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European Radiology
Published in: European Radiology 7/2017

Open Access 01-07-2017 | Breast

Assessment of early treatment response to neoadjuvant chemotherapy in breast cancer using non-mono-exponential diffusion models: a feasibility study comparing the baseline and mid-treatment MRI examinations

Authors: Reem Bedair, Andrew N. Priest, Andrew J. Patterson, Mary A. McLean, Martin J. Graves, Roido Manavaki, Andrew B. Gill, Oshaani Abeyakoon, John R. Griffiths, Fiona J. Gilbert

Published in: European Radiology | Issue 7/2017

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Abstract

Objectives

To assess the feasibility of the mono-exponential, bi-exponential and stretched-exponential models in evaluating response of breast tumours to neoadjuvant chemotherapy (NACT) at 3 T.

Methods

Thirty-six female patients (median age 53, range 32–75 years) with invasive breast cancer undergoing NACT were enrolled for diffusion-weighted MRI (DW-MRI) prior to the start of treatment. For assessment of early response, changes in parameters were evaluated on mid-treatment MRI in 22 patients. DW-MRI was performed using eight b values (0, 30, 60, 90, 120, 300, 600, 900 s/mm2). Apparent diffusion coefficient (ADC), tissue diffusion coefficient (D t), vascular fraction (ƒ), distributed diffusion coefficient (DDC) and alpha (α) parameters were derived. Then t tests compared the baseline and changes in parameters between response groups. Repeatability was assessed at inter- and intraobserver levels.

Results

All patients underwent baseline MRI whereas 22 lesions were available at mid-treatment. At pretreatment, mean diffusion coefficients demonstrated significant differences between groups (p < 0.05). At mid-treatment, percentage increase in ADC and DDC showed significant differences between responders (49 % and 43 %) and non-responders (21 % and 32 %) (p = 0.03, p = 0.04). Overall, stretched-exponential parameters showed excellent repeatability.

Conclusion

DW-MRI is sensitive to baseline and early treatment changes in breast cancer using non-mono-exponential models, and the stretched-exponential model can potentially monitor such changes.

Key points

• Baseline diffusion coefficients demonstrated significant differences between complete pathological responders and non-responders.
• Increase in ADC and DDC at mid-treatment can discriminate responders and non-responders.
• The ƒ fraction at mid-treatment decreased in responders whereas increased in non-responders.
• The mono- and stretched-exponential models showed excellent inter- and intrarater repeatability.
• Treatment effects can potentially be assessed by non-mono-exponential diffusion models.
Appendix
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Metadata
Title
Assessment of early treatment response to neoadjuvant chemotherapy in breast cancer using non-mono-exponential diffusion models: a feasibility study comparing the baseline and mid-treatment MRI examinations
Authors
Reem Bedair
Andrew N. Priest
Andrew J. Patterson
Mary A. McLean
Martin J. Graves
Roido Manavaki
Andrew B. Gill
Oshaani Abeyakoon
John R. Griffiths
Fiona J. Gilbert
Publication date
01-07-2017
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 7/2017
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-016-4630-x

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