Department of Radiology, The University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637.
Section of Hematology and Oncology, Department of Medicine, The University of Chicago, Chicago, Illinois.
Acad Radiol. 2022 Oct;29(10):1469-1479. doi: 10.1016/j.acra.2022.02.008. Epub 2022 Mar 26.
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.
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.
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).
Bilateral asymmetry in normal parenchyma could predict treatment outcome prior to NAT. Post-NAT tumor kinetics could evaluate the aggressiveness of residual tumor.
通过超快速动态对比增强磁共振成像（DCE-MRI）测量肿瘤和正常实质在新辅助治疗（NAT）前后的动力学，确定其是否可以预测乳腺癌对 NAT 的反应。
共纳入 24 例经组织学证实的浸润性乳腺癌患者。患者在接受 NAT 前后进行超快速 DCE-MRI（3-7 秒/帧）扫描。在分割的肿瘤和同侧及对侧正常实质中计算了 4 个动力学参数：（1）肿瘤（tSE30）或 30 秒时背景实质相对增强（BPE30），（2）最大相对增强斜率（MaxSlope），（3）对比剂到达时间（BAT），（4）初始 30 秒相对信号增强曲线下面积（AUC30）。比较了达到病理完全缓解（pCR）和 NAT 后仍有残留疾病的患者的肿瘤动力学和同侧与对侧实质动力学之间的差异。使用卡方检验和双侧 t 检验比较基线人口统计学特征。使用 Wilcoxon 秩和检验和单因素方差分析比较治疗反应的差异。
在同侧和对侧正常实质中，具有相似的预 NAT 平均 BPE30、中位 BAT 和平均 AUC30 的患者更有可能在 NAT 后达到 pCR（p < 0.02）。在 NAT 后被归类为具有残留肿瘤负荷（RCB）II 的患者，与被归类为 RCB I 或 pCR 的患者相比，其侧正常实质中的 post-NAT tSE30、肿瘤 AUC30 和 post-NAT MaxSlope 更高（p < 0.05）。
在接受 NAT 之前，正常实质的双侧不对称性可以预测治疗结果。NAT 后肿瘤动力学可以评估残留肿瘤的侵袭性。
