| Objective:To determine whether ADC, the semi-quantitative parameters and tCho integral and their changes could be applied to predict pathologic response before, during and after neoadjuvant chemotherapy of locally advanced breast. To assess the diagnositic performance of each parameter.Materials and methods:Routine plain scan, diffusion weighted imaging, dynamic contrast enhancement and magnetic resonance spectroscopy were performed in28women with histology proven breast cancer prior to NAC, following the first cycle of NAC and after the NAC. Imaging were obtained by using a T1WI3D fast low angle shot (3D FLASH) sequence, a T2WI short TI inversion recovery (STIR) sequence, a single shot echo plannar imaging (SS-EPI) sequence and a T1WI fast low angle shot3D fat-suppressed sequence before the injection of Gd-DTPA and saline. In each patient, seven sets of T1WI3D fast low angle shot fat-suppressed images were acquired immediately after injection. MR spectroscopy were performed after the DCE-MRI, the volume of interest was positioned within the first set image of DCE-MRI, CSI and SVS was performed. All postprocessing was completed using Siemens Sygno workstation. Statistical analysis was performed with SPSS17.0. All (?) were divided into MHR (major histological response) group and NMHR (non-major histological response) group by methods of Miller and Payne system according to the final pathologic response. Pre-and post-treatment measurements and changes in tumor size, ADC values, semi-quantitative parameters and tCho integral in MHR versus NMHR were analyzed using Mann-Whitney U test. Receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic performance of each parameter, identify which parameter could be used to predict the pathologic response to neoadjuvant chemotherapy and find the optimal cut off value for MHR prediction.Results:After NAC,15patients showed MHR and13showed NMHR. Before and after one cycle of NAC, lesion’s maximum diameters、ADC values (ADCmean、 ADCmin)、the semi-quantitative parameters (Ee、Emax、Smax、Ewash) and tCho integral (CSI、SVS) between the two groups had no difference (P>0.05). After NAC, all parameters were significant different between the MHR and NMHR groups (P<0.05), except for Emax. The change rate of all parameters after one cycle of NAC between the two groups had no difference(P>0.05), the change rate of all parameters after NAC were significant different between the two groups (P<0.05)All parameters between two groups at different time point were analyzed using ROC. Using0.94×10-3mm2/s of ADCmin after NAC as the cut off value, prediction of MHR with sensitivity and specificity was93.3%and92.3%, respectively. The change rate of all parameters after NAC can actively diagnosis the MHR according ROC. Using54.26%of the change rate of tCho integral (SVS) after NAC as the cut off value, prediction of MHR with sensitivity and specificity was100%and85.7%, respectively. The△ADCmin2%is better than△ADCmean2%, the AUC were0.908and0.892; among the semi-quantitative parameters,△Ewash2%(AUC=0.918)>△Smax2%(AUC=0.856)>△Ee2%(AUC=0.831)>△Emax2%(AUC=0.754).Conclusion:1、The time point to early evaluating the response to neoadjuvant chemotherapy of breast cancer need more research.2、After NAC, ADCmin can actively diagnosis the MHR, using0.94×10-3mm2/s as the cut off value, prediction of MHR with sensitivity and specificity was93.3%and92.3%, respectively.3、Magnetic resonance spectroscopy can diagnosis the response to neoadjuvant chemotherapy, especially the single voxel spectroscopy, using54.26%of the change rate of tCho integral after NAC as the cut off value, prediction of MHR with sensitivity and specificity was100%and85.7%, respectively.4、After NAC, the△ADCmin2%is better than△ADCmean2%, the AUC were0.908and0.892; among the semi-quantitative parameters,△Ewash2%(AUC=0.918)>△Smax2%(AUC=0.856)>△Ee2%(AUC=0.831)>△Emax2%(AUC=0.754)... |
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