Department of Radiology, Kitasato University School of Medicine and Kitasato University Hospital, 1-15-1 Kitasato, Sagamihara, Kanagawa 228-8555, Japan.
Radiology. 2010 Feb;254(2):357-66. doi: 10.1148/radiol.2542090405.
To compare the capability of diffusion-weighted (DW) and contrast material-enhanced magnetic resonance (MR) imaging to provide diagnostic information on residual breast cancers following neoadjuvant chemotherapy and to assess apparent diffusion coefficients (ADCs) of the carcinoma prior to neoadjuvant chemotherapy to determine if the method could help predict response to chemotherapy.
Institutional review board approval and informed consent were obtained. Three hundred ninety-eight patients underwent MR imaging of the breast, including DW MR (b values, 0 and 1500 sec/mm(2)) and contrast-enhanced MR imaging. Of these, the contralateral breast in 73 women was used as a control. Seventy-two patients with 73 lesions with malignant disease were treated by using neoadjuvant chemotherapy and were examined for residual disease following therapy. Three were excluded because of prolonged intervals between final MR imaging and surgery. Thus, 69 patients (70 lesions) with DW and contrast-enhanced MR imaging results were compared with postoperative histopathologic findings. The ADCs of the carcinoma prior to neoadjuvant chemotherapy were calculated for each patient, and those with complete response and residual disease were compared.
The accuracy for depicting residual tumor was 96% for DW MR imaging, compared with an accuracy of 89% for contrast-enhanced MR imaging (P = .06). There was no significant difference in prechemotherapy ADCs between pathologic complete response cases and those with residual disease.
DW MR imaging had at least as good of accuracy as did contrast-enhanced MR imaging for monitoring neoadjuvant chemotherapy. The ADCs prior to chemotherapy did not predict response to chemotherapy. The use of DW imaging to visualize residual breast cancer without the need for contrast medium could be advantageous in women with impaired renal function.
比较弥散加权（DW）和对比增强磁共振（MR）成像在提供新辅助化疗后残留乳腺癌的诊断信息方面的能力，并评估新辅助化疗前癌的表观扩散系数（ADC），以确定该方法是否有助于预测化疗反应。
获得机构审查委员会批准和知情同意。398 例患者接受了乳腺磁共振成像检查，包括 DW MR（b 值为 0 和 1500 sec/mm(2))和对比增强磁共振成像。其中，73 名女性的对侧乳房作为对照。72 例患有恶性疾病的 73 个病变的患者接受了新辅助化疗，并在治疗后检查残留疾病。由于最终 MR 成像和手术之间的时间间隔延长，有 3 例被排除在外。因此，对 69 例（70 个病变）接受 DW 和对比增强 MR 成像结果的患者与术后组织病理学结果进行了比较。为每位患者计算了新辅助化疗前癌的 ADC，比较了完全缓解和残留疾病的 ADC。
DW MR 成像对残留肿瘤的描绘准确性为 96%，而对比增强 MR 成像的准确性为 89%（P =.06）。病理完全缓解病例和残留疾病病例的化疗前 ADC 无显著差异。
DW MR 成像在监测新辅助化疗方面的准确性至少与对比增强 MR 成像相当。化疗前 ADC 不能预测化疗反应。在肾功能受损的女性中，使用 DW 成像观察残留的乳腺癌而无需使用造影剂可能具有优势。
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