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Chen S, Zheng B, Tang W, Ding S, Sui Y, Yu X, Zhong Z, Kong Q, Liu W, Guo Y. The longitudinal changes in multiparametric MRI during neoadjuvant chemotherapy can predict treatment response early in patients with HER2-positive breast cancer. Eur J Radiol 2024; 178:111656. [PMID: 39098252 DOI: 10.1016/j.ejrad.2024.111656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 07/17/2024] [Accepted: 07/29/2024] [Indexed: 08/06/2024]
Abstract
PURPOSE To investigate whether longitudinal changes in multiparametric MRI can predict early response to neoadjuvant chemotherapy (NAC) for HER2-positive breast cancer (BC) and to further establish quantitative models based on these features. METHODS A total of 164 HER2-positive BC patients from three centers were included. MRI was performed at baseline and after two cycles of NAC (early post-NAC). Clinicopathological characteristics were enrolled. MRI features were evaluated at baseline and early post-NAC, as well as longitudinal changes in multiparametric MRI, including changes in the largest diameter (LD) of the tumor (ΔLD), apparent diffusion coefficient (ADC) values (ΔADC), and time-signal intensity curve (TIC) (ΔTIC). The patients were divided into a training set (n = 95), an internal validation set (n = 31), and an independent external validation set (n = 38). Univariate and multivariate logistic regression analyses were used to identify the independent indicators of pCR, which were then used to establish the clinicopathologic model and combined model. The AUC was used to evaluate the predictive power of the different models and calibration curves were used to evaluate the consistency of the prediction of pCR in different models. Additionally, decision curve analysis (DCA) was employed to determine the clinical usefulness of the different models. RESULTS Two models were enrolled in this study, including the clinicopathologic model and the combined model. The LD at early post-NAC (OR=0.913, 95 % CI=0.953-0.994 p = 0.026), ΔADC (OR=1.005, 95 % CI=1.005-1.008, p = 0.007), and ΔTIC (OR=3.974, 95 % CI=1.276-12.358, p = 0.017) were identified as the best predictors of NAC response. The combined model constructed by the combination of LD at early post-NAC, ΔADC, and ΔTIC showed good predictive performance in the training set (AUC=0.87), internal validation set (AUC=0.78), and external validation set (AUC=0.79), which performed better than the clinicopathologic model in all sets. CONCLUSIONS The changes in multiparametric MRI can predict early treatment response for HER2-positive BC and may be helpful for individualized treatment planning.
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Affiliation(s)
- Siyi Chen
- Department of Radiology, Guangzhou First People's Hospital, South China University of Technology, No.1 Panfu Road, Guangzhou 510180, China.
| | - Bingjie Zheng
- Department of Radiology, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 150001, China.
| | - Wenjie Tang
- Department of Radiology, Guangzhou First People's Hospital, South China University of Technology, No.1 Panfu Road, Guangzhou 510180, China.
| | - Shishen Ding
- Department of Radiology, Liuzhou People's Hospital, Guangxi Medical University, Liuzhou 545006, China.
| | - Yi Sui
- Department of Radiology, Guangzhou First People's Hospital, South China University of Technology, No.1 Panfu Road, Guangzhou 510180, China.
| | - Xiaomeng Yu
- Department of Radiology, Guangzhou First People's Hospital, South China University of Technology, No.1 Panfu Road, Guangzhou 510180, China.
| | - Zhidan Zhong
- Department of Radiology, Guangzhou First People's Hospital, South China University of Technology, No.1 Panfu Road, Guangzhou 510180, China.
| | - Qingcong Kong
- Department of Radiology, The Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Tianhe District, Guangzhou 510630, China.
| | - Weifeng Liu
- Department of Radiology, Guangzhou First People's Hospital, South China University of Technology, No.1 Panfu Road, Guangzhou 510180, China.
| | - Yuan Guo
- Department of Radiology, Guangzhou First People's Hospital, South China University of Technology, No.1 Panfu Road, Guangzhou 510180, China.
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Wang X, Du L, Cao Y, Chen H, Shi J, Zeng X, Lan X, Huang H, Jiang S, Lin M, Zhang J. Comparing extracellular volume fraction with apparent diffusion coefficient for the characterization of breast tumors. Eur J Radiol 2024; 171:111268. [PMID: 38159522 DOI: 10.1016/j.ejrad.2023.111268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/27/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE To investigate the feasibility of dual-energy CT (DECT)-derived extracellular volume (ECV) fraction for characterization of breast tumors, compared to apparent diffusion coefficient (ADC) and validated against histopathological findings. MATERIAL AND METHODS The ECV fraction and ADC were prospectively assessed in patients with breast tumors using chest DECT and breast MRI. The diagnostic performance of ECV fraction and ADC was accessed in predicting breast histopathological subtypes and pathological complete response (pCR) status. Histopathological sections were analyzed by digital image analysis. Pearson's correlation analysis was used to correlate between DECT and histopathological ECV fractions. RESULTS This study included 271 patients, with 314 breast lesions (61 benign and 253 malignant). The ECV fraction and ADC showed comparable area under the curve (AUC) for distinguishing benign from malignant lesions (p = 0.123) and invasive carcinoma from ductal carcinoma in situ (p = 0.115). There were significant differences in ECV fraction between different hormone receptors and Ki67 states (p = 0.001 ∼ 0.014), while ADC values only differed among various Ki67 states (p < 0.001). The ECV fraction was lower (p = 0.007), ADC was higher (p = 0.013) in pCR than in non-pCR group, with an AUC of 0.748 and 0.730 (p = 0.887), respectively. There was a positive correlation between DECT and histopathological ECV fractions (r = 0.615, p < 0.01). CONCLUSIONS Routine chest DECT-derived ECV fraction is a viable quantitative imaging biomarker for predicting histopathological subtypes and pCR in patient with breast tumors, and correlated well with histopathology finding.
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Affiliation(s)
- Xiaoxia Wang
- Department of Radiology, Chongqing University Cancer Hospital, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC), Chongqing 400030, China
| | - Lihong Du
- Department of Radiology, Chongqing University Cancer Hospital, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC), Chongqing 400030, China
| | - Ying Cao
- School of Medicine, Chongqing University, Chongqing 400030, China
| | - Huifang Chen
- Department of Radiology, Chongqing University Cancer Hospital, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC), Chongqing 400030, China
| | - Jingfang Shi
- Department of Radiology, Chongqing University Cancer Hospital, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC), Chongqing 400030, China
| | - Xiangfei Zeng
- Department of Radiology, Chongqing University Cancer Hospital, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC), Chongqing 400030, China
| | - Xiaosong Lan
- Department of Radiology, Chongqing University Cancer Hospital, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC), Chongqing 400030, China
| | - Haiping Huang
- Department of Pathology, Chongqing University Cancer Hospital, Chongqing 400030, China
| | - Shixi Jiang
- Department of Radiology, Chongqing University Cancer Hospital, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC), Chongqing 400030, China
| | - Meng Lin
- Department of Radiology, Chongqing University Cancer Hospital, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC), Chongqing 400030, China
| | - Jiuquan Zhang
- Department of Radiology, Chongqing University Cancer Hospital, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC), Chongqing 400030, China.
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Jiang W, Du S, Gao S, Xie L, Xie Z, Wang M, Peng C, Shi J, Zhang L. Correlation between synthetic MRI relaxometry and apparent diffusion coefficient in breast cancer subtypes with different neoadjuvant therapy response. Insights Imaging 2023; 14:162. [PMID: 37775610 PMCID: PMC10541382 DOI: 10.1186/s13244-023-01492-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/25/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND To evaluate the correlation between synthetic MRI (syMRI) relaxometry and apparent diffusion coefficient (ADC) maps in different breast cancer subtypes and treatment response subgroups. METHODS Two hundred sixty-three neoadjuvant therapy (NAT)-treated breast cancer patients with baseline MRI were enrolled. Tumor annotations were obtained by drawing regions of interest (ROIs) along the lesion on T1/T2/PD and ADC maps respectively. Histogram features from T1/T2/PD and ADC maps were respectively calculated, and the correlation between each pair of identical features was analyzed. Meanwhile, features between different NAT treatment response groups were compared, and their discriminatory power was evaluated. RESULTS Among all patients, 20 out of 27 pairs of features weakly correlated (r = - 0.13-0.30). For triple-negative breast cancer (TNBC), features from PD map in the pathological complete response (pCR) group (r = 0.60-0.86) showed higher correlation with ADC than that of the non-pCR group (r = 0.30-0.43), and the mean from the ADC and PD maps in the pCR group strongly correlated (r = 0.86). For HER2-positive, few correlations were found both in the pCR and non-pCR groups. For luminal HER2-negative, T2 map correlated more with ADC than T1 and PD maps. Significant differences were seen in T2 low percentiles and median in the luminal-HER2 negative subtype, yielding moderate AUCs (0.68/0.72/0.71). CONCLUSIONS The relationship between ADC and PD maps in TNBC may indicate different NAT responses. The no-to-weak correlation between the ADC and syMRI suggests their complementary roles in tumor microenvironment evaluation. CRITICAL RELEVANCE STATEMENT The relationship between ADC and PD maps in TNBC may indicate different NAT responses, and the no-to-weak correlation between the ADC and syMRI suggests their complementary roles in tumor microenvironment evaluation. KEY POINTS • The relationship between ADC and PD in TNBC indicates different NAT responses. • The no-to-weak correlations between ADC and syMRI complementarily evaluate tumor microenvironment. • T2 low percentiles and median predict NAT response in luminal-HER2-negative subtype.
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Affiliation(s)
- Wenhong Jiang
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Siyao Du
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Si Gao
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Lizhi Xie
- GE Healthcare, MR Research China, Beijing, China
| | - Zichuan Xie
- Guangzhou institute of technology, Xidian University, Guangzhou, China
| | - Mengfan Wang
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Can Peng
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Jing Shi
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China.
| | - Lina Zhang
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China.
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Wessling D, Gassenmaier S, Olthof SC, Benkert T, Weiland E, Afat S, Preibsch H. Novel deep-learning-based diffusion weighted imaging sequence in 1.5 T breast MRI. Eur J Radiol 2023; 166:110948. [PMID: 37481831 DOI: 10.1016/j.ejrad.2023.110948] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/14/2023] [Accepted: 06/21/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE This study aimed to assess the technical feasibility, the impact on image quality, and the acquisition time (TA) of a new deep-learning-based reconstruction algorithm in diffusion weighted imaging (DWI) of breast magnetic resonance imaging (MRI). METHODS Retrospective analysis of 55 female patients who underwent breast DWI at 1.5 T. Raw data were reconstructed using a deep-learning (DL) reconstruction algorithm on a subset of the acquired averages, therefore a reduction of TA. Clinically used standard DWI sequence (DWIStd) and the DL-reconstructed images (DWIDL) were compared. Two radiologists rated the image quality of b800 and ADC images, using a Likert-scale from 1 to 5 with 5 being considered perfect image quality. Signal intensities were measured by placing a region of interest (ROI) at the same position in both sequences. RESULTS TA was reduced by 40 % in DWIDL, compared to DWIStd, DWIDL improved noise and sharpness while maintaining contrast, the level of artifacts, and diagnostic confidence. There were no differences regarding the signal intensity values of the apparent diffusion coefficient (ADC), (p = 0.955), b50-values (p = 0.070) and b800-values (p = 0.415) comparing standard and DL-imaging. Lesion assessment showed no differences regarding the number of lesions in ADC and DWI (both p = 1.000) and regarding the lesion diameter in DWI (p = 0.961;0.972) and ADC (p = 0.961;0.972). CONCLUSIONS The novel deep-learning-based reconstruction algorithm significantly reduces TA in breast DWI, while improving sharpness, reducing noise, and maintaining a comparable level of image quality, artifacts, contrast, and diagnostic confidence. DWIDL does not influence the quantifiable parameters.
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Affiliation(s)
- Daniel Wessling
- Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany; Department of Neuroradiology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Sebastian Gassenmaier
- Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany.
| | - Susann-Cathrin Olthof
- Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany.
| | - Thomas Benkert
- MR Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany.
| | - Elisabeth Weiland
- MR Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany.
| | - Saif Afat
- Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany.
| | - Heike Preibsch
- Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany.
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Wan C, Zhou L, Li H, Wang L, Li F, Yin W, Wang Y, Jiang L, Lu J. Multiparametric Contrast-Enhanced Ultrasound in Early Prediction of Response to Neoadjuvant Chemotherapy and Recurrence-Free Survival in Breast Cancer. Diagnostics (Basel) 2023; 13:2378. [PMID: 37510121 PMCID: PMC10378059 DOI: 10.3390/diagnostics13142378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
We aimed to explore the value of contrast-enhanced ultrasound (CEUS) in early prediction of pathologic complete response (pCR) and recurrence-free survival (RFS) in locally advanced breast cancer (LABC) patients treated with neoadjuvant chemotherapy (NAC). LABC patients who underwent CEUS before and during NAC from March 2014 to October 2018 were included and assessed. Logistic regression analysis and the Cox proportional hazards model were used to identify independent variables associated with pCR and RFS. Among 122 women, 44 underwent pCR. Molecular subtype, peak intensity (PEAK) and change in diameter were independent predictors of pCR after one cycle of NAC (area under the receiver operating characteristic curve [AUC], 0.81; 95% CI: 0.73, 0.88); Molecular subtype, PEAK and change in time to peak (TTP) were independently associated with pCR after two cycles of NAC (AUC, 0.85; 95% CI: 0.77, 0.91). A higher clinical T (hazard ratio [HR] = 4.75; 95% CI: 1.75, 12.87; p = 0.002) and N stages (HR = 3.39; 95% CI: 1.25, 9.19; p = 0.02) and a longer TTP (HR = 1.06; 95% CI: 1.01, 1.11; p = 0.02) at pre-NAC CEUS were independently associated with poorer RFS. CEUS can be used as a technique to predict pCR and RFS early in LABC patients treated with NAC.
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Affiliation(s)
- Caifeng Wan
- Department of Breast Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Pujian Rd., Shanghai 200127, China
- Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Pujian Rd., Shanghai 200127, China
| | - Liheng Zhou
- Department of Breast Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Pujian Rd., Shanghai 200127, China
| | - Hongli Li
- Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Pujian Rd., Shanghai 200127, China
| | - Lin Wang
- Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Pujian Rd., Shanghai 200127, China
| | - Fenghua Li
- Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Pujian Rd., Shanghai 200127, China
| | - Wenjin Yin
- Department of Breast Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Pujian Rd., Shanghai 200127, China
| | - Yaohui Wang
- Department of Breast Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Pujian Rd., Shanghai 200127, China
| | - Lixin Jiang
- Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Pujian Rd., Shanghai 200127, China
| | - Jinsong Lu
- Department of Breast Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Pujian Rd., Shanghai 200127, China
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Assessment of diffusion-weighted MRI in predicting response to neoadjuvant chemotherapy in breast cancer patients. Sci Rep 2023; 13:614. [PMID: 36635514 PMCID: PMC9837175 DOI: 10.1038/s41598-023-27787-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023] Open
Abstract
To compare region of interest (ROI)-apparent diffusion coefficient (ADC) on diffusion-weighted imaging (DWI) measurements and Ki-67 proliferation index before and after neoadjuvant chemotherapy (NACT) for breast cancer. 55 women were enrolled in this prospective single-center study, with a final population of 47 women (49 cases of invasive breast cancer). ROI-ADC measurements were obtained on MRI before and after NACT and were compared to histological findings, including the Ki-67 index in the whole study population and in subgroups of "pathologic complete response" (pCR) and non-pCR. Nineteen percent of women experienced pCR. There was a significant inverse correlation between Ki-67 index and ROI-ADC before NACT (r = - 0.443, p = 0.001) and after NACT (r = - 0.614, p < 0.001). The mean Ki-67 index decreased from 45.8% before NACT to 18.0% after NACT (p < 0.001), whereas the mean ROI-ADC increased from 0.883 × 10-3 mm2/s before NACT to 1.533 × 10-3 mm2/s after NACT (p < 0.001). The model for the prediction of Ki67 index variations included patient age, hormonal receptor status, human epidermal growth factor receptor 2 status, Scarff-Bloom-Richardson grade 2, and ROI-ADC variations (p = 0.006). After NACT, a significant increase in breast cancer ROI-ADC on diffusion-weighted imaging was observed and a significant decrease in the Ki-67 index was predicted. Clinical trial registration number: clinicaltrial.gov NCT02798484, date: 14/06/2016.
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Le NN, Li W, Onishi N, Newitt DC, Gibbs JE, Wilmes LJ, Kornak J, Partridge SC, LeStage B, Price ER, Joe BN, Esserman LJ, Hylton NM. Effect of Inter-Reader Variability on Diffusion-Weighted MRI Apparent Diffusion Coefficient Measurements and Prediction of Pathologic Complete Response for Breast Cancer. Tomography 2022; 8:1208-1220. [PMID: 35645385 PMCID: PMC9149942 DOI: 10.3390/tomography8030099] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/13/2022] [Accepted: 04/15/2022] [Indexed: 11/16/2022] Open
Abstract
This study evaluated the inter-reader agreement of tumor apparent diffusion coefficient (ADC) measurements performed on breast diffusion-weighted imaging (DWI) for assessing treatment response in a multi-center clinical trial of neoadjuvant chemotherapy (NAC) for breast cancer. DWIs from 103 breast cancer patients (mean age: 46 ± 11 years) acquired at baseline and after 3 weeks of treatment were evaluated independently by two readers. Three types of tumor regions of interests (ROIs) were delineated: multiple-slice restricted, single-slice restricted and single-slice tumor ROIs. Compared to tumor ROIs, restricted ROIs were limited to low ADC areas of enhancing tumor only. We found excellent agreement (intraclass correlation coefficient [ICC] ranged from 0.94 to 0.98) for mean ADC. Higher ICCs were observed in multiple-slice restricted ROIs (range: 0.97 to 0.98) than in other two ROI types (both in the range of 0.94 to 0.98). Among the three ROI types, the highest area under the receiver operating characteristic curves (AUCs) were observed for mean ADC of multiple-slice restricted ROIs (0.65, 95% confidence interval [CI]: 0.52–0.79 and 0.67, 95% CI: 0.53–0.81 for Reader 1 and Reader 2, respectively). In conclusion, mean ADC values of multiple-slice restricted ROI showed excellent agreement and similar predictive performance for pathologic complete response between the two readers.
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Affiliation(s)
- Nu N. Le
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, CA 94158, USA; (N.N.L.); (N.O.); (D.C.N.); (J.E.G.); (L.J.W.); (E.R.P.); (B.N.J.); (N.M.H.)
| | - Wen Li
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, CA 94158, USA; (N.N.L.); (N.O.); (D.C.N.); (J.E.G.); (L.J.W.); (E.R.P.); (B.N.J.); (N.M.H.)
- Correspondence:
| | - Natsuko Onishi
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, CA 94158, USA; (N.N.L.); (N.O.); (D.C.N.); (J.E.G.); (L.J.W.); (E.R.P.); (B.N.J.); (N.M.H.)
| | - David C. Newitt
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, CA 94158, USA; (N.N.L.); (N.O.); (D.C.N.); (J.E.G.); (L.J.W.); (E.R.P.); (B.N.J.); (N.M.H.)
| | - Jessica E. Gibbs
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, CA 94158, USA; (N.N.L.); (N.O.); (D.C.N.); (J.E.G.); (L.J.W.); (E.R.P.); (B.N.J.); (N.M.H.)
| | - Lisa J. Wilmes
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, CA 94158, USA; (N.N.L.); (N.O.); (D.C.N.); (J.E.G.); (L.J.W.); (E.R.P.); (B.N.J.); (N.M.H.)
| | - John Kornak
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA 94158, USA;
| | | | | | - Elissa R. Price
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, CA 94158, USA; (N.N.L.); (N.O.); (D.C.N.); (J.E.G.); (L.J.W.); (E.R.P.); (B.N.J.); (N.M.H.)
| | - Bonnie N. Joe
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, CA 94158, USA; (N.N.L.); (N.O.); (D.C.N.); (J.E.G.); (L.J.W.); (E.R.P.); (B.N.J.); (N.M.H.)
| | - Laura J. Esserman
- Department of Surgery and Radiology, University of California, San Francisco, CA 94143, USA;
| | - Nola M. Hylton
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, CA 94158, USA; (N.N.L.); (N.O.); (D.C.N.); (J.E.G.); (L.J.W.); (E.R.P.); (B.N.J.); (N.M.H.)
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