Cho Eun, Baek Hye Jin, Szczepankiewicz Filip, An Hyo Jung, Jung Eun Jung
Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea.
FRIENDS Imaging Center, Busan, Republic of Korea.
Gland Surg. 2024 Aug 31;13(8):1387-1399. doi: 10.21037/gs-24-124. Epub 2024 Aug 22.
Single diffusion encoding is a widely used, noninvasive technique for probing the tissue microstructure in breast tumors. However, it does not provide detailed information about the microenvironmental complexity. This study investigated the clinical utility of tensor-valued diffusion encoding for evaluating microstructural changes in breast cancer after neoadjuvant chemotherapy (NAC).
We retrospectively included patients underwent chemotherapy for histologically proven invasive breast cancer between July 2020 and June 2023 and monitored the tumor response with breast magnetic resonance imaging (MRI), including tensor-valued diffusion encoding. We reviewed pre- and post-NAC MRIs regarding chemotherapy in 23 breast cancers. Q-space trajectory imaging (QTI) parameters were estimated at each time-point, and were compared with histopathological parameters.
The mean total mean kurtosis (MK), anisotropic mean kurtosis (MK), and microscopic fractional anisotropy (µFA) were significantly decreased on post-NAC MRI compared with pre-NAC MRI, with the large effect size (ES) in MK and µFA (0.81±0.41 0.99±0.33, ES: 0.48, P=0.03; 0.48±0.30 0.73±0.27, ES: 0.88, P<0.001; 0.58±0.14 0.68±0.11, ES: 0.79, P=0.003; respectively). Regarding prognostic factors, tumors with high Ki-67 expression showed significantly lower pre-NAC mean diffusivity (MD) and higher pre-NAC µFA compared to tumors with low Ki-67 expression (0.98±0.09 1.25±0.20, P=0.002; and 0.72±0.07 0.57±0.10, P=0.005; respectively). And negative progesterone receptor (PR) group revealed significantly lower MK, MK, and isotropic mean kurtosis than positive PR group on the post-NAC MRI (0.60±0.31 1.03±0.40, P=0.008; 0.36±0.21 0.61±0.33, P=0.04; and 0.23±0.17 0.42±0.25, P=0.046; respectively).
QTI parameters reflected the microstructural changes in breast cancer treated with NAC and can be used as noninvasive imaging biomarkers correlated with prognostic factors.
单扩散编码是一种广泛应用于探测乳腺肿瘤组织微观结构的非侵入性技术。然而，它并未提供有关微环境复杂性的详细信息。本研究调查了张量值扩散编码在评估新辅助化疗（NAC）后乳腺癌微观结构变化中的临床应用价值。
我们回顾性纳入了2020年7月至2023年6月间因组织学确诊为浸润性乳腺癌而接受化疗的患者，并通过乳腺磁共振成像（MRI），包括张量值扩散编码，监测肿瘤反应。我们审查了23例乳腺癌患者NAC前后关于化疗的MRI图像。在每个时间点估计Q空间轨迹成像（QTI）参数，并与组织病理学参数进行比较。
与NAC前MRI相比，NAC后MRI上的平均总平均峰度（MK）、各向异性平均峰度（MK）和微观分数各向异性（µFA）显著降低，MK和µFA的效应量较大（分别为0.81±0.41对0.99±0.33，效应量：0.48，P = 0.03；0.48±0.30对0.73±0.27，效应量：0.88，P < 0.001；0.58±0.14对0.68±0.11，效应量：0.79，P = 0.003）。关于预后因素，与低Ki-67表达的肿瘤相比，高Ki-67表达的肿瘤在NAC前的平均扩散率（MD）显著更低，µFA更高（分别为0.98±0.09对1.25±0.20，P = 0.002；以及0.72±0.07对0.57±0.10，P = 0.005）。并且在NAC后MRI上，孕激素受体（PR）阴性组的MK、MK和各向同性平均峰度显著低于PR阳性组（分别为0.60±0.31对1.03±0.40，P = 0.008；0.
