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Egyptian Journal of Radiology and Nuclear Medicine
Fig. 2 | Egyptian Journal of Radiology and Nuclear Medicine

Fig. 2

From: Diffusion-weighted imaging or MR spectroscopy: Which to use for the assessment of the response to chemotherapy in breast cancer patients?

Fig. 2Fig. 2

A 34-year-old female presented with right breast lump. Pre-therapy: a Right breast lower inner quadrant indistinct mass with extensive skin edema (peau d'orange). The mass showed delayed peak of contrast uptake at 274 s with corresponding signal intensity percentage of 58% and delayed washout curve pattern type Ib. b Right lower inner quadrant mass (ADC value = 0.851 × 10−3 mm2). c MRS was positive for choline (choline peak = 0.9 mmol/l). Histopathology: Invasive ductal carcinoma, grade III. Immunohistopathology: Negative for ER and PR, positive for HER2/NEU (class 3+), Ki 67 high proliferation index. Treatment decision: Neo-adjuvant chemotherapy and modified radical mastectomy. Post-therapy: d Regressive course regarding the size of the right lower inner quadrant mass. The right breast dominant mass (at the upper inner quadrant) showed faint contrast uptake. Kinetics displayed signal intensity percentage of 35% and progressively rising curve pattern- type I. Also, there was mild regression of previously noted dermal edema seen. e DWI showed restricted diffusion and an ADC value of 0.730 × 10−3 mm2/s. f MRS showed choline peak of 0.4 mmol/l height value. Pathology report of the surgical specimen: Gritty mass with wide area of necrosis (partial tumor response). Free deep surgical margins. Metastatic deposits were found in 7 from 12 dissected axillary lymph nodes. Comments: Partial pathological and radiological response

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