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OBJECTIVE: To explore the predictive value of parameters derived from diffusion-weighted imaging (DWI) and contrast-enhanced (CE)-MRI at different time-points during neoadjuvant chemotherapy (NACT) in breast cancer. METHODS: Institutional review board approval and written, informed consent from 42 breast cancer patients were obtained. The patients were investigated before and at three different time-points during neoadjuvant chemotherapy (NACT) using tumour diameter and volume from CE-MRI and ADC values obtained from drawn 2D and segmented 3D regions of interest. Prediction of pathologic complete response (pCR) was evaluated using the area under the curve (AUC) of receiver operating characteristic analysis. RESULTS: There was no significant difference between pathologic complete response and non-pCR in baseline size measures (p > 0.39). Diameter change was significantly different in pCR (p < 0.02) before the mid-therapy point. The best predictor was lesion diameter change observed before mid-therapy (AUC = 0.93). Segmented volume was not able to differentiate between pCR and non-pCR at any time-point. The ADC values from 3D-ROI were not significantly different from 2D data (p = 0.06). The best AUC (0.79) for pCR prediction using DWI was median ADC measured before mid-therapy of NACT. CONCLUSIONS: The results of this study should be considered in NACT monitoring planning, especially in MRI protocol designing and time point selection. KEY POINTS: • Mid-therapy diameter changes are the best predictors of pCR in neoadjuvant chemotherapy. • Volumetric measures are not strictly superior in therapy monitoring to lesion diameter. • Size measures perform as a better predictor than ADC values.

Original publication




Journal article


Eur Radiol

Publication Date





1901 - 1911


Breast, Contrast-Enhanced Magnetic Resonance Imaging, Diffusion Weighted Imaging, Neoadjuvant Chemotherapy, Neoplasms, Adult, Aged, Antineoplastic Combined Chemotherapy Protocols, Area Under Curve, Breast, Breast Neoplasms, Carcinoma, Intraductal, Noninfiltrating, Diffusion Magnetic Resonance Imaging, Female, Humans, Magnetic Resonance Imaging, Middle Aged, Neoadjuvant Therapy, ROC Curve, Treatment Outcome, Tumor Burden