A quantitative dynamic contrast-enhanced MR imaging method has been developed to assess treatment response to neoadjuvant chemotherapy in patients with breast cancer by using standard clinical dynamic contrast-enhanced MR imaging data without measuring either arterial input function or baseline T1.
To develop a method that combines a fixed-T1, fuzzy c-means (FCM) technique with a reference region (RR) model (T1-FCM method) to estimate pharmacokinetic parameters without measuring the arterial input function or baseline T1, or T1(0), and to demonstrate its feasibility in the assessment of treatment response to neoadjuvant chemotherapy (NAC) in patients with breast cancer by using data from dynamic contrast material–enhanced magnetic resonance (MR) imaging.
Materials and Methods
This study was approved by the human investigation committees of the two participating institutions. All patients gave written informed consent. A conventional dual-flip-angle gradient-echo method was used to evaluate the effects of noise and the T1 in the tissue itself on the accuracy of T1 estimation. Both conventional RR and fixed-T1 methods were used to evaluate the effects of noise and preselected T1(0) on the estimation of pharmacokinetic parameters by means of a simulation study. Thirty-three women (age range, 32–66 years; mean age, 45 years) with pathologically proved breast tumors were examined to evaluate the feasibility of using the T1-FCM method as a means of assessing treatment response to NAC. A nonparametric Mann-Whitney U test was used to assess the difference in each of the MR imaging parameters between patients with a major histologic response to treatment and those with a nonmajor histologic response.
With use of the dual-flip-angle method, the accuracy and distribution of T1 estimation are dependent on the T1 in the tissue itself. The T1-FCM method is more accurate than other methods and is relatively insensitive to the effects of noise and incorrect T1(0) selection. Preliminary clinical data revealed a significant difference (P < .01) in the change of the volume transfer constant after two cycles of NAC between the major and nonmajor histologic response groups.
Results of the simulation study demonstrate that the T1-FCM method appears to be relatively insensitive to noisy dynamic contrast-enhanced MR imaging data. This method could prove useful in the evaluation of breast cancer therapy.
© RSNA, 2010
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Article HistoryReceived November 18, 2009; revision requested January 12, 2010; revision received April 1; accepted April 19; final version accepted May 19.
Published online: Oct 2010
Published in print: Oct 2010