients successfully completed the exams. Before chemotherapy, BOLD contrast enhancement was observed in all tumors, but the patients, who ultimately had complete pathological response, exhibited a significantly higher BOLD response to oxygen breathing.

Conclusion:

We have successfully implemented an oxygen‐breathing challenge BOLD contrast technique as part of the standard breast MRI exam in patients with locally advanced breast cancer. The preliminary observation that a large BOLD response correlated with better treatment response suggests a predictive capability for BOLD MRI. J. Magn. Reson. Imaging 2013;37:1083–1092. © 2012 Wiley Periodicals, Inc.     

乳腺癌患者新辅助化疗的MRI研究

乳腺癌新辅助化疗(亦称初始化疗或术前化疗)最初是指对局部晚期乳腺癌患者手术治疗之前所进行的辅助化疗,目前己将该治疗扩展至肿瘤较大的可手术的乳腺癌患者,以使肿瘤降期,进而达到保乳手术治疗的目的。随着新辅助化疗在乳腺癌患者中不断推广应用,临床实践中迫切需要一种能准确评价化疗后肿瘤变化的检查方法,本文对RI(magnetic resonance imaging)在乳腺癌新辅助化疗中的研究进行综述。     

Monitoring the response of large (>3 cm) and locally advanced (T3-4, N0-2) breast cancer to neoadjuvant chemotherapy using (99m)Tc-Sestamibi uptake

BACKGROUND AND AIM: (99m)Tc-Sestamibi (MIBI) scintimammography has an established role in the diagnosis of breast cancer. As a functional imaging technique, it may also be useful in assessing the response to chemotherapy. The aim of this study was to assess the effectiveness of the technique for this purpose. METHODS: Twenty-six patients undergoing neoadjuvant chemotherapy for large or locally advanced breast cancer were monitored using the tumour to background ratio measured on MIBI scintimammograms. Patients were assessed and the size of the tumour was measured by callipers and ultrasonography before and at the end of treatment. Patients were assessed as complete, partial or non-responders. Following chemotherapy, patients proceeded to surgery with pathological evaluation of the operative specimen. RESULTS: Twenty-four of the 26 patients showed a reduction in MIBI uptake on completion of chemotherapy. Residual tumour was demonstrated on the scintimammogram in four patients and all had significant residual disease on histology. In the remaining 22 patients, the final scintimammogram was negative, although three patients were assessed as non-responders and had large residual tumours on histology. CONCLUSION: A positive MIBI scan is highly predictive of the presence of significant residual disease on completion of chemotherapy. However, a negative MIBI scan does not rule out the presence of considerable residual tumour. Whereas ultrasound and clinical assessment may underestimate the response to chemotherapy, MIBI imaging tends to overestimate the response.     

表观扩散系数预测乳腺癌新辅助化疗反应初探

目的 探讨乳腺癌患者新辅助化疗前肿瘤表观扩散系数(ADC)及化疗第1周期后ADC的变化,预测新辅助化疗反应的价值.方法 20例21个病灶经穿刺活检证实为乳腺癌的患者分别于阿霉素类和紫杉类抗肿瘤新辅助化疗前1周之内、第1周期化疗后(18～21 d之内)、术前1周之内进行MR扩散加权成像(DWI)和增强扫描,根据增强MRI肿瘤的变化,将其分为反应组及相对无反应组,对2组肿瘤初始ADC及化疗第1周期后ADC的变化进行分析.结果 反应组15个病灶化疗前初始ADC为(0.98±0.15)×10-3 mm2/s,化疗第1周期后升高到(1.22±0.23)x 10-3 mm2/s,差异具有统计学意义(P<0.05);相对无反应组6个病灶化疗前初始ADC为(1.09±0.08)×10-3mm 2/s,第1周期后为(1.11±0.07)×10-3 mm2/s,差异无统计学意义(P>0.05);反应组初始ADC低于相对无反应组(P<0.05);肿瘤初始ADC与化疗第1周期后ADC的变化值呈负相关关系(r=-0.51,P<0.05).结论 初步研究结果表明,乳腺癌肿瘤初始ADC值及新辅助化疗第1周期后ADC值变化有可能成为预测乳腺癌新辅助化疗疗效的指标之一.     

Computer-aided detection applied to breast MRI: assessment of CAD-generated enhancement and tumor sizes in breast cancers before and after neoadjuvant chemotherapy

RATIONALE AND OBJECTIVES: MRI has shown promise in assessing breast cancer patients undergoing neoadjuvant chemotherapy. Computer-aided detection (CAD) for MRI can automatically display tumor enhancement parameters. This study was performed to determine the utility of CAD applied to breast MRI in this patient population. MATERIALS AND METHODS: Fifteen patients with 16 newly diagnosed locally advanced breast cancers were evaluated with MRI before and after neoadjuvant chemotherapy. CAD assessments, including presence or absence of significant enhancement, enhancement profiles, and maximum sizes, were recorded. Pre-chemotherapy and post-chemotherapy enhancement profiles were compared. Sizes were compared to those measured by the radiologist and at final pathology. RESULTS: Prior to chemotherapy, all tumors demonstrated CAD-assessed significant enhancement. Following chemotherapy, 7/16 tumors showed no residual significant enhancement, but all had residual disease at pathology. In those patients with residual enhancement, comparison of the post-chemotherapy to pre-chemotherapy CAD enhancement profiles showed a significant decrease in percentage of washout enhancement (P = 0.0147) in patients with less than 5 mm of residual microscopic disease. Radiologist-measured tumor sizes demonstrated better correlation with sizes at pathology (r = 0.60) than did CAD-generated tumor sizes (r = 0.32). CONCLUSION: CAD may be helpful in assessing changes in MRI enhancement profiles of tumors following chemotherapy. However, CAD-assessed significant enhancement following chemotherapy can be falsely negative for residual malignancy, and CAD tumor sizes are less accurate than those measured by the radiologist in predicting size of residual malignancy. CAD may complement but should not replace the radiologist's assessment of tumors in this patient population.     

Perfusion CT – A novel quantitative and qualitative imaging biomarker in gastric cancer

ObjectivesThe aim of this research was to examine whether Perfusion Computed Tomography (P-CT) can qualitatively and quantitatively help detect gastric cancer neoangiogenesis in vivo as well as treatment response evaluation. We attempted to explore which P-CT parameters are best used in neoangiogenesis and neoadjuvant therapy for most effective evaluation. We also tried to recognize a positive prediction value of P-CT in early responders and non-responders patients identification.Materials and methodsTwenty-four patients with positive biopsy results and/or clinically proven gastric cancer were enrolled in the P-CT exam. Patients were qualified for systemic treatment (16 patients received chemotherapy and 8 patients received radiochemotherapy). The baseline Perfusion-CT exam and after neoadjuvant treatment Perfusion-CT exam were conducted using a 64-row GE tomograph based on a deconvolution model in first-pass protocol perfusion. The P-CT examined the following parameters: Blood Flow (BF), Blood Volume (BV), Mean Transit Time (MTT) and Permeability Surface (PS). Positive clinical response to neoadjuvant treatment (CHT and RCT) was defined as tumor size reduction 25% or more.ResultsTumor dimension reduction after neoadjuvant therapy was significantly correlated with the BF and the PS. Neoadjuvant therapy was more effective for patients with higher output BF and PS values. We did not register a significant relationship between BV and MTT parameters and tumor dimension reduction. Patients with a positive treatment response showed a decrease in BF, BV and PS perfusion parameters with an increase in MTT.ConclusionsP-CT examination allows a noninvasive neoangiogenesis assessment in vivo, leading to early identification of responding and non-responding patients. As a standard procedure, a full evaluation of treatment response should include a P-CT exam assessing neoangiogenesis.     

Diffusion-weighted and dynamic contrast-enhanced MRI in evaluation of early treatment effects during neoadjuvant chemotherapy in breast cancer patients

Purpose:

To use dynamic contrast‐enhanced (DCE) and diffusion‐weighted (DW) MRI at 3 Tesla (T) for early evaluation of treatment effects in breast cancer patients undergoing neoadjuvant chemotherapy (NAC), and assess the reliability of DW‐MRI.

Materials and Methods:

DW‐ and DCE‐MRI acquisitions of 15 breast cancer patients were performed before and after one cycle of NAC. MRI tumor diameter and volume, apparent diffusion coefficient (ADC) and kinetic parameters (K^trans, v_e) were derived. The reliability of ADC before NAC was assessed. Changes in MRI parameters after NAC were analyzed, and logistic regression analysis was used to find the best predictors for pathologic response.

Results:

The reliability for ADC values was high, with intraclass correlation coefficient of 0.84 (P = 0.001). After one cycle of NAC, MRI tumor diameter (8%, P = 0.005) and tumor volume (30%, P = 0.008) was reduced for all patients, while ADC mean values increased (0.12 mm²/s, P = 0.008). The best predictor for treatment response was a change in MRI tumor diameter with mean error rate of 0.167 (13% for responders, 5% for nonresponders, P = 0.291).

Conclusion:

Changes in MRI derived tumor diameter and ADC after only one cycle of NAC could provide a valuable tool for early evaluation of treatment effects in breast cancer patients. J. Magn. Reson. Imaging 2011;. © 2011 Wiley Periodicals, Inc.     

MRI在乳腺癌新辅助化疗疗效评价中的应用研究

乳腺癌新辅助化疗（neoadjuvant chemotherapy,NAC）（亦称初始化疗或术前化疗）最初是指对局部晚期乳腺癌患者手术治疗之前所进行的辅助化疗,目前已将该治疗扩展至肿瘤较大的可手术的乳腺癌患者,以使肿瘤降期,进而达到保乳手术治疗的目的。随着新辅助化疗在乳腺癌患者中不断推广应用,临床实践中迫切需要一种能准确评价化疗后肿瘤变化的检查方法,本文对MRI在乳腺癌新辅助化疗中的研究进行综述。     

Factors predicting tumour regression in locally advanced cervical adenocarcinoma treated with balloon-occluded intra-arterial chemotherapy

We retrospectively assessed the factors that may impede tumour reduction of locally advanced cervical adenocarcinoma treated with balloon-occluded arterial infusion chemotherapy (BOAI) as initial therapy. We reviewed the medical records and MRI scans of 31 patients (mean age, 54.7 years; age range, 33-78 years). BOAI was performed via uterine arteries in 21 patients, and via the anterior division or main trunk of the internal iliac artery (when the uterine arteries were obscured) in 10 patients. Tumour reduction rate was calculated from the tumour size on MRI before and after BOAI, and patients given chemotherapy were classified as "non-responders" or "responders". Factors including the patient's age, tumour stage (using the International Federation of Gynecology and Obstetrics classification), the artery used for infusion, infused drug, presence of intravenous systemic chemotherapy, initial tumour size, tumour volume and presence of lymph node metastases were assessed for their ability to predict tumour response to BOAI using univariate and multivariate analyses. Patients who underwent chemotherapy included 10 non-responders and 21 responders. The age of non-responders was significantly higher than that of responders (66 years vs 49 years, p<0.001). Internal iliac arterial infusion significantly correlated with "no response" compared with uterine arterial infusion (p<0.001). In multivariate analyses, internal iliac arterial infusion was an independent predictor for BOAI non-responders (odds ratio, 19.6; 95% confidence interval, 1.4-280.6; p = 0.02). These data suggest that uterine arteries being obscured to arterial infusion may be associated with a poor response to BOAI for cervical adenocarcinoma.     

Characterization of cirrhotic nodules with gadoxetic acid-enhanced magnetic resonance imaging: the efficacy of hepatocyte-phase imaging

Purpose:

To assess the efficacy of quantitative ¹H MR spectroscopy (MRS) using the external standard method to predict the pathological response to neoadjuvant chemotherapy with an anthracycline‐based regimen in breast cancer patients.

Materials and Methods:

Sixteen patients with breast cancer were included. Tumor response to chemotherapy was evaluated after the second cycle using MRI and MRS. Final histopathology following surgery after four cycles of chemotherapy served as reference.

Results:

The average normalized choline (Cho) signal was 1.2 (range, 0.40 to 2.8). There were no significant differences in the baseline tumor size and normalized Cho signals between the pathological responders (n = 8) and nonresponders (n = 8). The reduction rates of the normalized Cho signal were statistically significantly different between the pathological responders and nonresponders (P = 0.004), whereas the reduction rates of the lesion size were not significantly different between the two groups. When 40–50% of the reduction rates of the normalized Cho was chosen as the cutoff value, the positive and negative predictive values of MRS were 89% (8/9) and 100% (7/7), respectively.

Conclusion:

The changes in Cho after the second cycle of chemotherapy as determined by quantitative MRS may be more sensitive than changes in the tumor size to predict the pathological response. J. Magn. Reson. Imaging 2010;31:895–902. ©2010 Wiley‐Liss, Inc.     

Chemotherapy response assessment in stage IV melanoma patients—comparison of <Superscript>18</Superscript>F-FDG-PET/CT,CT, brain MRI,and tumormarker S-100B

PURPOSE: This study aims to compare the use of 18F-FDG-PET/CT, CT, brain MRI, and tumormarker S-100B in chemotherapy response assessment of stage IV melanoma patients. METHODS: In 25 patients with stage IV melanoma, FDG-PET/CT and S-100B after 2-3 months (three cycles) of chemotherapy was compared with baseline PET/CT and baseline S-100B. Retrospectively, the response was correlated with the outcome. In patients with clinical suspicion for brain metastases, MRI or CCT was performed. RESULTS: There was agreement between FDG-PET/CT and CT regarding response to chemotherapy in all patients. There was a clear trend to a longer OS of PET/CT responders (n=10) compared with PET/CT non-responders (n=15; p=0.072) with remarkably better 1-year OS of 80% compared to 40% (p=0.048). There was a significant longer PFS of PET/CT responders compared with PET/CT non-responders (p=0.002). S-100B was normal at baseline in eight of 22 patients where it was available. Chemotherapy response assessment with S-100B failed to show correlation with OS or PFS. Eleven patients developed brain metastases during treatment, first detected by PET/CT in two and by MRI or CCT in nine of 11 patients. Appearance of brain metastases was associated with a poor survival. CONCLUSIONS: 18F-FDG-PET/CT and CT alone are equally suitable for chemotherapy response assessment in melanoma patients and clearly superior to S-100B. PET/CT responders have better early survival, but this is shortlived due to late therapy failure--often with brain recurrence. Additional brain MRI for therapy response assessment in such high-risk patients is mandatory to detect brain metastases missed by PET/CT.     

Monitoring the therapeutic response of locally advanced breast cancer patients: sequential in vivo proton MR spectroscopy study

PURPOSE: To evaluate the use of the water-to-fat (W-F) value obtained from in vivo proton ((1)H) MR spectroscopy (MRS) as a response indicator of cytologically confirmed patients with locally advanced breast cancer (LABC), and to monitor the therapeutic response of such patients to neoadjuvant chemotherapy (NACT). MATERIALS AND METHODS: Serial (1)H MR spectra were recorded both before and after the completion of chemotherapy in 33 LABC patients (with infiltrating ductal carcinoma (IDC)) at 1.5T. In addition, spectra from normal breast tissues of 28 healthy volunteers were recorded. RESULTS: Malignant breast tissues showed elevated W-F values compared to normal breast tissues of controls. Statistically significant higher pretherapy W-F value (P < 0.01) was observed in patients compared to controls. In patients who received NACT resulting in the reduction of the primary tumor size, the W-F value showed a decrease that was statistically significant (P < 0.01). Analysis of the MR data further indicates that the W-F value had no correlation with the menstrual status of the patients. A comparison of pretherapy W-F value with pretherapy tumor volume showed a fair correlation (P = 0.05), while the posttherapy W-F value showed no such correlation with the posttherapy tumor volume. CONCLUSION: This study demonstrates that simple, conventional in vivo (1)H MRS is a useful technique for monitoring the therapeutic response of breast cancer patients. The observed trend in the reduction of W-F value provides a noninvasive response indicator to monitor the clinical outcome of locally advanced breast cancer patients to NACT.     

乳腺癌新辅助化疗的动态增强磁共振成像评价

目的:探讨乳腺癌患者新辅助化疗(NAC)后通过动态增强MRI评估肿瘤边界的准确性;观察NAC前、后时间-信号强度曲线(TIC)变化。方法:搜集57例行NAC乳腺癌患者,化疗前后均行病理及MRI检查,以病理结果作为金标准,将NAC后MRI所测肿瘤最大径与其进行比较;观察记录NAC前、后TIC类型。结果:化疗后MRI测量的肿瘤最大径与病理量出的最大径有很高的相关性(r=0.926,P<0.005);NAC后TIC类型变化多样。结论:动态增强MRI可以对乳腺癌NAC后进行有效评价。化疗前、后的TIC变化可以为临床评价NAC疗效提供丰富的信息。