Early assessment of breast cancer response to neoadjuvant chemotherapy by semi-quantitative analysis of high-temporal resolution DCE-MRI: Preliminary results

Abstract

Purpose To evaluate whether semi-quantitative analysis of high temporal resolution dynamic contrast-enhanced MRI (DCE-MRI) acquired early in treatment can predict the response of locally advanced breast cancer (LABC) to neoadjuvant chemotherapy (NAC). Materials and Methods As part of an IRB-approved prospective study, 21 patients with LABC provided informed consent and underwent high temporal resolution 3 T DCE-MRI before and after 1 cycle of NAC. Using measurements performed by two radiologists, the following parameters were extracted for lesions at both examinations: lesion size (short and long axes, in both early and late phases of enhancement), radiologist’s subjective assessment of lesion enhancement, and percentages of voxels within the lesion demonstrating progressive, plateau, or washout kinetics. The latter data were calculated using two filters, one selecting for voxels enhancing ≥50% over baseline and one for voxels enhancing ≥100% over baseline. Pretreatment imaging parameters and parameter changes following cycle 1 of NAC were evaluated for their ability to discriminate patients with an eventual pathological complete response (pCR). Results All 21 patients completed NAC followed by surgery, with 9 patients achieving a pCR. No pretreatment imaging parameters were predictive of pCR. However, change after cycle 1 of NAC in percentage of voxels demonstrating washout kinetics with a 100% enhancement filter discriminated patients with an eventual pCR with an area under the receiver operating characteristic curve (AUC) of 0.77. Changes in other parameters, including lesion size, did not predict pCR. Conclusion Semi-quantitative analysis of high temporal resolution DCE-MRI in patients with LABC can discriminate patients with an eventual pCR after one cycle of NAC.

Bloch–Siegert B1-Mapping Improves Accuracy and Precision of Longitudinal Relaxation Measurements in the Breast at 3 T

“…Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is a common method for evaluating tumor response to therapy in a variety of cancers (1–3), including breast (4, 5). DCE-MRI acquires images before, during, and after injection of a contrast agent to characterize, for example, tumor-related perfusion.…”

Early prediction of pathological outcomes to neoadjuvant chemotherapy in breast cancer patients using automated breast ultrasound

“…Studies focused on MRI imaging parameter changes after cycle 1 demonstrated AUCs greater than 0.70 when predicting final pCR (22, 23). DCE-MRI kinetic parameters after 2 cycles of anthracycline-based NAC were also shown to be predictive of final clinical and pathologic response after 6 cycles (24).…”

“…DCE-MRI kinetic parameters after 2 cycles of anthracycline-based NAC were also shown to be predictive of final clinical and pathologic response after 6 cycles (24). Interestingly, many of these studies also showed that change in MRI-derived tumor size did not predict pathologic response (22, 24). Analysis of 216 patients from the prospective ACRIN 6657/I-SPY TRIAL showed that the AUCs for predicting pCR after one cycle of anthracyline-based chemotherapy using MRI was 0.64 for longest diameter (LD) measurement, 0.70 for volume measurement and 0.57 for signal enhancement ratio (SER) measurement (25).…”

Evaluation of the effect of transcytolemmal water exchange analysis for therapeutic response assessment using DCE-MRI: a comparison study

“…Because of these advantages, DCE-MRI is considered as a promising imaging technique for tumor staging (Delongchamps et al , 2011) and treatment planning (van der Heide et al , 2012). In the area of treatment response assessment, DCE-MRI is also capable of monitoring the therapeutic effect of radiotherapy (Cabrera et al , 2013; Wang et al , 2015), chemotherapy (Abramson et al , 2013; Yankeelov et al , 2007) and anti-vascular drugs (O’Connor et al , 2012). …”