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Breast Imaging |
1 From the Departments of Radiology (K.L.L., B.N.J., J.E.G., Y.L., N.M.H.) and Surgery (L.J.E.), University of California, San Francisco, 1 Irving St, Room AC-109, San Francisco, CA 94143-1290; and Department of Radiology, University of Washington, Seattle, Wash (S.C.P.). Received May 15, 2007; revision requested July 20; revision received October 22; accepted January 15, 2008; final version accepted February 19. Supported by National Institutes of Health grant CA 069587. Address correspondence to K.L.L., 185 Berry St, Suite 180A, San Francisco, CA 94107-0946 (e-mail: ka-loh.li{at}radiology.ucsf.edu).
Purpose: To retrospectively evaluate high-spatial-resolution signal enhancement ratio (SER) imaging for the prediction of disease recurrence in patients with breast cancer who underwent preoperative magnetic resonance (MR) imaging.
Materials and Methods: This retrospective study was approved by the institutional review board and was HIPAA compliant; informed consent was waived. From 1995 to 2002, gadolinium-enhanced MR imaging data were acquired with a three time point high-resolution method in women undergoing neoadjuvant therapy for invasive breast cancers. Forty-eight women (mean age, 49.1 years; range, 29.7–72.4 years) were divided into recurrence-free or recurrence groups. Volume measurements were tabulated for SER values between set ranges; cutoff criteria were defined to predict disease recurrence after surgery. Wilcoxon rank sum tests and the multivariate Cox proportional hazards regression model were used for evaluation.
Results: Breast tumor volume calculated from the number of voxels with SER values above a threshold corresponding to the upper limit of mean redistribution rate constant in benign tumors (0.88 minutes–1) and the volume of cancerous breast tissue infiltrating into the parenchyma were important predictors of disease recurrence. Seventy-five percent of patients with recurrence and 100% of deceased patients were identified as being at high risk for recurrence. Thirty percent of patients with recurrence and 67% of deceased patients were identified as having high risk before chemotherapy. No patients in the recurrence-free group were misidentified as likely to have recurrence. All three prechemotherapy parameters (total tumor volume, tumor volumes with high and low SER) and the postchemotherapy tumor volume with high SER were significantly different between the two groups. The multivariate Cox proportional hazards regression showed that, of the three prechemotherapy covariates, only the low SER and high SER tumor volumes (P = .017 and .049, respectively) were significant and independent predictors of tumor recurrence. Tumor volume with high SER was the only significant postchemotherapy covariate predictor (P = .038).
Conclusion: High-spatial-resolution SER imaging may improve prediction for patients at high risk for disease recurrence and death.
Supplemental material: http://radiology.rsnajnls.org/cgi/content/full/248/1/79/DC1
© RSNA, 2008
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  J. H. Lee, E. L. Rosen, and D. A. Mankoff The Role of Radiotracer Imaging in the Diagnosis and Management of Patients with Breast Cancer: Part 2--Response to Therapy, Other Indications, and Future Directions J. Nucl. Med., May 1, 2009; 50(5): 738 - 748. [Abstract] [Full Text] [PDF]
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