| [Objective]:To investigate whether texture analysis based on contrast-enhanced MRI can predict treatment response in locally advanced breast cancer undergoing neoadjuvant chemotherapy(NAC).[Methods]:Forty-seven breast cancer patients who had undergone neoadjuvant chemotherapy from January 2015 to February 2016 were retrospectively enrolled.All of them received breast MR examination at the baseline and were repeatedly scanned after the second cycle of NAC.Subjects were divided into pathological complete response(pCR)and non-pathological complete response(non-pCR)groups according to the surgical pathologic specimen.Their parameters of texture analysis base on MRI before neoadjuvant chemotherapy and after 2 cycles of the treatment were analyzed.Parameters(Energy,Entropy,Inertia,Correlation,Inverse Difference Moment)before and after 2 cycles of NAC and their corresponding change rate(Aparameter)between pCR and non-pCR groups were compared using the Student t test or Wilcoxon rank sum test.Normally distributed data are presented as mean±standard deviation,while non-normal data are presented as median and interquartile range.The diagnostic performance of different parameters was judged by the receiver-operating characteristic curve analysis.[Results]:The post-treatment value was significantly different from the pre-treatment value(all P<0.05).Pre-treatment parameters(Energy,Entropy,Inertia,Correlation,Inverse Difference Moment)were 78.58×10-5,(55.64×10-5,135.23×10-5),10.06±1.02,7993.91±2428.10,(4.76±0.99)×10-5 and(18.10±4.13)×10-3 in pCR group and 76.84×10-5(48.68×10-5,154.15×10-5),10.28±1.26,7184.77(4938.03,9974.04),(5.21±2.01)×10-5 and(17.68±5.87)×10-3 in non-pCR group.No significant difference was found between two groups.At the end of the second cycle of NAC,the parameters(Energy,Entropy,Inertia,Correlation,Inverse Difference Moment)were(542.11±361.04)×10-5,7.95±1.28,16765.08±9706.56,(0.43±0.07)×10-5and(12.18±9.82)×10-3 in pCR group,and133.00×10-5(79.80×10-5,239.00×10-5),9.29±1.46,7916.64(6418.89,10934.40),(0.38±0.08)×10-5and(14.80±5.06)×10-3in non-pCR group.At the end of the second cycle of NAC,there was significant difference in the parameters(Energy,Entropy,Inertia,Correlation)andAparameters(? Energy,? Entropy,? Inertia,? Inverse Difference Moment)between the pCR and non-pCR group(P<0.05).The AUCs(area under the curve)of mid-treatment parameters were larger than that of pre-treatment parameters.Except that of ? correlation,the AUCs of the other ? parameters were higher than that of mid-treatment parameters.The AUCs of pre-treatment correlation,mid-treatment Energy&Entropy and AEntropy were 0.56,0.77,and 0.81 respectively.Sensitivity of the three parameters for predicting pCR were 91.67%,83.33%and 75.00%,and specificity were 34.29%,77.14%and 85.71%.[Conclusion]:Texture analysis based on dynamic contrast enhanced MRI can predict early treatment response in primary breast cancers.Parameters(Energy,Entropy,Inertia,Correlation)after 2 cycles of NAC can be used to distinguish pCR from non-pCR.? Entropy had excellent diagnostic performance.[Objective]:To compare intravoxel incoherent model(IVIM)diffusion weighted imaging(DWI)and quantitative dynamic contrast-enhanced(DCE)magnetic resonance imaging(MRI)for early prediction of breast cancer response to neoadjuvant chemotherapy.[Methods]:Twenty-eight patients with locally advanced breast cancer who had undergone neoadjuvant chemotherapy from June 2015 to June 2016 were enrolled.All of them were imaged using multiple-b DWI with 12 b values and dynamic contrast-enhanced MRI with 38 phases(10 seconds per phase)at the baseline and were repeatedly scanned after the first cycle of NAC.GE AW 4.6 workstation was used to automatically calculate the value of D,D*and f derived from IVIM model and that of Ktrans,Kep and Ve derived from DCE-MRI.ROIs were manually drawn.The level of maximum transverse diameter of the breast lesion was located,encompassing as much of the tumor area as possible,and avoiding the obvious necrotic,hemorrhagic,and cystic areas.Subjects were divided into major histological response(MHR)group and non-major histological response(NMHR)group according to the surgical pathologic specimen.All parameters between MHR group and NMHR group were compared by Student t test or nonparametric test.The diagnostic performance of different parameters(including D,D*,f,Ktrans,Kep and Ve)was judged by the receiver-operating characteristic curve analysis.[Results]:There was no significant difference in all pre-treatment parameters(including D,D*and f)derived from IVIM model or DCE-MRI(including Ktrans,Kep and Ve)between MHR group and NMHR group(p>0.05).Before NAC,AUCs of D*,f and D were 0.632,0.614,0.570 respectively.At the end of the first cycle of NAC,the D value was higher than that of the baseline(P<0.001),whereas the D*value and f value were lower than that of the baseline(P>0.05).After one cycle of NAC,there was no significant difference in D,D*and f value between the MHR group and NMHR group(P>0.05).Before NAC,AUCs of Ve,Ktrans and Kep were 0.716,0.591 and 0.538 respectively.At the end of the first cycle of NAC,the Ktrans value and Kep value were significantly lower than that of the baseline(P<0.05).After one cycle of NAC,the prediction performance of D*derived from IVIM model and Ktrans&Kep derived from DCE-MRI markedly increased compared with that of the baseline.The prediction performance of mid-treatment Ktrans value was the highest(AUC=0.749,[95%confidence interval=0.550-0.892]).When the optimal cut-off was set at 0.202,the values for sensitivity and specificity were up to 100.00%and 63.16%.[Conclusion]:Before NAC,all the parameters of IVIM model and quantitative DCE-MRI parameters can not predict treatment response.After one cycle of NAC,IVIM-derived parameters can not distinguish MHR group from NMHR group.At the end of the first cycle of NAC,quantitative DCE-MRI parameters show potential value in the monitoring early response to NAC in locally advanced breast cancer.Ktrans value had the best prediction performance for major histologic response after NAC.[Objective]:To investigate whether a correlation between perfusion parameters obtained from dynamic contrast-enhanced(DCE)magnetic resonance imaging(MRI)and immunohistochemical subtypes of breast cancers[Methods]:91 patients who had newly diagnosed breast cancers on core biopsies from May 2014 to May 2016 were enrolled.The estrogen(ER),progesterone(PR),and HER2 hormonal receptor subtypes were evaluated by immunohistochemistry(IHC)SP method.those of HER-2(++)were further tested by fluorescence in situ hybridization(FISH)analysis.Subtypes based on the immunohistochemical profile were categorized as follows:luminal A,Luminal B,tripel negative,and HER2 overexpressing.Before core biopsies,all patients underwent MRI examination using dedicated dynamic contrast-enhanced MRI sequence(38 phases in all,10s per phase).Quantitative parameters(Ktrans,Kep,Ve)of 91 patients were obtained using DCE-MRI as a postprocessing procedure on GE AW 4.6 work station.The level of maximum transverse diameter of the breast lesion was located,encompassing as much of the tumor area as possible,and avoiding the obvious necrotic,hemorrhagic,and cystic areas.the distributions of the perfusion parameters between groups according to immunonistochemical subtype were compared using the Kruskal-Wallis test,and the Mann-Whitney U-test was used for pairwise comparisons.Statistical significance was assigned if the P-value was less than 0.05.[Results]:Finally,91 cases(mean age,46.09±10.95 years)were included for data analysis.In terms of menopausal status,57 patients were premenopausal women,and 34 patients were postmenopausal women.35cases received radical mastectomy or breast-conserving surgery according to personal selection.56 cases had accepted a completed NAC and subsequently received either breast conserving surgery with axillary nodal clearance or modified radical mastectomy.The luminal-A,luminal-B,HER-2-enriched and triple-negative subtype accounted for 7(7.7%),59(64.8%),10(10.9%),and 15 cases(16.6%)respectively.There was association between unifocal lesions or tumor size and different subtypes of breast cancer(p<0.05).The multicentric lesions are more frequently detected in HER-2-enriched subtype,with 50%.Women with luminal-1 subtype were more likely to have small tumors(71.4%).There was no significant differences between the quantitative dynamic contast-enhanced MRI parameters and different receptors status(P>0.05).No significant difference was observed in the assessment of quantitative dynamic contast-enhanced MRI parameters between tumor subtypes.A total of 56 NAC-treated patients were included in the study.Fourteen patients(25.0%)achieved a pCR and forty-two patients(75.0%)achieved a non-pCR after NAC treatment.The luminal,HER-2-enriched and triple-negative subtype accounted for 35(62.5%),8(14.3%),and 13 cases(10.9%)respectively.Eight patients(22.9%)with luminal subtype reached a pCR and five patients(50%)with HER2 enriched reached a pCR.[Conclusion]:The multicentric lesions are more frequently detected in HER-2-enriched subtype.Luminal-A presented more often with small size(71.4%)than the others tumors.Quantitative DCE-MRI parameters show limited value in differentiation of different receptor status or different subtypes.Different subtypes differ in response to chemotherapy. |
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