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. 2021 Jul;54(1):251-260.
doi: 10.1002/jmri.27557. Epub 2021 Feb 15.

Functional Tumor Volume by Fast Dynamic Contrast-Enhanced MRI for Predicting Neoadjuvant Systemic Therapy Response in Triple-Negative Breast Cancer

Benjamin C Musall  1 , Abeer H Abdelhafez  2 , Beatriz E Adrada  2 , Rosalind P Candelaria  2 , Rania M M Mohamed  2 , Medine Boge  2 , Huong Le-Petross  2 , Elsa Arribas  2 , Deanna L Lane  2 , David A Spak  2 , Jessica W T Leung  2 , Ken-Pin Hwang  1 , Jong Bum Son  1 , Nabil A Elshafeey  2 , Hagar S Mahmoud  2 , Peng Wei  3 , Jia Sun  3 , Shu Zhang  4 , Jason B White  5 , Elizabeth E Ravenberg  5 , Jennifer K Litton  5 , Senthil Damodaran  5 , Alastair M Thompson  6 , Stacy L Moulder  5 , Wei T Yang  2 , Mark D Pagel  1   4 , Gaiane M Rauch  2   7 , Jingfei Ma  1
Affiliations

Functional Tumor Volume by Fast Dynamic Contrast-Enhanced MRI for Predicting Neoadjuvant Systemic Therapy Response in Triple-Negative Breast Cancer

Benjamin C Musall et al. J Magn Reson Imaging. 2021 Jul.

Abstract

Background: Dynamic contrast-enhanced (DCE) MRI is useful for diagnosis and assessment of treatment response in breast cancer. Fast DCE MRI offers a higher sampling rate of contrast enhancement curves in comparison to conventional DCE MRI, potentially characterizing tumor perfusion kinetics more accurately for measurement of functional tumor volume (FTV) as a predictor of treatment response.

Purpose: To investigate FTV by fast DCE MRI as a predictor of neoadjuvant systemic therapy (NAST) response in triple-negative breast cancer (TNBC).

Study type: Prospective.

Population/subjects: Sixty patients with biopsy-confirmed TNBC between December 2016 and September 2020.

Field strength/sequence: A 3.0 T/3D fast spoiled gradient echo-based DCE MRI ASSESSMENT: Patients underwent MRI at baseline and after four cycles (C4) of NAST, followed by definitive surgery. DCE subtraction images were analyzed in consensus by two breast radiologists with 5 (A.H.A.) and 2 (H.S.M.) years of experience. Tumor volumes (TV) were measured on early and late subtractions. Tumors were segmented on 1 and 2.5-minute early phases subtractions and FTV was determined using optimized signal enhancement thresholds. Interpolated enhancement curves from segmented voxels were used to determine optimal early phase timing.

Statistical tests: Tumor volumes were compared between patients who had a pathologic complete response (pCR) and those who did not using the area under the receiver operating curve (AUC) and Mann-Whitney U test.

Results: About 26 of 60 patients (43%) had pCR. FTV at 1 minute after injection at C4 provided the best discrimination between pCR and non-pCR, with AUC (95% confidence interval [CI]) = 0.85 (0.74,0.95) (P < 0.05). The 1-minute timing was optimal for FTV measurements at C4 and for the change between C4 and baseline. TV from the early phase at C4 also yielded a good AUC (95%CI) of 0.82 (0.71,0.93) (P < 0.05).

Data conclusion: FTV and TV measured at 1 minute after injection can predict response to NAST in TNBC.

Level of evidence: 1 TECHNICAL EFFICACY: 4.

Keywords: DCE MRI; Triple-negative breast cancer; breast MRI; functional tumor volume; treatment response.

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Figures

FIGURE 1:
FIGURE 1:
Examples of tumor volume measurements in a 52-year-old woman with triple-negative breast cancer in her left breast: (a) tumor volume dimensions, (b) segmented enhanced tumor volume, and (c) enhancement threshold-based functional tumor volume in blue at percentage enhancement >130% and signal enhancement ratio > 1.1.
FIGURE 2:
FIGURE 2:
Map of fast dynamic contrast-enhanced MRI data flow, processing, and segmentation for volume measurements: (a) tumor volume by 3D measurements (TV), (b) enhanced tumor volume (ETV) and functional tumor volume (FTV) from early phase segmentations, with percentage enhancement (PE) and signal enhancement ratio (SER) thresholds applied for FTV, and (c) FTV with optimization of early phase timing.
FIGURE 3:
FIGURE 3:
Comparison of tumor volume (TV) by 3D measurements from early phase and late phase measurements (a,c,e) and enhanced tumor volume (ETV) from 1-minute and 2.5-minute early phase timings (b,d,f) between patients who had a pathologic complete response (pCR) and those who did not, at the baseline (BL) scan (a,b), cycle 4 (C4) scan (c,d), and %C4/BL (e,f).
FIGURE 4:
FIGURE 4:
Comparison of functional tumor volume (FTV) optimization contour plots between 1-minute and 2.5-minute early phase timings for the baseline (BL) scan (a), cycle 4 (C4) scan (c), and %C4/BL (e). Peak AUC for each plot is marked with a red dot. Dot plots are also shown, comparing optimal FTV between patients who had a pathologic complete response (pCR) and those who did not for each early phase timing at BL scan (b), C4 scan (d), and %C4/BL (f).
FIGURE 5:
FIGURE 5:
Comparison of functional tumor volume (FTV) optimization contour plots between different early phase timings for FTVOpt at baseline (BL) scan (a), cycle 4 (C4) scan (b), and the relative change (%C4/BL) between the two scans (c). AUC = area under the receiver operating characteristic curve, PE = percentage enhancement, SER = signal enhancement ratio.
See this image and copyright information in PMC

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