BREAST RADIOLOGY / ORIGINAL PAPER
Utility of signal enhancement ratio on DCE-MRI for detection of residual breast cancer following surgery or neoadjuvant chemotherapy – a pilot study
1
Department of Radiology, St Johns Medical College Hospital, Bengaluru, Karnataka, India
2
Department of Radiodiagnosis and Imaging, All India Institute of Medical Sciences (AIIMS), Bhopal, India
Submission date: 2025-10-23
Final revision date: 2026-01-27
Acceptance date: 2026-01-29
Publication date: 2026-07-31
Corresponding author
Allen Johnson
Department of Radiology, St Johns Medical College Hospital, Bengaluru, Karnataka, 560034 India
Department of Radiology, St Johns Medical College Hospital, Bengaluru, Karnataka, 560034 India
Pol J Radiol, 2026; 91(1): 361-368
KEYWORDS
TOPICS
ABSTRACT
Purpose:
Accurate detection of residual disease following breast-conserving surgery or neoadjuvant chemotherapy is essential for appropriate treatment planning in breast cancer. This retrospective pilot study aimed to evaluate the utility of the signal enhancement ratio (SER), a quantitative parameter derived from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), in detecting residual malignancy.
Material and methods:
Fourteen women who underwent 3T bilateral breast DCE-MRI at a tertiary care centre in central India were included. SER maps were generated using voxel-wise calculations, and regions of interest were placed on areas of maximum enhancement. Residual disease was confirmed histologically in 4 patients and excluded in 10 patients (8 by histopathology, 2 by long-term follow-up).
Results:
Median SER was significantly higher in residual disease (136.2) compared to non-residual cases (44.0, p < 0.05). Morphological features showed high sensitivity (100%) but low specificity (50%). An SER cut-off of 90 improved specificity to 90% without loss of sensitivity.
Conclusions:
SER mapping may enhance diagnostic accuracy in post-treatment breast MRI, supporting its use as a quantitative adjunct.
Accurate detection of residual disease following breast-conserving surgery or neoadjuvant chemotherapy is essential for appropriate treatment planning in breast cancer. This retrospective pilot study aimed to evaluate the utility of the signal enhancement ratio (SER), a quantitative parameter derived from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), in detecting residual malignancy.
Material and methods:
Fourteen women who underwent 3T bilateral breast DCE-MRI at a tertiary care centre in central India were included. SER maps were generated using voxel-wise calculations, and regions of interest were placed on areas of maximum enhancement. Residual disease was confirmed histologically in 4 patients and excluded in 10 patients (8 by histopathology, 2 by long-term follow-up).
Results:
Median SER was significantly higher in residual disease (136.2) compared to non-residual cases (44.0, p < 0.05). Morphological features showed high sensitivity (100%) but low specificity (50%). An SER cut-off of 90 improved specificity to 90% without loss of sensitivity.
Conclusions:
SER mapping may enhance diagnostic accuracy in post-treatment breast MRI, supporting its use as a quantitative adjunct.
REFERENCES (11)
1.
Blichert-Toft M, Nielsen M, Düring M, Møller S, Rank F, Overgaard M, et al. Long-term results of breast conserving surgery vs mastectomy for early stage invasive breast cancer: 20-year follow-up of the Danish randomized DBCG-82TM protocol. Acta Oncol 2008; 47: 672-681.
2.
Kurtz JM, Amalric R, Brandone H, Ayme Y, Jacquemier J, Pietra JC, et al. Local recurrence after breast-conserving surgery and radiotherapy: frequency, time course, and prognosis. Cancer 1989; 63: 1912-1917.
3.
Preda L, Villa G, Rizzo S, Bazzi L, Origgi D, Cassano E, et al. Magnetic resonance mammography in the evaluation of recurrence at the prior lumpectomy site after conservative surgery and radiotherapy. Breast Cancer Res 2006; 8: R53.
4.
Cheng Q, Huang J, Liang J, Ma M, Ye K, Shi C, et al. The diagnostic performance of DCE-MRI in evaluating the pathological response to neoadjuvant chemotherapy in breast cancer: a meta-analysis. Front Oncol 2020; 10: 93.
5.
Marinovich ML, Houssami N, Macaskill P, Sardanelli F, Irwig L, Mamounas EP, et al. Meta-analysis of magnetic resonance imaging in detecting residual breast cancer after neoadjuvant therapy. J Natl Cancer Inst 2013; 105: 321-333.
6.
Li X, Abramson RG, Arlinghaus LR, Kang H, Chakravarthy AB, Abramson VG, et al. Multiparametric magnetic resonance imaging for predicting pathological response after the first cycle of neoadjuvant chemotherapy in breast cancer. Invest Radiol 2015; 50: 195-204.
7.
Orel SG, Reynolds C, Schnall MD, Solin LJ, Fraker DL, Sullivan DC. Breast carcinoma: MR imaging before re-excisional biopsy. Radiology 1997; 205: 429-436.
8.
El Khouli RH, Macura KJ, Jacobs MA, Khalil TH, Kamel IR, Dwyer A, et al. Dynamic contrast-enhanced MRI of the breast: quantitative method for kinetic curve type assessment. AJR Am J Roentgenol 2009; 193: W295-W300.
9.
Jansen SA, Shimauchi A, Zak L, Fan X, Wood AM, Karczmar GS, et al. Kinetic curves of malignant lesions are not consistent across MRI systems: need for improved standardization of breast dynamic contrast-enhanced MRI acquisition. AJR Am J Roentgenol 2009; 193: 832-839.
10.
Li KL, Henry RG, Wilmes LJ, Gibbs J, Zhu X, Lu Y, et al. Kinetic assessment of breast tumors using high spatial resolution signal enhancement ratio (SER) imaging. Magn Reson Med 2007; 58: 572-581.
11.
Arasu VA, Chen RCY, Newitt DN, Chang CB, Tso H, Hylton NM, et al. Can signal enhancement ratio (SER) reduce the number of recommended biopsies without affecting cancer yield in occult MRI-detected lesions? Acad Radiol 2011; 18: 716-721.
Share
RELATED ARTICLE
| ISSN: | 1899-0967 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
