10.1371/journal.pone.0183855.g002 A. M. T. Schmitz A. M. T. Schmitz W. B. Veldhuis W. B. Veldhuis M. B. E. Menke-Pluijmers M. B. E. Menke-Pluijmers W. J. M. van der Kemp W. J. M. van der Kemp T. A. van der Velden T. A. van der Velden M. A. Viergever M. A. Viergever W. P. T. M. Mali W. P. T. M. Mali M. C. J. M. Kock M. C. J. M. Kock P. J. Westenend P. J. Westenend D. W. J. Klomp D. W. J. Klomp K. G. A. Gilhuijs K. G. A. Gilhuijs Examples of 7 tesla MR imaging in three patients, showing the first post-contrast dynamic contrast-enhanced MR imaging in the (A) transverse plane and the (B) coronal plane, with (C) the corresponding apparent diffusion coefficient (ADC) map; and (D) the corresponding 31-phosphorus MR spectroscopy (<sup>31</sup>P-MRS) scoring upon the ratio of phosphomonoesters (PME) to phosphodiesters (PDE). Public Library of Science 2017 decision model DCE 10- year risk-estimates 31- phosphorus spectroscopy therapy preoperative indication tumor size preoperative decision model breast cancer mortality 31 P-MRS Preoperative indication 7- tesla field strength multiparametric 7- tesla breast MRI Purpose early-stage breast cancer PME postoperative indication DCE-MRI 31 P-MRS score preoperative multiparametric 7- tesla breast MRI 2017-09-26 17:25:49 Figure https://plos.figshare.com/articles/figure/Examples_of_7_tesla_MR_imaging_in_three_patients_showing_the_first_post-contrast_dynamic_contrast-enhanced_MR_imaging_in_the_A_transverse_plane_and_the_B_coronal_plane_with_C_the_corresponding_apparent_diffusion_coefficient_ADC_map_and_D_the_corresponding/5443810 <p>All three patients (left/middle/right) had a negative preoperative indication for systemic therapy based on biopsy and conventional breast imaging. On <u>the left</u>, imaging is shown of a 47-year old woman. The decision-tree model upstages this assessment to positive indication: DCE-MRI showed a 23-mm sized lesion, an ADC of 746 x10<sup>−6</sup>mm<sup>2</sup>/s, and a PME>PDE score. Postoperatively, a grade 2 tumor and a positive indication for systemic therapy was established. <u>In the middle</u>, imaging is shown of a 58-year old women. The decision-tree model again upstages this assessment to positive indication: DCE-MRI showed an 18-mm sized lesion, an ADC of 980 x10<sup>−6</sup>mm<sup>2</sup>/s. The MRS score was, however, PME>PDE. Postoperatively, a grade 2 tumor and a positive indication for systemic therapy was established. <u>On the right</u>, imaging is shown of a 71-year old woman. The decision-tree model confirms the negative indication: DCE-MRI showed a 16-mm sized lesion, DWI a mean ADC of 834 x10<sup>−6</sup>mm<sup>2</sup>/s, and <sup>31</sup>P-MRS a PME</p>