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Fig. 3 | Egyptian Journal of Radiology and Nuclear Medicine

Fig. 3

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

Fig. 3Fig. 3

A 44-year-old female presented with left breast upper outer quadrant mass. Pre-therapy: a The left breast showed a sizable partly spiculated solid mass at the upper outer quadrant that displayed rim enhancement in the post-contrast MR images. It was seen closely adherent and infiltrating the overlying skin along the outer aspect of the breast. Kinetic curve showed maximum relative enhancement of 134% and type III early washout curve pattern. b DWI showed restricted diffusion and a low ADC value of 0.767 × 10−3 mm2/s. c MRS was positive for choline (choline peak = 1.0 mmol/l). Histopathology: Invasive ductal carcinoma, grade II. Immunohistopathology: ER (4/8) and PR (8/8), negative for HER 2 NEU and Ki 67 30%. Treatment decision: Neo-adjuvant chemotherapy and breast conservative surgery. Post-therapy: d The lesion showed delayed peak of contrast uptake at 448 s with corresponding signal intensity percentage of 109% and benign type curve pattern. e DWI showed restricted diffusion and displayed also low ADC value of 0.830 × 10−3 mm2/s. f Choline peak on the MRS images was still positive of estimated height value of 0.9 mmol/l. Pathology report of surgical specimen: A whitish gritty irregular mass reaching the skin surface that measured 3.2 cm along its maximal diameter with picture of invasive duct carcinoma grade II and associated lobular features. Free surgical margins. One of the dissected lymph nodes showed metastatic deposits (1/5). Comments: Radiological and pathological non-responder. The case showed stationary size and the findings at the post-contrast series gave false impression of response. DWI and MRS showed malignant criteria and suggested the accurate diagnosis of a non-responder case that was proved by the pathology report after surgery

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