Rationale and Objectives
To determine whether kinetics measured with ultrafast dynamic contrast-enhanced magnetic
resonance imaging in tumor and normal parenchyma pre- and post-neoadjuvant therapy
(NAT) can predict the response of breast cancer to NAT.
Materials and Methods
Twenty-four patients with histologically confirmed invasive breast cancer were enrolled.
They were scanned with ultrafast dynamic contrast-enhanced magnetic resonance imaging
(3-7 seconds/frame) pre- and post-NAT. Four kinetic parameters were calculated in
the segmented tumors, and ipsi- and contra-lateral normal parenchyma: (1) tumor (tSE30)
or background parenchymal relative enhancement at 30 seconds (BPE30), (2) maximum
relative enhancement slope (MaxSlope), (3) bolus arrival time (BAT), and (4) area
under relative signal enhancement curve for the initial 30 seconds (AUC30). The tumor
kinetics and the differences between ipsi- and contra-lateral parenchymal kinetics
were compared for patients achieving pathologic complete response (pCR) vs those who
had residual disease after NAT. The chi-squared test and two-sided t-test were used
for baseline demographics. The Wilcoxon rank sum test and one-way analysis of variance
were used for differential responses to therapy.
Results
Patients with similar pre-NAT mean BPE30, median BAT and mean AUC30 in the ipsi- and
contralateral normal parenchyma were more likely to achieve pCR following NAT (p < 0.02). Patients classified as having residual cancer burden (RCB) II after NAT
showed higher post-NAT tSE30 and tumor AUC30 and higher post-NAT MaxSlope in ipsilateral
normal parenchyma compared to those classified as RCB I or pCR (p < 0.05).
Conclusion
Bilateral asymmetry in normal parenchyma could predict treatment outcome prior to
NAT. Post-NAT tumor kinetics could evaluate the aggressiveness of residual tumor.
Key Words
Abbreviations:
AUC30 (initial area under signal enhancement curve over 30 seconds), BAT (bolus arrival time), BPE (background parenchymal enhancement), BPE30 (initial background parenchymal enhancement at 30 seconds), DCE-MRI (Dynamic contrast-enhanced magnetic resonance imaging), IDC (invasive ductal carcinoma), MaxSlope (maximum relative enhancement slope), NAT (Neoadjuvant therapy), pCR (pathologic complete response), PSE (percent signal enhancement), RCB (residual cancer burden), ROI (Region of interest), tSE30 (initial relative signal enhancement in tumor at 30 seconds)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 26, 2022
Accepted:
February 8,
2022
Received in revised form:
February 2,
2022
Received:
October 25,
2021
Identification
Copyright
© 2022 Published by Elsevier Inc. on behalf of The Association of University Radiologists.
