title: MR quantification of the washout changes in breast tumors under preoperative chemotherapy: feasibility and preliminary results.
abstract: 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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Département d'Imagerie, Institut Curie, 26, rue d'Ulm, Paris 75005, France.
authors.forename: Carl
authors.initials: C
authors.lastname: El Khoury
authors.forename: Vincent
authors.initials: V
authors.lastname: Servois
authors.forename: Fabienne
authors.initials: F
authors.lastname: Thibault
authors.forename: Anne
authors.initials: A
authors.lastname: Tardivon
authors.forename: Lilianne
authors.initials: L
authors.lastname: Ollivier
authors.forename: Martine
authors.initials: M
authors.lastname: Meunier
authors.forename: Caroline
authors.initials: C
authors.lastname: Allonier
authors.forename: Sylvia
authors.initials: S
authors.lastname: Neuenschwander
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016896:Treatment Outcome