Evaluation of breast tumor response to neoadjuvant chemotherapy with tomographic diffuse optical spectroscopy: case studies of tumor region-of-interest changes.

PURPOSE: To evaluate two methods of summarizing tomographic diffuse optical spectroscopic (DOS) data through region-of-interest (ROI) analysis to differentiate complete from incomplete responses in patients with locally advanced breast cancer undergoing neoadjuvant treatment and to estimate the standard deviations of these methods for power analysis of larger study designs in the future. MATERIALS AND METHODS: Subjects participating in the HIPAA-compliant imaging study, approved by the institutional review board, provided written informed consent and were compensated for their examination participation. Seven of 16 cases in women with complete study data were analyzed by using both fixed- and variable-size (full-width-at-half-maximum) ROI measures of the DOS total hemoglobin concentration (Hb(T)), blood oxygen saturation, water fraction, optical scattering amplitude, and scattering power in the ipsilateral and contralateral breasts. Postsurgical histopathologic analysis was used to categorize patients as having a complete or incomplete treatment response. RESULTS: Average normalized change in Hb(T) was the only DOS parameter to show significant differences (P < or = .05) in the pathologic complete response (pCR) and pathologic incomplete response (pIR) outcomes in seven patients. Mean values of the changes for fixed-size ROIs were -64.2% +/- 50.8 (standard deviation) and 16.9% +/- 38.2 for the pCR and pIR groups, respectively, and those for variable-size ROIs were -96.7% +/- 91.8, and 14.1% +/- 26.7 for the pCR and pIR groups, respectively. CONCLUSION: Tomographic DOS may provide findings predictive of therapeutic response, which could lead to superior individualized patient treatment. SUPPLEMENTAL MATERIAL: http://radiology.rsnajnls.org/cgi/content/full/2522081202/DC1.

Quick-brain magnetic resonance imaging for nonhydrocephalus indications.

OBJECT: In 2002, "quick-brain" (QB) MR imaging (ultrafast spin echo T2-weighted imaging) was introduced as an alternative technique to CT scanning for assessing children with hydrocephalus. The authors have observed high patient and physician satisfaction with this technique at their institution, which has led to an increasing frequency of its use for nonhydrocephalic indications. The goal in this study was to characterize, quantitate, and assess the use of QB MR imaging for these additional indications. METHODS: Between February 2003 and December 2007, 1146 consecutive QB MR imaging studies were performed, and the findings were entered prospectively into a radiology database. All available clinical records were retrospectively reviewed to assign > or = 1 of the following indications to each study: hydrocephalus, macrocephaly, Chiari malformation, intracranial cyst, screening prior to lumbar puncture, screening for congenital anomalies, trauma, and other. Changes in the distribution of indications over time and clinical experience for each indication were reviewed. RESULTS: The total number of QB imaging studies performed increased each year. The proportion of studies performed for nonhydrocephalic indications also increased (from 23 to 50%). The most common indication was screening for macrocephaly, and all other indications were nearly evenly distributed. Quick-brain MR imaging was used extensively for the initial evaluation and follow-up in patients with little need for additional studies. Its false-negative rate, however, remains unknown. CONCLUSIONS: The role of QB MR imaging for nonhydrocephalic indications is expanding, and it appears promising for a number of screening and surveillance paradigms. "Quick-brain plus" protocols for specific indications may add sensitivity and are under development.