title: Multiparametric magnetic resonance imaging for predicting pathological response after the first cycle of neoadjuvant chemotherapy in breast cancer.
abstract: OBJECTIVE
  The purpose of this study was to determine whether multiparametric magnetic resonance imaging (MRI) using dynamic contrast-enhanced MRI (DCE-MRI) and diffusion-weighted MRI (DWI), obtained before and after the first cycle of neoadjuvant chemotherapy (NAC), is superior to single-parameter measurements for predicting pathologic complete response (pCR) in patients with breast cancer.
  
  
  METHODS
  Patients with stage II/III breast cancer were enrolled in an institutional review board-approved study in which 3-T DCE-MRI and DWI data were acquired before (n = 42) and after 1 cycle (n = 36) of NAC. Estimates of the volume transfer rate (K), extravascular extracellular volume fraction (ve), blood plasma volume fraction (vp), and the efflux rate constant (kep = K/ve) were generated from the DCE-MRI data using the Extended Tofts-Kety model. The apparent diffusion coefficient (ADC) was estimated from the DWI data. The derived parameter kep/ADC was compared with single-parameter measurements for its ability to predict pCR after the first cycle of NAC.
  
  
  RESULTS
  The kep/ADC after the first cycle of NAC discriminated patients who went on to achieve a pCR (P < 0.001) and achieved a sensitivity, specificity, positive predictive value, and area under the receiver operator curve (AUC) of 0.92, 0.78, 0.69, and 0.88, respectively. These values were superior to the single parameters kep (AUC, 0.76) and ADC (AUC, 0.82). The AUCs between kep/ADC and kep were significantly different on the basis of the bootstrapped 95% confidence intervals (0.018-0.23), whereas the AUCs between kep/ADC and ADC trended toward significance (-0.11 to 0.24).
  
  
  CONCLUSIONS
  The multiparametric analysis of DCE-MRI and DWI was superior to the single-parameter measurements for predicting pCR after the first cycle of NAC.
authors.affiliation: From the *Institute of Imaging Science, †Department of Radiology and Radiological Sciences, ‡the Vanderbilt-Ingram Cancer Center, Departments of §Biostatistics, ∥Radiation Oncology, ¶Medical Oncology, #Surgical Oncology, **Pathology, ††Physics and Astronomy, ‡‡Cancer Biology, and §§Biomedical Engineering, Vanderbilt University, Nashville, TN.
authors.forename: Xia
authors.initials: X
authors.lastname: Li
authors.forename: Richard G
authors.initials: RG
authors.lastname: Abramson
authors.forename: Lori R
authors.initials: LR
authors.lastname: Arlinghaus
authors.forename: Hakmook
authors.initials: H
authors.lastname: Kang
authors.forename: Anuradha Bapsi
authors.initials: AB
authors.lastname: Chakravarthy
authors.forename: Vandana G
authors.initials: VG
authors.lastname: Abramson
authors.forename: Jaime
authors.initials: J
authors.lastname: Farley
authors.forename: Ingrid A
authors.initials: IA
authors.lastname: Mayer
authors.forename: Mark C
authors.initials: MC
authors.lastname: Kelley
authors.forename: Ingrid M
authors.initials: IM
authors.lastname: Meszoely
authors.forename: Julie
authors.initials: J
authors.lastname: Means-Powell
authors.forename: Ana M
authors.initials: AM
authors.lastname: Grau
authors.forename: Melinda
authors.initials: M
authors.lastname: Sanders
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Yankeelov
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000188:drug therapy*; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media