Abstract
BackgroundThe purpose of this work was to investigate noninvasive early detection of treatment response of breast cancer patients to neoadjuvant chemotherapy (NAC) using chemical exchange saturation transfer (CEST) measurements sensitive to amide proton transfer (APT) at 7 T.MethodsCEST images were acquired in 10 tumors of nine breast cancer patients treated with NAC. APT signals in the tumor, before and after the first cycle of NAC, were quantified using a three-pool Lorentzian fit of the z-spectra in the region of interest. The changes in APT were subsequently related to pathological response after surgery defined by the Miller-Payne system.ResultsSignificant differences (P < 0.05, unpaired Mann-Whitney test) were found in the APT signal before and after the first cycle of NAC in six out of 10 lesions, of which two showed a pathological complete response. Of the remaining four lesions, one showed a pathological complete response. No significant difference in changes of APT signal were found between the different pathological responses to NAC treatment (P > 0.05, Kruskal-Wallis test).ConclusionsThis preliminary study shows the feasibility of using APT CEST magnetic resonance imaging as a noninvasive biomarker to assess the effect of NAC in an early stage of NAC treatment of breast cancer patients.Trial registrationRegistration number, NL49333.041.14/NTR4980. Registered on 16 October 2014.
Highlights
The purpose of this work was to investigate noninvasive early detection of treatment response of breast cancer patients to neoadjuvant chemotherapy (NAC) using chemical exchange saturation transfer (CEST) measurements sensitive to amide proton transfer (APT) at 7 T
Patients being treated with NAC were selected, and they were examined with APT CEST magnetic resonance imaging (MRI) before and after the first cycle of NAC
A reduced amide signal of 21% in the APT map was observed after the first cycle of NAC
Summary
The purpose of this work was to investigate noninvasive early detection of treatment response of breast cancer patients to neoadjuvant chemotherapy (NAC) using chemical exchange saturation transfer (CEST) measurements sensitive to amide proton transfer (APT) at 7 T. To spare patients from ineffective treatment, it would be beneficial to predict the pathological response early in the course of treatment, allowing adjustments for patient-specific therapy. Since underlying tumor changes in response to treatment usually precede a relatively slow process of change in tumor size [7,8,9], we set out to investigate metabolic properties of breast cancers that are expected to reveal changes early in the course of treatment. A recently developed MRI method, chemical exchange saturation transfer (CEST), allows detection of interactions between metabolites and water in the body [10, 11]
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