Wang Xiao-hong, Peng Wei-jun, Xin Chao, Tan Hong-na, Gu Ya-jia, Tang Feng, Mao Jian
Department of Diagnostic Radiology, Cancer Hospital, Fudan University, Shanghai 200032, China.
Zhonghua Zhong Liu Za Zhi. 2010 Jul;32(7):539-43.
To assess the value of dynamic contrast-enhanced MRI (DMRI) in predicting early response to neoadjuvant chemotherapy (NAC) in patients with locally advanced breast cancer (LABC) and to assess the accuracy of MRI in evaluation of residual disease after NAC.
Forty-three women with LABC (44 lesions, all were invasive ductal carcinoma) underwent DMRI before, after the first and final cycles of NAC. For each patient, the tumor volume, early enhancement ratio (E1), maximum enhancement ratio (Emax), and maximum enhancement time (Tmax), dynamic signal intensity-time curve were obtained during treatment. The residual tumor volumes obtained by DMRI were compared with pathological findings to assess the accuracy of DMRI.
After the first cycle of NAC, the mean volume of responders decreased insignificantly (P = 0.055), but after NAC, mean volume of residual tumor decreased significantly (P = 0.000). Morphological changes: 29 cases showed a concentric shrinkage pattern while 7 cases showed a dendritic shrinkage pattern. Significant differences were found in E1, Emax and Tmax between responders and non-responders (P < 0.05). After the first cycle of NAC, E1, Emax and Tmax of responders changed significantly (P < 0.001), while there was no significant change in non-responders (P > 0.05). After NAC, the dynamic signal intensity-time types were changed in responders, and tended to be significantly flattening, while no significant change was found in non-responders. The residual tumor volume correlation coefficient between MRI and pathology measurements was very high (r = 0.866, P < 0.01).
DMRI is useful to evaluate the early response to NAC in LABC. The presence and volume of residual tumor in LABC patients treated with NAC can be accurately evaluated by DMRI.
评估动态对比增强磁共振成像（DMRI）在预测局部晚期乳腺癌（LABC）患者新辅助化疗（NAC）早期反应中的价值，并评估MRI在评估NAC后残留病灶的准确性。
43例LABC女性患者（44个病灶，均为浸润性导管癌）在NAC的第一个周期及最后一个周期前后接受了DMRI检查。对于每位患者，在治疗期间获取肿瘤体积、早期增强率（E1）、最大增强率（Emax）、最大增强时间（Tmax）及动态信号强度-时间曲线。将DMRI获得的残留肿瘤体积与病理结果进行比较，以评估DMRI的准确性。
在NAC的第一个周期后，有反应者的平均体积下降不显著（P = 0.055），但在NAC后，残留肿瘤的平均体积显著下降（P = 0.000）。形态学变化：29例表现为同心性缩小模式，7例表现为树枝状缩小模式。有反应者与无反应者在E1、Emax和Tmax方面存在显著差异（P < 0.05）。在NAC的第一个周期后，有反应者的E1、Emax和Tmax发生显著变化（P < 0.001），而无反应者无显著变化（P > 0.05）。NAC后，有反应者的动态信号强度-时间类型发生变化，且趋于显著变平，而无反应者无显著变化。MRI与病理测量的残留肿瘤体积相关系数非常高（r = 0.866，P < 0.01）。
DMRI有助于评估LABC患者对NAC的早期反应。DMRI可准确评估接受NAC治疗的LABC患者残留肿瘤的存在及体积。
