The rate of breast fibroglandular enhancement during dynamic contrast-enhanced MRI reflects response to neoadjuvant therapy

John Virostko; Garrett Kuketz; Erin Higgins; Chengyue Wu; Anna G Sorace; Julie C DiCarlo; Sarah Avery; Debra Patt; Boone Goodgame; Thomas E Yankeelov

doi:10.1016/j.ejrad.2021.109534

The rate of breast fibroglandular enhancement during dynamic contrast-enhanced MRI reflects response to neoadjuvant therapy

Eur J Radiol. 2021 Mar:136:109534. doi: 10.1016/j.ejrad.2021.109534. Epub 2021 Jan 9.

Authors

Affiliations

¹ Department of Diagnostic Medicine, University of Texas at Austin, Austin, TX, USA; Livestrong Cancer Institutes, University of Texas at Austin, Austin, TX, USA; Department of Oncology, University of Texas at Austin, Austin, TX, USA. Electronic address: jack.virostko@austin.utexas.edu.
² Department of Biomedical Engineering, University of Texas at Austin, Austin, TX, USA.
³ Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL, USA; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.
⁴ Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, TX, USA.
⁵ Austin Radiological Association, Austin, TX, USA.
⁶ Texas Oncology, Austin, TX, USA.
⁷ Seton Hospital, Austin, TX, USA; Department of Internal Medicine, University of Texas at Austin, Austin, TX, USA.
⁸ Department of Diagnostic Medicine, University of Texas at Austin, Austin, TX, USA; Livestrong Cancer Institutes, University of Texas at Austin, Austin, TX, USA; Department of Oncology, University of Texas at Austin, Austin, TX, USA; Department of Biomedical Engineering, University of Texas at Austin, Austin, TX, USA; Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, TX, USA; Department of Imaging Physics, MD Anderson Cancer Center, Houston, TX, USA.

Abstract

Purpose: This study assesses the rate of enhancement of breast fibroglandular tissue after administration of a magnetic resonance imaging (MRI) gadolinium-based contrast agent and determines its relationship with response to neoadjuvant therapy (NAT) in women with breast cancer.

Method: Women with locally advanced breast cancer (N = 19) were imaged four times over the course of NAT. Dynamic contrast-enhanced (DCE) MRI was acquired after administration of a gadolinium-based contrast agent with a temporal resolution of 7.27 s. The tumor, fibroglandular tissue, and adipose tissue were semi-automatically segmented using a manually drawn region of interest encompassing the tumor followed by fuzzy c-means clustering. The rate and relative intensity of signal enhancement were calculated for each voxel within the tumor and fibroglandular tissue.

Results: The rate of fibroglandular tissue enhancement after contrast agent injection declined by an average of 29 % over the course of NAT. This decline was present in 16 of the 19 patients in the study. The rate of enhancement is significantly higher in women who achieve pathological complete response (pCR) after both 1 cycle (68 % higher, p < 0.05) and after 3-5 cycles of NAT (58 % higher; p < 0.05). The relative intensity of fibroglandular enhancement correlates with the rate of enhancement (R² = 0.64, p < 0.001) and is higher in women who achieve pCR after both 1 cycle and after 3-5 cycles of NAT (p < 0.05, both timepoints).

Conclusion: The rate of fibroglandular tissue enhancement declines over the course of therapy, provides novel information not reflected by tumoral measures, and may predict pathological response early in the course of therapy, with smaller declines in enhancement in women who achieve favorable response.

Keywords: BPE; Breast cancer; Fibroglandular; Ipsilateral; NAT.

MeSH terms

Breast / diagnostic imaging
Breast Neoplasms* / diagnostic imaging
Breast Neoplasms* / drug therapy
Contrast Media
Female
Humans
Magnetic Resonance Imaging
Neoadjuvant Therapy*

Substances

Contrast Media

Abstract

MeSH terms

Substances

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