Dynamic Contrast-enhanced and Diffusion-weighted Magnetic Resonance Imaging for Response Evaluation After Single-Dose Ablative Neoadjuvant Partial Breast Irradiation

Jeanine E Vasmel; Maureen L Groot Koerkamp; Stefano Mandija; Wouter B Veldhuis; Maaike R Moman; Martijn Froeling; Bas H M van der Velden; Ramona K Charaghvandi; Celien P H Vreuls; Paul J van Diest; A M Gijs van Leeuwen; Joost van Gorp; Marielle E P Philippens; Bram van Asselen; Jan J W Lagendijk; Helena M Verkooijen; H J G Desirée van den Bongard; Antonetta C Houweling

doi:10.1016/j.adro.2021.100854

Dynamic Contrast-enhanced and Diffusion-weighted Magnetic Resonance Imaging for Response Evaluation After Single-Dose Ablative Neoadjuvant Partial Breast Irradiation

Adv Radiat Oncol. 2021 Nov 20;7(2):100854. doi: 10.1016/j.adro.2021.100854. eCollection 2022 Mar-Apr.

Authors

Jeanine E Vasmel¹, Maureen L Groot Koerkamp¹, Stefano Mandija^{1

2}, Wouter B Veldhuis³, Maaike R Moman³, Martijn Froeling³, Bas H M van der Velden⁴, Ramona K Charaghvandi⁵, Celien P H Vreuls⁶, Paul J van Diest⁶, A M Gijs van Leeuwen⁷, Joost van Gorp⁷, Marielle E P Philippens¹, Bram van Asselen¹, Jan J W Lagendijk¹, Helena M Verkooijen^{8

9}, H J G Desirée van den Bongard¹⁰, Antonetta C Houweling¹

Affiliations

¹ Department of Radiation Oncology, UMC Utrecht, Utrecht, the Netherlands.
² Computational Imaging Group for MRI Diagnostics and Therapy, Center for Image Sciences, UMC Utrecht, Utrecht, the Netherlands.
³ Department of Radiology, UMC Utrecht, Utrecht, the Netherlands.
⁴ Image Sciences Institute, UMC Utrecht, Utrecht, the Netherlands.
⁵ Department of Radiation Oncology, RadboudUMC, Nijmegen, the Netherlands.
⁶ Department of Pathology, UMC Utrecht, Utrecht, the Netherlands.
⁷ Department of Pathology, St Antonius Hospital, Nieuwegein, the Netherlands.
⁸ Imaging Division, UMC Utrecht, Utrecht, the Netherlands.
⁹ Utrecht University, Utrecht, the Netherlands.
¹⁰ Department of Radiation Oncology, Amsterdam University Medical Centers, Amsterdam, the Netherlands.

Abstract

Purpose: We aimed to evaluate changes in dynamic contrast-enhanced (DCE) and diffusion-weighted (DW) magnetic resonance imaging (MRI) scans acquired before and after single-dose ablative neoadjuvant partial breast irradiation (NA-PBI), and explore the relation between semiquantitative MRI parameters and radiologic and pathologic responses.

Methods and materials: We analyzed 3.0T DCE and DW-MRI of 36 patients with low-risk breast cancer who were treated with single-dose NA-PBI, followed by breast-conserving surgery 6 or 8 months later. MRI was acquired before NA-PBI and 1 week, 2, 4, and 6 months after NA-PBI. Breast radiologists assessed the radiologic response and breast pathologists scored the pathologic response after surgery. Patients were grouped as either pathologic responders or nonresponders (<10% vs ≥10% residual tumor cells). The semiquantitative MRI parameters evaluated were time to enhancement (TTE), 1-minute relative enhancement (RE_1min), percentage of enhancing voxels (%EV), distribution of washout curve types, and apparent diffusion coefficient (ADC).

Results: In general, the enhancement increased 1 week after NA-PBI (baseline vs 1 week median - TTE: 15s vs 10s; RE_1min: 161% vs 197%; %EV: 47% vs 67%) and decreased from 2 months onward (6 months median - TTE: 25s; RE_1min: 86%; %EV: 12%). Median ADC increased from 0.83 × 10^-3 mm²/s at baseline to 1.28 × 10^-3 mm²/s at 6 months. TTE, RE_1min, and %EV showed the most potential to differentiate between radiologic responses, and TTE, RE_1min, and ADC between pathologic responses.

Conclusions: Semiquantitative analyses of DCE and DW-MRI showed changes in relative enhancement and ADC 1 week after NA-PBI, indicating acute inflammation, followed by changes indicating tumor regression from 2 to 6 months after radiation therapy. A relation between the MRI parameters and radiologic and pathologic responses could not be proven in this exploratory study.