title: Prognostic value of pretreatment dynamic contrast-enhanced MR imaging in breast cancer patients receiving neoadjuvant chemotherapy: overall survival predicted from combined time course and volume analysis.
abstract: BACKGROUND
  The prognostic value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in breast cancer has been explored, and the results are promising.
  
  
  OBJECTIVE
  To investigate the possible correlation between pretreatment DCE-MRI and overall survival 5 years after diagnosis in breast cancer patients receiving neoadjuvant chemotherapy (NAC) using combined time course analysis and volume measurement from DCE-MRI data acquired with 1 min temporal resolution.
  
  
  METHODS
  Pretreatment DCE-MR images of 32 female patients were examined. The total enhancing volume was calculated by including the voxels with >60% signal enhancing 1 min postcontrast. The signal intensity time course data were automatically classified on a voxel-by-voxel basis according to the enhancing characteristics: persistent (type I), plateau (type II) or washout (type III), and the resulting volumes of each enhancement type were calculated.
  
  
  RESULTS
  A significant correlation between total enhancing volume and 5-year survival was found, P=0.05 (log-rank). The survival was 51 +/-15 months (mean +/-95% confidence intervals (CI)) and 73+/-12 months in patients with a total enhancing volume >41 cm(3) and < or =41 cm(3), respectively. A two-dimensional discriminator, taking both total enhancing volume and type III enhancing volume into account, improved the prediction of survival, resulting in a P value (log-rank) between survivors and non-survivors of <0.001. The survival was 44+/-16 months (mean +/-95% CI) and 74+/-11 months in patients with a total enhancing volume >58 cm(3) and/or a type III volume >8 cm(3), and < or =58 cm(3) and < or =8 cm(3), respectively.
  
  
  CONCLUSIONS
  Pretreatment DCE-MRI might help in predicting prognosis in breast cancer patients receiving NAC.
authors.affiliation: Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. mariann.g.heldahl@ntnu.no
authors.forename: Mariann G
authors.initials: MG
authors.lastname: Heldahl
authors.forename: Tone F
authors.initials: TF
authors.lastname: Bathen
authors.forename: Jana
authors.initials: J
authors.lastname: Rydland
authors.forename: Kjell A
authors.initials: KA
authors.lastname: Kvistad
authors.forename: Steinar
authors.initials: S
authors.lastname: Lundgren
authors.forename: Ingrid S
authors.initials: IS
authors.lastname: Gribbestad
authors.forename: Pål E
authors.initials: PE
authors.lastname: Goa
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality*; D005260:Female; D006801:Humans; D007700:Kinetics; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D016019:Survival Analysis