Breast Stromal Enhancement on MRI Is Associated with Response to Neoadjuvant Chemotherapy
Jona Hattangadi1,2,
Catherine Park2,
James Rembert2,
Catherine Klifa1,
Jimmy Hwang3,
Jessica Gibbs1 and
Nola Hylton1
1 Department of Radiology, Magnetic Resonance Science Center, 1 Irving St., Rm.
AC-109, Box 1290, University of California, San Francisco, San Francisco, CA
94143.
2 Department of Radiation Oncology, University of California, San Francisco, San
Francisco, CA.
3 Comprehensive Cancer Center, University of California, San Francisco, San
Francisco, CA.
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Fig. 1 —Analysis of kinetics with signal enhancement ratio. Graph
shows signal intensity (S) versus time (t). S0, S1, and
S2 represent signal intensity of images obtained at t0
(before contrast injection), t1 (2.5 minutes after contrast
injection), and t2 (7.5 minutes after contrast injection),
respectively. Three curves display different patterns of signal increase and
washout that are seen with time: bottom curve shows slow gradual increase in
enhancement, more characteristic of normal tissue; middle curve shows early
enhancement with little washout, essentially a plateau in signal intensity;
top curve shows pattern of early enhancement with quick washout, which is more
characteristic of highly vascularized tissue and neoangiogenic vessels. Signal
enhancement ratio is measured as the increase in signal intensity at
t1 relative to baseline (t0) divided by increase from
baseline to t2: (S1 -
S0)/(S2 - S0).
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Fig. 2B —Selection of regions of interest (ROIs) on dynamic
contrast-enhanced MRI in 42-year-old woman with invasive ductal carcinoma.
First contrast-enhanced MR image (at t1 [2.5 minutes after contrast
injection]) shows two sets of five ROIs, each 5 mm in diameter, extend
radially from tumor edge. The first ROI in one set was placed in visible tumor
(T) and next four ROIs were placed in normal-appearing breast fibroglandular
stroma (S). The second set of similarly placed ROIs was obtained along a
different radius for each scan if enough normal (nonenhancing) stroma was
present.
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Fig. 3 —Disease-free survival and recurrence among study population.
Graph shows disease-free survival distribution curve of entire patient cohort
(n = 42). There were 15 recurrences (35.7% of patients): 11 distant
metastases (26.2%) and four local recurrences (9.5%). Of the 15 patients with
recurrence, seven received taxane. There was no statistical difference in
recurrence rates based on taxane use.
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Fig. 4A —Stromal signal enhancement ratio and recurrence. Mean stromal
signal enhancement ratio values at scan 1 (pretreatment) and scan 2 (after one
cycle of chemotherapy) are shown: patients with recurrence (dark
gray) and patients without recurrence (light gray) (bar = mean
value ± 95% CI). Patients with recurrence had significantly lower mean
stromal signal enhancement ratio values of < 0.7 (p < 0.05,
chi-square test) than those without recurrence.
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Copyright © 2008 by the American Roentgen Ray Society.
), 10
had both scan 1 and scan 2 values. Of 27 patients without recurrence
(
), 23 had both scan 1 and scan 2 values.
0.7 (p = 0.012, log-rank test). Dotted line
=