Monitoring of early response to neoadjuvant chemotherapy in breast cancer with ¹H MR spectroscopy: Comparison to sequential 2‐[18F]‐fluorodeoxyglucose positron emission tomography

Abstract

Purpose:To assess the efficacy of 1 H MR spectroscopy (MRS) to evaluate early responses to neoadjuvant chemotherapy in breast cancer patients, as compared to that of the standardized uptake value (SUV) in 18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET). Materials and Methods:This retrospective study included seven patients with breast cancer who had both single-voxel 1 H MRS and PET/computed tomography (CT) acquired before, during, and after neoadjuvant chemotherapy. Results:The averages of the Choline (Cho) integral value and peak SUV before chemotherapy were 2.5 (range, 1.2-5.3) and 7.5 (range, 1.9 -19), respectively. Three cases became negative for both Cho and peak SUV after two cycles of chemotherapy, and one patient became negative before surgery. In the remaining three patients, the curves of both values paralleled the time course of chemotherapy treatment. The difference between Cho and peak SUV before, during, and after chemotherapy was r ϭ 0.65 (P ϭ 0.12), r ϭ 0.80 (P ϭ 0.03), and r ϭ 0.99 (P Ͻ 0.001), respectively. The reduction rate (RR) of both values after chemotherapy was also correlated (r ϭ 0.84, P ϭ 0.02). Conclusion:A change in the Cho integral value is well correlated with that of peak SUV in the time course of neoadjuvant chemotherapy; thus, breast 1 H MRS is thought to be an alternative to sequential 18 F-FDG PET.

1H‐magnetic resonance spectroscopy of the breast at 3.0‐T: Comparison of results obtained before and after administration of gadolinium‐based contrast agent

“…The context bias, including a considerable number of nonmass-like enhancement lesions and noninvasive ductal carcinomas, might have affected our result because the majority of previous studies concentrated on mass-type lesions only. Tozaki et al (8) proposed that radiologists should consider the potential pitfalls of DWI in the diagnosis of noninvasive ductal carcinomas of nonmass-like enhancement type (17). On the contrary, Partridge et al (25) reported that breast DWI was useful for differentiating between benign and malignant masses as well as lesions with nonmass-like enhancement.…”

“…However, several studies have reported the effects of GBCA that showed reductions in the choline peak of the tumors (15)(16)(17)(18). There are some reports that integral value of the choline peak was used in differentiation between malignancy and benign breast lesions and evaluation of chemotherapy for breast cancer (7,8), and if these reductions are significant, there may be a risk of misdiagnosing tumor malignancy and overestimation of chemotherapy effects on MRS acquired after contrast-enhanced studies.…”

Recent Advances in the Molecular Imaging of Programmed Cell Death: Part II—Non–Probe-Based MRI, Ultrasound, and Optical Clinical Imaging Techniques

“…The interruption of global protein synthesis in the endoplasmic reticulum causes the decrease in choline resonance observed on 1 H-MRS both clinically (13)(14)(15)(16)(17)(18) and in animal models (3,5,19,20). 1 H-MRS has also been successful in the brain, breast, lower extremities, and liver using clinical 1.5-or 3.0-T MRI units and coils.…”

Appropriate Timing of Proton MR Spectroscopy in Breast Cancer

“…[3][4][5][6][7][8][9][10][11] Accurately assessing response to neoadjuvant chemotherapy is a critical factor in optimizing the overall chemotherapy regimen and planning further surgery. Early prediction of e‹cacy reduces unnecessary adverse eŠects, expedites treatment, and avoids administration of expensive drugs that show no promise of eŠective-ness.…”