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Contrast-enhanced spectral mammography in treatment monitoring: an initial comparison to breast MRI Poster No.: B-0437 Congress: ECR 2015 Type: Scientific Paper Authors: S. Ravaioli , R. Sghedoni , A. Nitrosi , V. Iotti , C. Coriani , R. 1 1 1 1 1 2 1 1 1 1 Vacondio , C. A. Mori , V. Ginocchi , P. Pattacini ; Reggio Emilia/ 2 IT, Guastalla/IT Keywords: Breast, Oncology, Mammography, MR, Chemotherapy, Cancer, Neoplasia DOI: 10.1594/ecr2015/B-0437 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myESR.org Page 1 of 8 Purpose To compare Contrast-Enhanced Spectral Mammography (CESM) and ContrastEnhanced MRI (CE-MRI) in breast cancer response to chemotherapy. Methods and materials 43 consenting women with in situ, lobular or ductal carcinoma and with indication of neoadjuvant chemotherapy (NAC) were enrolled into this prospective study between October 2012 and October 2014. The patients underwent CESM and CE-MRI before, after the first NAC cycle and after the end of NAC. 29 patients completed the therapy up to October 2014. Response to therapy was evaluated for each patient using the variation of the largest dimension of malignancies measured on CE-MRI and CESM image sets. A CESM examination consisted in a pair of low and high energy exposures for each mammographic view, combined to visualize lesions with contrast up-take. CESM and CE-MRI size measurements were compared through correlation (Pearson) and agreement (Paired t-test). Clinical outcomes were also compared: patients were considered as responding to therapy when size reduction after NAC was larger than 30%. Results Pearson correlation coefficients between CESM and CE-MRI measurements were 0.982, 0.946 and 0.894 and paired t-test p-values were 0.71, 0.20 and 0.43, respectively before, during and after NAC. P-values show that there was no statistical difference between measurement sets with CESM and MRI at each stage. Clinical outcomes (response or non-response to chemotherapy) with CESM and CE-MRI were identical for 28 over 29 patients. Page 2 of 8 Images for this section: Page 3 of 8 Page 4 of 8 Fig. 1: 44-year-old woman with 30-mm in situ and invasive ductal carcinoma in right breast. Complete response to chemotherapy after 6-months. A: CESM subtracted image, pre-treatment. B: CESM subtracted image, post-treatment. C: DCE-MRI processed by CAD, pre-treatment. D: DCE-MRI processed by CAD, post-treatment. Fig. 2: 53-year-old woman with 33-mm invasive lobular carcinoma in the left breast. Complete response to chemotherapy after 6-months. A: CESM subtracted image, pretreatment. B: DCE-MRI processed by CAD, pre-treatment. C: CESM subtracted image, post-treatment. D: DCE-MRI processed by CAD, post-treatment. Page 5 of 8 Fig. 3: 40-year-old woman with 48-mm invasive ductal carcinoma with microcalcifications in left breast. Not responding to chemotherapy: after 3-months no dimensional reduction but appearance of a second lesion (circled in white). A: CESM subtracted image, pretreatment. B: CESM low-energy, pre-treatment. C: CESM subtracted image, duringtreatment. D: CESM low-energy, during treatment. E: DCE-MRI processed by CAD, pretreatment. F: DCE-MRI processed by CAD, during-treatment. Page 6 of 8 Conclusion CESM and MRI lesion size measurements were highly correlated and in strong agreement. CESM may be an alternative to CE-MRI in assessing response to chemotherapy in patients with breast cancer. Personal information References 1. 2. 3. 4. 5. 6. 7. Dromain C, Thibault F, Muller S, Rimareix F, Delaloge S, Tardivon A, Balleyguier C. 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