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Dynamic Contrast-Enhanced MRI for Prediction of Breast Cancer Response to Neoadjuvant Chemotherapy: Initial Results

¹ Department of Radiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
² Department of Medical Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
³ Department of Pathology, Netherlands Cancer Institute and Amsterdam Medical Centre, Amsterdam, The Netherlands.
⁴ Department of Surgery, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.

View larger version (97K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —Assessment of initial and late enhancement before initiating chemotherapy in 49-year-old woman. Simultaneous viewing of subtracted images for initial enhancement (A–C) and late enhancement (D–F) in sagittal (A, D), axial (B, E), and coronal (C, F) planes. Shown are measurements of largest tumor diameter of late enhancement in three planes containing tumor with necrotic core.

View larger version (87K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —Assessment of initial and late enhancement before initiating chemotherapy in 49-year-old woman. Simultaneous viewing of subtracted images for initial enhancement (A–C) and late enhancement (D–F) in sagittal (A, D), axial (B, E), and coronal (C, F) planes. Shown are measurements of largest tumor diameter of late enhancement in three planes containing tumor with necrotic core.

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —Assessment of initial and late enhancement before initiating chemotherapy in 49-year-old woman. Simultaneous viewing of subtracted images for initial enhancement (A–C) and late enhancement (D–F) in sagittal (A, D), axial (B, E), and coronal (C, F) planes. Shown are measurements of largest tumor diameter of late enhancement in three planes containing tumor with necrotic core.

View larger version (110K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —Assessment of initial and late enhancement before initiating chemotherapy in 49-year-old woman. Simultaneous viewing of subtracted images for initial enhancement (A–C) and late enhancement (D–F) in sagittal (A, D), axial (B, E), and coronal (C, F) planes. Shown are measurements of largest tumor diameter of late enhancement in three planes containing tumor with necrotic core.

View larger version (108K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1E —Assessment of initial and late enhancement before initiating chemotherapy in 49-year-old woman. Simultaneous viewing of subtracted images for initial enhancement (A–C) and late enhancement (D–F) in sagittal (A, D), axial (B, E), and coronal (C, F) planes. Shown are measurements of largest tumor diameter of late enhancement in three planes containing tumor with necrotic core.

View larger version (115K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1F —Assessment of initial and late enhancement before initiating chemotherapy in 49-year-old woman. Simultaneous viewing of subtracted images for initial enhancement (A–C) and late enhancement (D–F) in sagittal (A, D), axial (B, E), and coronal (C, F) planes. Shown are measurements of largest tumor diameter of late enhancement in three planes containing tumor with necrotic core.

View larger version (32K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2 —Flow diagram shows change of largest diameter of late enhancement in tumor on MRI scan 2 relative to MRI scan 1 (LDlate2–1) of 54 tumors divided into two groups. Upper arm shows group with at least 25% LDlate2–1; lower arm shows group < 25% LDlate2–1. Complete remission at pathology occurred in 15 patients, incomplete remission (residual tumor at pathology) in 39.

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Example of favorable response predicted by MRI in 48-year-old woman. Shown are largest diameter of late enhancement (LDlate) in tumor (dark area) in sagittal (A, D), axial (B, E), and coronal (C, F) planes before chemotherapy (MRI scan 1, A–C) and after two courses of chemotherapy (MRI scan 2, D–F). LDlate at MRI scan 1 is 28 mm and at MRI scan 2 is 11 mm. Percentage of difference, LDlate2–1, = [(28 – 11) / 28] x 100% = 61% reduction. Favorable response is to be anticipated according to MRI response prediction test. After chemotherapy was completed, final pathology showed complete remission.

View larger version (120K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Example of favorable response predicted by MRI in 48-year-old woman. Shown are largest diameter of late enhancement (LDlate) in tumor (dark area) in sagittal (A, D), axial (B, E), and coronal (C, F) planes before chemotherapy (MRI scan 1, A–C) and after two courses of chemotherapy (MRI scan 2, D–F). LDlate at MRI scan 1 is 28 mm and at MRI scan 2 is 11 mm. Percentage of difference, LDlate2–1, = [(28 – 11) / 28] x 100% = 61% reduction. Favorable response is to be anticipated according to MRI response prediction test. After chemotherapy was completed, final pathology showed complete remission.

View larger version (114K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —Example of favorable response predicted by MRI in 48-year-old woman. Shown are largest diameter of late enhancement (LDlate) in tumor (dark area) in sagittal (A, D), axial (B, E), and coronal (C, F) planes before chemotherapy (MRI scan 1, A–C) and after two courses of chemotherapy (MRI scan 2, D–F). LDlate at MRI scan 1 is 28 mm and at MRI scan 2 is 11 mm. Percentage of difference, LDlate2–1, = [(28 – 11) / 28] x 100% = 61% reduction. Favorable response is to be anticipated according to MRI response prediction test. After chemotherapy was completed, final pathology showed complete remission.

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —Example of favorable response predicted by MRI in 48-year-old woman. Shown are largest diameter of late enhancement (LDlate) in tumor (dark area) in sagittal (A, D), axial (B, E), and coronal (C, F) planes before chemotherapy (MRI scan 1, A–C) and after two courses of chemotherapy (MRI scan 2, D–F). LDlate at MRI scan 1 is 28 mm and at MRI scan 2 is 11 mm. Percentage of difference, LDlate2–1, = [(28 – 11) / 28] x 100% = 61% reduction. Favorable response is to be anticipated according to MRI response prediction test. After chemotherapy was completed, final pathology showed complete remission.

View larger version (140K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3E —Example of favorable response predicted by MRI in 48-year-old woman. Shown are largest diameter of late enhancement (LDlate) in tumor (dark area) in sagittal (A, D), axial (B, E), and coronal (C, F) planes before chemotherapy (MRI scan 1, A–C) and after two courses of chemotherapy (MRI scan 2, D–F). LDlate at MRI scan 1 is 28 mm and at MRI scan 2 is 11 mm. Percentage of difference, LDlate2–1, = [(28 – 11) / 28] x 100% = 61% reduction. Favorable response is to be anticipated according to MRI response prediction test. After chemotherapy was completed, final pathology showed complete remission.

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3F —Example of favorable response predicted by MRI in 48-year-old woman. Shown are largest diameter of late enhancement (LDlate) in tumor (dark area) in sagittal (A, D), axial (B, E), and coronal (C, F) planes before chemotherapy (MRI scan 1, A–C) and after two courses of chemotherapy (MRI scan 2, D–F). LDlate at MRI scan 1 is 28 mm and at MRI scan 2 is 11 mm. Percentage of difference, LDlate2–1, = [(28 – 11) / 28] x 100% = 61% reduction. Favorable response is to be anticipated according to MRI response prediction test. After chemotherapy was completed, final pathology showed complete remission.

View larger version (174K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —Example of unfavorable response predicted by MRI in 48-year-old woman. Shown are largest diameter of late enhancement (LDlate) in tumor (dark area) in sagittal (A, D), axial (B, E), and coronal (C, F) planes before chemotherapy (MRI scan 1, A–C) and after two courses of chemotherapy (MRI scan 2, D–F). LDlate at MRI scan 1 is 37 mm and at MRI scan 2 is 32 mm. Percentage of difference, LDlate2–1, = [(37 – 32) / 37] x 100% = 14% reduction. Unfavorable response is to be anticipated according to MRI response prediction test. After chemotherapy was completed, final pathology showed residual tumor.

View larger version (124K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —Example of unfavorable response predicted by MRI in 48-year-old woman. Shown are largest diameter of late enhancement (LDlate) in tumor (dark area) in sagittal (A, D), axial (B, E), and coronal (C, F) planes before chemotherapy (MRI scan 1, A–C) and after two courses of chemotherapy (MRI scan 2, D–F). LDlate at MRI scan 1 is 37 mm and at MRI scan 2 is 32 mm. Percentage of difference, LDlate2–1, = [(37 – 32) / 37] x 100% = 14% reduction. Unfavorable response is to be anticipated according to MRI response prediction test. After chemotherapy was completed, final pathology showed residual tumor.

View larger version (135K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —Example of unfavorable response predicted by MRI in 48-year-old woman. Shown are largest diameter of late enhancement (LDlate) in tumor (dark area) in sagittal (A, D), axial (B, E), and coronal (C, F) planes before chemotherapy (MRI scan 1, A–C) and after two courses of chemotherapy (MRI scan 2, D–F). LDlate at MRI scan 1 is 37 mm and at MRI scan 2 is 32 mm. Percentage of difference, LDlate2–1, = [(37 – 32) / 37] x 100% = 14% reduction. Unfavorable response is to be anticipated according to MRI response prediction test. After chemotherapy was completed, final pathology showed residual tumor.

View larger version (150K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4D —Example of unfavorable response predicted by MRI in 48-year-old woman. Shown are largest diameter of late enhancement (LDlate) in tumor (dark area) in sagittal (A, D), axial (B, E), and coronal (C, F) planes before chemotherapy (MRI scan 1, A–C) and after two courses of chemotherapy (MRI scan 2, D–F). LDlate at MRI scan 1 is 37 mm and at MRI scan 2 is 32 mm. Percentage of difference, LDlate2–1, = [(37 – 32) / 37] x 100% = 14% reduction. Unfavorable response is to be anticipated according to MRI response prediction test. After chemotherapy was completed, final pathology showed residual tumor.

View larger version (114K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4E —Example of unfavorable response predicted by MRI in 48-year-old woman. Shown are largest diameter of late enhancement (LDlate) in tumor (dark area) in sagittal (A, D), axial (B, E), and coronal (C, F) planes before chemotherapy (MRI scan 1, A–C) and after two courses of chemotherapy (MRI scan 2, D–F). LDlate at MRI scan 1 is 37 mm and at MRI scan 2 is 32 mm. Percentage of difference, LDlate2–1, = [(37 – 32) / 37] x 100% = 14% reduction. Unfavorable response is to be anticipated according to MRI response prediction test. After chemotherapy was completed, final pathology showed residual tumor.

View larger version (111K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4F —Example of unfavorable response predicted by MRI in 48-year-old woman. Shown are largest diameter of late enhancement (LDlate) in tumor (dark area) in sagittal (A, D), axial (B, E), and coronal (C, F) planes before chemotherapy (MRI scan 1, A–C) and after two courses of chemotherapy (MRI scan 2, D–F). LDlate at MRI scan 1 is 37 mm and at MRI scan 2 is 32 mm. Percentage of difference, LDlate2–1, = [(37 – 32) / 37] x 100% = 14% reduction. Unfavorable response is to be anticipated according to MRI response prediction test. After chemotherapy was completed, final pathology showed residual tumor.

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