Nam Kibo, Eisenbrey John R, Stanczak Maria, Sridharan Anush, Berger Adam C, Avery Tiffany, Palazzo Juan P, Forsberg Flemming
From the Departments of Radiology (K.N., J.R.E., M.S., A.S., F.F.), Surgery (A.C.B.), Medical Oncology (T.A.), and Pathology (J.P.P.), Thomas Jefferson University, 763H Main Building, 132 S 10th St, Philadelphia, PA 19107; and Department of Electrical and Computer Engineering, Drexel University, Philadelphia, Pa (A.S.).
Radiology. 2017 Oct;285(1):53-62. doi: 10.1148/radiol.2017161683. Epub 2017 May 3.
Purpose To determine whether three-dimensional subharmonic aided pressure estimation (SHAPE) and subharmonic imaging can help predict the response of breast cancer to neoadjuvant chemotherapy. Materials and Methods In this HIPAA-compliant prospective study, 17 women (age range, 45-70 years) scheduled to undergo neoadjuvant therapy for breast cancer underwent ultrasonography (US) immediately before therapy and at completion of 10%, 60%, and 100% of chemotherapy. All patients provided written informed consent. At each examination, radiofrequency data were collected from SHAPE and subharmonic imaging during infusion of a US contrast agent. Maximum-frequency magnitude and mean intensity were calculated for SHAPE and subharmonic imaging. The signal differences in the tumor relative to the surrounding area were compared with the final treatment response by using the Student t test. Results Four patients left the study, and data from two patients were discarded because of technical problems. Eight patients completed the entire imaging protocol, and an additional three patients dropped out after the imaging session at completion of 10% of chemotherapy as a result of disease progression (these patients were counted as nonresponders). Patients' imaging outcomes consisted of six responders (tumor volume reduction >90%) and five partial responders or nonresponders. The results at completion of 10% of therapy showed that the subharmonic signal increased more in the tumor than in the surrounding area for responders than in partial responders or nonresponders (mean ± standard deviation, 3.23 dB ± 1.41 vs -0.88 dB ± 1.46 [P = .001], respectively, for SHAPE and 1.32 dB ± 0.73 vs -0.82 dB ± 0.88 [P = .002], respectively, for subharmonic imaging). Moreover, three patients whose tumor measurements initially increased were correctly predicted to be responders with SHAPE and subharmonic imaging after completion of 10% of therapy. Conclusion SHAPE and subharmonic imaging have the potential to help predict response to neoadjuvant chemotherapy for breast cancer as early as completion of 10% of therapy, albeit on the basis of a small sample size. RSNA, 2017 Online supplemental material is available for this article.
目的 确定三维次谐波辅助压力估计（SHAPE）和次谐波成像是否有助于预测乳腺癌对新辅助化疗的反应。材料与方法 在这项符合健康保险流通与责任法案（HIPAA）的前瞻性研究中，17名计划接受乳腺癌新辅助治疗的女性（年龄范围45 - 70岁）在治疗前以及化疗完成10%、60%和100%时接受超声检查（US）。所有患者均提供了书面知情同意书。每次检查时，在注入超声造影剂期间从SHAPE和次谐波成像收集射频数据。计算SHAPE和次谐波成像的最大频率幅值和平均强度。使用Student t检验将肿瘤相对于周围区域的信号差异与最终治疗反应进行比较。结果 4名患者退出研究，2名患者的数据因技术问题被丢弃。8名患者完成了整个成像方案流程，另外3名患者在化疗完成10%的成像检查后因疾病进展退出（这些患者被计为无反应者）。患者的成像结果包括6名反应者（肿瘤体积缩小>90%）和5名部分反应者或无反应者。化疗完成10%时的结果显示，与部分反应者或无反应者相比，反应者肿瘤中的次谐波信号增加幅度大于周围区域（SHAPE分别为平均±标准差，3.23 dB±1.41与 -0.88 dB±1.46 [P = 0.001]，次谐波成像分别为1.32 dB±0.73与 -0.82 dB±0.88 [P = 0.002]）。此外，3名肿瘤测量值最初增加的患者在化疗完成10%后通过SHAPE和次谐波成像被正确预测为反应者。结论 SHAPE和次谐波成像有潜力早在化疗完成10%时就帮助预测乳腺癌对新辅助化疗的反应，尽管基于的样本量较小。RSNA，2017 本文有在线补充材料。
