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Background  This study aims to observe and analyze the effect of diffusion weighted magnetic resonance imaging (MRI) on the patients with locally advanced breast cancer undergoing neoadjuvant chemotherapy.    Methods  Fifty patients (mean age, 48.7 years) with stage II–III breast cancer who underwent neoadjuvant chemotherapy and preoperative MRI between 2016 and 2020 were retrospectively evaluated. The associations between preoperative breast MRI findings/clinicopathological features and outcomes of neoadjuvant chemotherapy were assessed.    Results  Clinical stage at baseline (OR: 0.104, 95% confidence interval (CI) 0.021–0.516,  P  = 0.006) and standard apparent diffusion coefficient (ADC) change (OR: 9.865, 95% CI 1.024–95.021,  P  = 0.048) were significant predictive factors of the effects of neoadjuvant chemotherapy. The percentage increase of standard ADC value in pathologic complete response (pCR) group was larger than that in non-pCR group at first time point ( P  < 0.05). A correlation was observed between the change in standard ADC values and tumor diameter at first follow-up (r: 0.438,  P  < 0.05).    Conclusions  Our findings support that change in standard ADC values and clinical stage at baseline can predict the effects of neoadjuvant chemotherapy for patients with breast cancer in early stage.    Supplementary Information  The online version contains supplementary material available at 10.1186/s12880-021-00688-z.

Predicting pathologic response to neoadjuvant chemotherapy in patients with locally advanced breast cancer using multiparametric MRI