Prognostic value of pretreatment dynamic contrast-enhanced MR imaging in breast cancer patients receiving neoadjuvant chemotherapy: Overall survival predicted from combined time course and volume analysis

Background: The prognostic value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in breast cancer has been explored, and the results are promising. Purpose: To investigate the possible correlation between pretreatment DCE-MRI and overall survival 5 years after diagnosis in breast cancer patients receiving neoadjuvant chemotherapy (NAC) using combined time course analysis and volume measurement from DCE-MRI data acquired with 1 min temporal resolution. Material and Methods: Pretreatment DCE-MR images of 32 female patients were examined. The total enhancing volume was calculated by including the voxels with >60% signal enhancing 1 min postcontrast. The signal intensity time course data were automatically classified on a voxel-by-voxel basis according to the enhancing characteristics: persistent (type I), plateau (type II) or washout (type III), and the resulting volumes of each enhancement type were calculated. Results: A significant correlation between total enhancing volume and 5-year survival was found, P < 0.05 (log-rank). The survival was 51 +/- 15 months (mean +/- 95% confidence intervals (CI)) and 73 +/- 12 months in patients with a total enhancing volume >41 cm(3) and <= 41 cm(3), respectively. A two-dimensional discriminator, taking both total enhancing volume and type III enhancing volume into account, improved the prediction of survival, resulting in a P value (log-rank) between survivors and non-survivors of P < 0.001. The survival was 44 +/- 16 months (mean +/- 95% CI) and 74 +/- 11 months in patients with a total enhancing volume >58 cm(3) and/or a type III volume >8 cm(3), and <= 58 cm(3) and <= 8 cm(3), respectively. Conclusion: Pretreatment DCE-MRI might help in predicting prognosis in breast cancer patients receiving NAC.