Multiparametric assessment of tumor pathological regression grade of peritoneal metastases from non-mucinous colorectal cancer during neoadjuvant chemotherapy using dual-energy CT - 31/10/25
, Nazim Benzerdjeb b, Salim Si-Mohamed c, Marie Gavrel d, Alexandre Galan d, Laurent Villeneuve e, Olivier Glehen f, Vahan Kepenekian f, Pascal Rousset dHighlight |
• | Dual-energy CT variables of peritoneal metastases differ significantly according to the pathological regression grade after neoadjuvant chemotherapy. |
• | Extracellular volume fraction and normalized iodine concentration are the best predictors of pathological regression grade of peritoneal metastases after neoadjuvant chemotherapy. |
• | Dual-energy CT may help distinguish between good and poor responses of peritoneal metastases after neoadjuvant chemotherapy. |
Abstract |
Purpose |
The purpose of this prospective study was to evaluate the diagnostic performance of dual-energy computed tomography (DECT) using a dual-layer detector scanner in assessing the pathological response of peritoneal metastases (PMs) from non-mucinous colorectal cancer to neoadjuvant chemotherapy (NAC).
Materials and methods |
Consecutive patients with PMs from non-mucinous colorectal cancer who underwent preoperative DECT using a dual-layer detector scanner before cytoreductive surgery were prospectively included. Virtual monoenergetic images at 40 keV (VMI40kev), VMIs at 100 keV (VMI100kev), VMI slope (VMIslope), iodine concentration (IC), normalized iodine concentration with aorta (nICaorta) and liver (nICliver), effective Z atomic number (Zeff), and extracellular volume fraction (ECVf) were evaluated on PMs by two radiologists. Pathological response of PM was classified using the peritoneal regression grading score (PRGS), and classified as either good (complete response or major histological regression - PRGS ½) or poor (minor or no histological response - PRGS ¾) responses. DECT variables of PMs with good responses were compared to those of PMs with poor responses using independent-sample t-tests. Receiver operating characteristic curves were built to estimate the capabilities of the different DECT variables in differentiating between PMs with good responses (PRGS ½) and those with poor responses (PRGS ¾). Intra-class correlation coefficients analyses were performed to estimate interobserver variability in DECT variable measurements.
Results |
Forty-four patients (22 men median age, 62 years; age range: 35–78 years) with 77 PM were included from September 1st 2023 to July 1st 2025. Thirty-nine out of 77 PMs (51 %) exhibited good response (PRGS ½) and 38 PMs (49 %) exhibited poor response (PRGS ¾). VMI40kev, VMIslope, IC, nICaorta, nICliver, ECVf were significantly greater in PRGS ¾ PMs by comparison with PRGS ½ (P < 0.05). The best AUC values to distinguish between good and poor pathological response of PMs were obtained with nICaorta (AUC, 0.74: 95 % confidence interval [CI]: 0.63–0.85) and ECVf (AUC, 0.74; 95 % CI: 0.63–0.84). ICC was > 0.8 for most DECT variables.
Conclusion |
DECT using a dual-layer detector scanner provides promising biomarkers for predicting pathological response in non-mucinous PM after chemotherapy.
Le texte complet de cet article est disponible en PDF.Keywords : Dual-energy CT, Dual-layer computed tomography, Colorectal cancer, Neoadjuvant chemotherapy, Peritoneal metastases
Abbreviations : AUC, BMI, BRAF, CC, CI, ConvHU, CRS, DECT, ECVf, FN, FP, HIPEC, HU, ICC, IC, NAC, nIC, PCI, PM, PRGS, RECIST, ROC, TN, TP, TRG, VMI, Zeff
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