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).

<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>