Choline by magnetic spectroscopy and dynamic contrast enhancement curve by magnetic resonance imaging in neoadjuvant chemotherapy for invasive breast cancer

Abstract

Abstract. This study investigated the relationship between choline by magnetic resonance spectroscopy (MRS) and late enhancement curves by dynamic magnetic resonance imaging (DMRI) in determining therapeutic response to neoadjuvant chemotherapy (NAC) among invasive breast cancer patients. Subjects comprised 21 women (22 breasts) with biopsyconfirmed invasive breast cancer (mean age 54 years) who underwent MRS with choline and gadolinium-enhanced DMRI at 1.5 T before and after NAC. Choline signals on MRS were classified into 2 patterns: choline-positive or cholinenegative, while late enhancement curves were classified as 'plateau' or 'washout' (type A), or 'persistent' (type B) according to the consensus of 2 radiologists. Maximum tumor diameters and clinical tumor reduction rates were assessed by MRI. Before NAC, choline-positive results were found in all 22 tumors, 21 of which were type A and 1 of which was type B. After NAC, a change from choline-positive to cholinenegative was observed with MRS in 11 tumors, while another 11 remained choline-positive. According to DMRI, enhancement curves changed from type A to type B in 14 tumors, remained type A in 7 tumors, and remained type B in 1 tumor. Tumor reduction rates were significantly greater for cholinenegative tumors than for choline-positive tumors after NAC (p=0.0115). Following NAC, no significant correlation was noted between enhancement curves and reduction rates (p=0.1210), although a significant correlation was noted between enhancement curves and choline signals (p=0.0014). Changes in choline signals as noted using MRS might offer advantages over changes in enhancement curves by DMRI when evaluating response to NAC in terms of the tumor reduction rate in invasive breast cancer. IntroductionAmong conventional modalities such as ultrasonography, mammography and computed tomography (1-3), magnetic resonance imaging (MRI) has priority for the detection of breast cancer and for the evaluation of breast cancer response to neoadjuvant chemotherapy (NAC) (4-11). Enhancement curves by dynamic MRI (DMRI) are known to be useful for detecting or monitoring breast cancer (4,12,13). In addition to MRI, magnetic resonance spectroscopy (MRS) is becoming increasingly attractive for the detection or monitoring of breast cancer (14-24). MRS detects elevated levels of cholinecontaining compounds in breast cancer tissue, which yield a signal at a chemical shift of 3.2 ppm (25). Choline by MRS and enhancement curves by DMRI represent common methods for dealing with non-morphological diagnostic parameters. The present study therefore assessed the correlation between MRS and enhancement curves from DMRI in determining response to NAC. Materials and methodsPatients. The present study was performed at our institution between January 2007 and Feburary 2008. Subjects comprised 21 patients with invasive ductal breast carcinoma (unilateral n=20; bilateral n=1) diagnosed by ultrasonography-guided fine needle biopsy. Mean subject age was 54 years (range 40-67 years).Neoadjuvant chemo...

The additive role of 1H-magnetic resonance spectroscopic imaging to ensure pathological complete response after neoadjuvant chemotherapy in breast cancer patients

“…Elevated tCho concentration was previously reported in many studies in malignant neoplasms [19][20][21]. The composite Cho resonance reflects the abnormal cellular proliferation and is considered as a biomarker of the rapid growth rate of malignant tumours that can be assessed in association with tumour size to achieve better diagnostic accuracy [22,23]. Hence, all the pathologically proven malignant tumours (47 lesions) in the current study showed increased Cho levels before starting NAC.…”

Proton MR spectroscopy in the breast: Technical innovations and clinical applications

“…There are cases where no tCho can be measured before chemotherapy, which limits the clinical utility of the MRS technique. The tCho detection rate in the pretreatment cohort ranges between 60% and 100% . Thus, improvements to increase the sensitivity of MRS for measuring tCho would be needed.…”

“…The tCho detection rate in the pretreatment cohort ranges between 60% and 100%. [99][100][101] Thus, improvements to increase the sensitivity of MRS for measuring tCho would be needed. tCho metabolite detection level could be decreased following several cycles of postchemotherapy in pathological responders.…”

“…[87][88][89][90] However, pathological nonresponders generally tend to have detectable tCho peak after therapy. Hence, tCho may still be a valuable prognostic marker in preoperative assessment when combined with contrast-enhanced MRI [101][102][103][104] (Fig. 5).…”

Screening and Monitoring Response to Treatment Using Subsecond Molecular Imaging and Hyperpolarized Contrast Agents

“…Several studies have correlated changes in ADC on DW-MRI with treatment response in breast cancer patients breast cancer diagnosis as well as for monitoring response to treatment during NAT. [65][66][67][68][69][70][71][72] Applications A recent clinical trial reported by Kumar et al 67 demonstrated that malignant breast tissues have elevated W-F levels compared with controls, and that breast cancers decreasing in size with NAT also exhibited decreasing W-F ratios. 67 In a separate clinical trial reported by Tozaki et al 71 using choline MRS in patients undergoing NAT, the reduction rates of choline were statistically significantly different between pathological responders and nonresponders after two treatment cycles, with positive and negative predictive values of choline MRS of 89% and 100%, respectively.…”