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Invasive Ductal Breast Carcinoma Response to Neoadjuvant Chemotherapy: Noninvasive Monitoring with Functional MR Imaging— Pilot Study¹

¹ From the NMR Center (J.P.D., L.G.) and Division of Breast Imaging (E.D.Y., E.F.H., D.B.K.), Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Mass; and Division of Breast Imaging, Department of Radiology, Saint Elizabeth’s Medical Center, 736 Cambridge St, Brighton, MA 02135 (P.J.S.). From the 2000 RSNA scientific assembly. Received July 31, 2001; revision requested September 24; final revision received October 18, 2002; accepted November 5. Supported by the Association pour la Recherche contre le Cancer, Société Française de Radiologie, Institut National de la Santé et de la Recherche Médicale, Massachusetts General Hospital-NMR Center, and RSNA Research and Education Foundation. Address correspondence to P.J.S. (e-mail: priscilla_slanetz@cchcs.org).

View larger version (26K): [in a new window]   Figure 1. Bar graph shows postchemotherapy EFPmean (gray bars; error bars indicate SDs) in the responders and nonresponders (P < .005).

View larger version (15K): [in a new window]   Figure 2. Plot shows relative percentage changes in the ratio of EFPcount measured before and after treatment. A significant difference is observed between the responders and nonresponders (P < .02). pCR = pathologically complete responders (), pPR = pathologically partial responders (), mNR = morphologic nonresponders (X), * = two patients with the same response.

View larger version (93K): [in a new window]   Figure 3a. Images show a lesion in the inner right breast (arrows). (a) Gradient-echo MR image and (b) T1 map calculated from echo-planar inversion-recovery (inversion time, 8 msec) MR images before contrast material injection. (c, d) Dynamic echo-planar inversion-recovery (inversion time, 160 msec) MR images obtained (c) before and (d) 12 seconds after contrast material injection with an area of signal loss in the inner right breast. (e) EFP color-encoded map calculated from the T1 map and dynamic echo-planar acquisitions shows an area with high EFP values in the inner right breast parenchyma. (f) Gradient-echo MR image obtained at the equilibrium of contrast material injection shows right breast tumor enhancement and bilateral small areas of physiologic focal enhancement. Invasive ductal carcinoma was proven at pathologic examination.

View larger version (71K): [in a new window]   Figure 3b. Images show a lesion in the inner right breast (arrows). (a) Gradient-echo MR image and (b) T1 map calculated from echo-planar inversion-recovery (inversion time, 8 msec) MR images before contrast material injection. (c, d) Dynamic echo-planar inversion-recovery (inversion time, 160 msec) MR images obtained (c) before and (d) 12 seconds after contrast material injection with an area of signal loss in the inner right breast. (e) EFP color-encoded map calculated from the T1 map and dynamic echo-planar acquisitions shows an area with high EFP values in the inner right breast parenchyma. (f) Gradient-echo MR image obtained at the equilibrium of contrast material injection shows right breast tumor enhancement and bilateral small areas of physiologic focal enhancement. Invasive ductal carcinoma was proven at pathologic examination.

View larger version (59K): [in a new window]   Figure 3c. Images show a lesion in the inner right breast (arrows). (a) Gradient-echo MR image and (b) T1 map calculated from echo-planar inversion-recovery (inversion time, 8 msec) MR images before contrast material injection. (c, d) Dynamic echo-planar inversion-recovery (inversion time, 160 msec) MR images obtained (c) before and (d) 12 seconds after contrast material injection with an area of signal loss in the inner right breast. (e) EFP color-encoded map calculated from the T1 map and dynamic echo-planar acquisitions shows an area with high EFP values in the inner right breast parenchyma. (f) Gradient-echo MR image obtained at the equilibrium of contrast material injection shows right breast tumor enhancement and bilateral small areas of physiologic focal enhancement. Invasive ductal carcinoma was proven at pathologic examination.

View larger version (57K): [in a new window]   Figure 3d. Images show a lesion in the inner right breast (arrows). (a) Gradient-echo MR image and (b) T1 map calculated from echo-planar inversion-recovery (inversion time, 8 msec) MR images before contrast material injection. (c, d) Dynamic echo-planar inversion-recovery (inversion time, 160 msec) MR images obtained (c) before and (d) 12 seconds after contrast material injection with an area of signal loss in the inner right breast. (e) EFP color-encoded map calculated from the T1 map and dynamic echo-planar acquisitions shows an area with high EFP values in the inner right breast parenchyma. (f) Gradient-echo MR image obtained at the equilibrium of contrast material injection shows right breast tumor enhancement and bilateral small areas of physiologic focal enhancement. Invasive ductal carcinoma was proven at pathologic examination.

View larger version (48K): [in a new window]   Figure 3e. Images show a lesion in the inner right breast (arrows). (a) Gradient-echo MR image and (b) T1 map calculated from echo-planar inversion-recovery (inversion time, 8 msec) MR images before contrast material injection. (c, d) Dynamic echo-planar inversion-recovery (inversion time, 160 msec) MR images obtained (c) before and (d) 12 seconds after contrast material injection with an area of signal loss in the inner right breast. (e) EFP color-encoded map calculated from the T1 map and dynamic echo-planar acquisitions shows an area with high EFP values in the inner right breast parenchyma. (f) Gradient-echo MR image obtained at the equilibrium of contrast material injection shows right breast tumor enhancement and bilateral small areas of physiologic focal enhancement. Invasive ductal carcinoma was proven at pathologic examination.

View larger version (89K): [in a new window]   Figure 3f. Images show a lesion in the inner right breast (arrows). (a) Gradient-echo MR image and (b) T1 map calculated from echo-planar inversion-recovery (inversion time, 8 msec) MR images before contrast material injection. (c, d) Dynamic echo-planar inversion-recovery (inversion time, 160 msec) MR images obtained (c) before and (d) 12 seconds after contrast material injection with an area of signal loss in the inner right breast. (e) EFP color-encoded map calculated from the T1 map and dynamic echo-planar acquisitions shows an area with high EFP values in the inner right breast parenchyma. (f) Gradient-echo MR image obtained at the equilibrium of contrast material injection shows right breast tumor enhancement and bilateral small areas of physiologic focal enhancement. Invasive ductal carcinoma was proven at pathologic examination.