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18.05.2017 | Magnetic Resonance | Ausgabe 11/2017 Open Access

European Radiology 11/2017

Interim heterogeneity changes measured using entropy texture features on T2-weighted MRI at 3.0 T are associated with pathological response to neoadjuvant chemotherapy in primary breast cancer

European Radiology > Ausgabe 11/2017
Shelley Henderson, Colin Purdie, Caroline Michie, Andrew Evans, Richard Lerski, Marilyn Johnston, Sarah Vinnicombe, Alastair M. Thompson
Wichtige Hinweise
Sarah Vinnicombe and Alastair M. Thompson are joint senior authors



To investigate whether interim changes in hetereogeneity (measured using entropy features) on MRI were associated with pathological residual cancer burden (RCB) at final surgery in patients receiving neoadjuvant chemotherapy (NAC) for primary breast cancer.


This was a retrospective study of 88 consenting women (age: 30–79 years). Scanning was performed on a 3.0 T MRI scanner prior to NAC (baseline) and after 2–3 cycles of treatment (interim). Entropy was derived from the grey-level co-occurrence matrix, on slice-matched baseline/interim T2-weighted images. Response, assessed using RCB score on surgically resected specimens, was compared statistically with entropy/heterogeneity changes and ROC analysis performed. Association of pCR within each tumour immunophenotype was evaluated.


Mean entropy percent differences between examinations, by response category, were: pCR: 32.8%, RCB-I: 10.5%, RCB-II: 9.7% and RCB-III: 3.0%. Association of ultimate pCR with coarse entropy changes between baseline/interim MRI across all lesions yielded 85.2% accuracy (area under ROC curve: 0.845). Excellent sensitivity/specificity was obtained for pCR prediction within each immunophenotype: ER+: 100%/100%; HER2+: 83.3%/95.7%, TNBC: 87.5%/80.0%.


Lesion T2 heterogeneity changes are associated with response to NAC using RCB scores, particularly for pCR, and can be useful across all immunophenotypes with good diagnostic accuracy.

Key Points

Texture analysis provides a means of measuring lesion heterogeneity on MRI images.
Heterogeneity changes between baseline/interim MRI can be linked with ultimate pathological response.
Heterogeneity changes give good diagnostic accuracy of pCR response across all immunophenotypes.
Percentage reduction in heterogeneity is associated with pCR with good accuracy and NPV.

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