The purpose of this work was to investigate whether noninvasive early detection (after the first cycle) of response to
neoadjuvant chemotherapy (NAC) in
breast cancer patients was possible. 31 P-MRSI at 7 T was used to determine different phosphor metabolites ratios and correlate this to pathological response. 31 P-MRSI was performed in 12
breast cancer patients treated with NAC. 31 P spectra were fitted and aligned to the frequency of
phosphoethanolamine (PE). Metabolic signal ratios for phosphomonoesters/phosphodiesters (PME/PDE),
phosphocholine/glycerophosphatidylcholine (PC/GPtC),
phosphoethanolamine/
glycerophosphoethanolamine (PE/GPE) and phosphomonoesters/in-organic
phosphate (PME/Pi) were determined from spectral fitting of the individual spectra and the summed spectra before and after the first cycle of NAC. Metabolic ratios were subsequently related to pathological response. Additionally, the correlation between the measured metabolic ratios and Ki-67 levels was determined using linear regression. Four patients had a pathological complete response
after treatment, five patients a partial pathological response, and three patients did not respond to NAC. In the summed spectrum after the first cycle of NAC, PME/Pi and PME/PDE decreased by 18 and 13%, respectively. A subtle difference among the different response groups was observed in PME/PDE, where the nonresponders showed an increase and the partial and complete responders a decrease (P = 0.32). No significant changes in metabolic ratios were found. However, a significant association between PE/Pi and the Ki-67 index was found (P = 0.03). We demonstrated that it is possible to detect subtle changes in 31 P metabolites with a 7 T MR system after the first cycle of NAC treatment in
breast cancer patients. Nonresponders showed different changes in metabolic ratios compared with partial and complete responders, in particular for PME/PDE; however, more patients need to be included to investigate its clinical value.