1. Assessment of Early Response to Neoadjuvant Systemic Therapy in Triple-Negative Breast Cancer Using Amide Proton Transfer–weighted Chemical Exchange Saturation Transfer MRI: A Pilot Study
- Author
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Benjamin C. Musall, Shu Zhang, Jingfei Ma, Mitsuharu Miyoshi, Xinzeng Wang, Ken-Pin Hwang, Mark D. Pagel, Nabil Elshafeey, Aikaterini Kotrotsou, Rania M.M Mohamed, Abeer H Abdelhafez, Peng Wei, Jia Sun, Medine Boge, Beatriz E. Adrada, Jason B White, Gaiane M. Rauch, and Jong Bum Son
- Subjects
business.industry ,Amide proton ,Pilot Projects ,Triple Negative Breast Neoplasms ,General Medicine ,Middle Aged ,Tumor response ,medicine.disease ,Mr imaging ,Systemic therapy ,Amides ,Magnetic Resonance Imaging ,Neoadjuvant Therapy ,Nuclear magnetic resonance ,Breast cancer ,Medicine ,Chemical Exchange Saturation Transfer MRI ,Humans ,Prospective Studies ,Protons ,business ,Triple-negative breast cancer ,Original Research - Abstract
PURPOSE: To determine if amide proton transfer–weighted chemical exchange saturation transfer (APT(W) CEST) MRI is useful in the early assessment of treatment response in persons with triple-negative breast cancer (TNBC). MATERIALS AND METHODS: In this prospective study, a total of 51 participants (mean age, 51 years [range, 26–79 years]) with TNBC were included who underwent APT(W) CEST MRI with 0.9- and 2.0-µT saturation power performed at baseline, after two cycles (C2), and after four cycles (C4) of neoadjuvant systemic therapy (NAST). Imaging was performed between January 31, 2019, and November 11, 2019, and was a part of a clinical trial (registry number NCT02744053). CEST MR images were analyzed using two methods—magnetic transfer ratio asymmetry (MTR(asym)) and Lorentzian line shape fitting. The APT(W) CEST signals at baseline, C2, and C4 were compared for 51 participants to evaluate the saturation power levels and analysis methods. The APT(W) CEST signals and their changes during NAST were then compared for the 26 participants with pathology reports for treatment response assessment. RESULTS: A significant APT(W) CEST signal decrease was observed during NAST when acquisition at 0.9-µT saturation power was paired with Lorentzian line shape fitting analysis and when the acquisition at 2.0 µT was paired with MTR(asym) analysis. Using 0.9-µT saturation power and Lorentzian line shape fitting, the APT(W) CEST signal at C2 was significantly different from baseline in participants with pathologic complete response (pCR) (3.19% vs 2.43%; P = .03) but not with non-pCR (2.76% vs 2.50%; P > .05). The APT(W) CEST signal change was not significant between pCR and non-pCR at all time points. CONCLUSION: Quantitative APT(W) CEST MRI depended on optimizing acquisition saturation powers and analysis methods. APT(W) CEST MRI monitored treatment effects but did not differentiate participants with TNBC who had pCR from those with non-pCR. © RSNA, 2021 Clinical trial registration no. NCT02744053 Supplemental material is available for this article. Keywords Molecular Imaging-Cancer, Molecular Imaging-Clinical Translation, MR-Imaging, Breast, Technical Aspects, Tumor Response, Technology Assessment
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- 2021