Monitoring breast cancer response to neoadjuvant systemic chemotherapy using parametric contrast-enhanced MRI: a pilot study.
OBJECTIVE
Neoadjuvant systemic therapy (NST) is the standard treatment for locally advanced breast cancer and a common option for primary operable disease. It is important to develop standardized imaging techniques that can monitor and quantify response to NST enabling treatment tailored to each individual patient, and facilitating surgical planning. Here we present a high spatial resolution, parametric method based on dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI), which evaluates breast cancer response to NST.


METHODS
DCE-MRI examinations were performed twice on 17 breast cancer patients, before and after treatment. Seven sets of axial breast images were sequentially recorded at 1.5 Tesla applying a three-dimensional, gradient echo at a spatial resolution approximately 2 x 1.2 x 0.6 mm(3) and temporal resolution approximately 2 minutes, using gadopentate dimeglumine (0.1 mmol/kg wt). Image analysis was based on a color-coded scheme related to physiologic perfusion parameters.


RESULTS
A high Pearson correlation coefficient of 0.96 (P < .0001) was found between the histopathologic estimation of viable neoplastic tissue volume and the segmented volume of all the pixels demonstrating fast and steady state washout after NST (colored in light red and green). Segmentation of these pixels before and after NST indicated response in terms of reduced tumor volume and a parallel decrease in enhancement rate which reflects diminished transcapillary transfer of the contrast agent.


CONCLUSIONS
The use of a parametric MRI technique provided a means to standardize segmentation and quantify changes in the perfusion of breast neoplastic tissue in response to NST. Whether this technique can serve to predict breast cancer recurrence and survival rates requires further clinical testing.
Chou
Chen-Pin
CP
Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.
Wu
Ming-Ting
MT
Chang
Hong-Tai
HT
Lo
Yu-Shin
YS
Pan
Huay-Ben
HB
Degani
Hadassa
H
Furman-Haran
Edna
E
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant; D003287:Contrast Media; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D019786:Gadolinium DTPA; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010865:Pilot Projects; D011379:Prognosis; D016896:Treatment Outcome
D003287:Contrast Media; D004317:Doxorubicin; D003520:Cyclophosphamide; D019786:Gadolinium DTPA; D005472:Fluorouracil