Tozaki Mitsuhiro, Uno Shinji, Kobayashi Tadashi, Aiba Keisuke, Yoshida Kazuhiko, Takeyama Hiroshi, Shioya Hisashi, Tabei Isao, Toriumi Yasuo, Suzuki Masafumi, Kawakami Makio, Fukuda Kunihiko
Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, JAPAN.
Radiat Med. 2004 Jul-Aug;22(4):246-53.
To evaluate the efficacy of dynamic multidetector-row CT (MDCT) in assessing residual cancer extent after neoadjuvant chemotherapy (NAC), and to compare MDCT results with those derived from dynamic three-dimensional MRI using the volumetric interpolated breath-hold examination (VIBE) sequence.
MDCT before and after NAC was performed in 19 consecutive patients with breast cancer. MRI was also performed before surgery. The early phase of MDCT and MRI was started 60 sec after commencing contrast injection. The late phase was started at a 4-min delay from the injection. The injection rate was 3 mL/sec. The distribution pattern of contrast enhancement (CE) by CT before NAC was classified into two groups: replaced lesion (diffuse CE in whole quadrants) and non-replaced lesion (localized CE).
Pathological complete response (pCR) was obtained in one case. In replaced lesions, accuracy for the detection of tumor extent with a deviation of less than 2 cm in length was 0% (0/7) with early-phase CT/MRI and 100% (7/7) with late-phase CT/MRI. In non-replaced lesions, accuracy was 55% (6/11) with early-phase CT/MRI and 82% (9/11) with late-phase CT/MRI. One case of ductal carcinoma in situ (DCIS) could be detected only with late phase MRI.
Late-phase images obtained by MDCT and MRI may be accurate in the diagnosis of residual cancer extent after NAC. The tumor distribution determined by MDCT before NAC is thought to be useful in the evaluation of shrinkage pattern following NAC.
评估动态多排螺旋CT（MDCT）在评估新辅助化疗（NAC）后残留癌范围方面的有效性，并将MDCT结果与使用容积内插屏气检查（VIBE）序列的动态三维MRI结果进行比较。
对19例连续的乳腺癌患者在NAC前后进行MDCT检查。术前也进行了MRI检查。MDCT和MRI的早期在开始注射造影剂后60秒启动。晚期在注射后延迟4分钟启动。注射速率为3 mL/秒。NAC前CT的对比增强（CE）分布模式分为两组：替代病变（整个象限弥漫性CE）和非替代病变（局限性CE）。
1例获得病理完全缓解（pCR）。在替代病变中，早期CT/MRI检测肿瘤范围长度偏差小于2 cm的准确率为0%（0/7），晚期CT/MRI为100%（7/7）。在非替代病变中，早期CT/MRI的准确率为55%（6/11），晚期CT/MRI为82%（9/11）。仅在晚期MRI中检测到1例原位导管癌（DCIS）。
MDCT和MRI获得的晚期图像在诊断NAC后残留癌范围方面可能是准确的。NAC前MDCT确定的肿瘤分布被认为有助于评估NAC后的缩小模式。
