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. 2014 Aug;40(2):476-82.
doi: 10.1002/jmri.24351. Epub 2013 Dec 18.

Optimized breast MRI functional tumor volume as a biomarker of recurrence-free survival following neoadjuvant chemotherapy

Nazia F Jafri  1 , David C Newitt, John Kornak, Laura J Esserman, Bonnie N Joe, Nola M Hylton
Affiliations

Optimized breast MRI functional tumor volume as a biomarker of recurrence-free survival following neoadjuvant chemotherapy

Nazia F Jafri et al. J Magn Reson Imaging. 2014 Aug.

Abstract

Purpose: To evaluate optimal contrast kinetics thresholds for measuring functional tumor volume (FTV) by breast magnetic resonance imaging (MRI) for assessment of recurrence-free survival (RFS).

Materials and methods: In this Institutional Review Board (IRB)-approved retrospective study of 64 patients (ages 29-72, median age of 48.6) undergoing neoadjuvant chemotherapy (NACT) for breast cancer, all patients underwent pre-MRI1 and postchemotherapy MRI4 of the breast. Tumor was defined as voxels meeting thresholds for early percent enhancement (PEthresh) and early-to-late signal enhancement ratio (SERthresh); and FTV (PEthresh, SERthresh) by summing all voxels meeting threshold criteria and minimum connectivity requirements. Ranges of PEthresh from 50% to 220% and SERthresh from 0.0 to 2.0 were evaluated. A Cox proportional hazard model determined associations between change in FTV over treatment and RFS at different PE and SER thresholds.

Results: The plot of hazard ratios for change in FTV from MRI1 to MRI4 showed a broad peak with the maximum hazard ratio and highest significance occurring at PE threshold of 70% and SER threshold of 1.0 (hazard ratio = 8.71, 95% confidence interval 2.86-25.5, P < 0.00015), indicating optimal model fit.

Conclusion: Enhancement thresholds affect the ability of MRI tumor volume to predict RFS. The value is robust over a wide range of thresholds, supporting the use of FTV as a biomarker.

Keywords: MRI breast functional tumor volume; SER/PE thresholds; neoadjuvant chemotherapy.

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Figures

Figure 1
Figure 1
Example of quantification method and tumor volume measurements based on varying threshold.
Figure 2
Figure 2
Diagrammatic representation of SER and PE calculations.
Figure 3
Figure 3
Recurrence-free survival. Graph demonstrating RFS in weeks.
Figure 4
Figure 4
P-values for percent change in FTV over treatment. P-values for model fit are depicted for combined PE (x-axis) and SER (z-axis) thresholds.
Figure 5
Figure 5
Hazard ratios for percent change in FTV over treatment. Hazard ratios are shown for combined PE (x-axis) and SER (z-axis) thresholds per unit change in percent change in FTV between the pretreatment MRI and presurgery MRI.
Figure 6
Figure 6
2D plot demonstrating the optimal PE and SER thresholds. The pink area demonstrates the threshold ranges with the highest hazard ratios (HR >80% of maximum) and most significant P-values (P < 0.001). Of note, there is narrower range of SER (~0.8–1.0) that can be used at a wide range of lower PE thresholds (~60%–80%), which resulted in the highest hazard ratios.
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