Haag Nina Pauline, Bodin Pascal, Kröger Jan Robert, Niehoff Julius Henning, Saeed Saher, Gerdes Berthold, Danebrock Raihanatou Ina, Fetzner Ulrich Klaus, Borggrefe Jan, Wienke Andreas, Surov Alexey
Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Minden, Germany.
Siemens Healthineers USA, Princeton, NJ, USA.
Eur Radiol. 2025 May 23. doi: 10.1007/s00330-025-11683-1.
Evaluating esophageal cancer (EC) response to neoadjuvant radiochemotherapy (NARC) has been challenging, but photon-counting CT (PCCT) provides multiparametric data, including iodine concentration (IC), which can be utilized for evaluation. This study explored the relationship between IC and histopathological features of EC, assessing its role in predicting NARC responses.
Of 105 patients with EC, 85 (67 men; mean age 66.0 ± 11.0 years) met the inclusion criteria and underwent PCCT scans during the portal venous phase. Normalized iodine concentration (NIC) was calculated, and tumor characteristics, including stage, grade, and lymphovascular invasion, were analyzed. Statistical analyses included Mann-Whitney U tests, sensitivity, specificity, and area under the curve (AUC) calculations. Interobserver reliability of NIC measurements was assessed.
Interobserver reliability for NIC was excellent (ICC = 0.99 for all tumors, p < 0.01). In adenocarcinoma, NIC was lower in good therapy responders (Becker 1a/1b: 0.40 ± 0.13) than poor responders (Becker 2/3: 0.51 ± 0.12, p = 0.01). An NIC cutoff ≤ 0.41 predicted good regression (OR = 4.77, p = 0.03; AUC = 0.704, sensitivity = 72.2%, specificity 64.7%). Poor response prediction showed moderate accuracy (AUC = 0.662).
NIC values show excellent interobserver agreement and can predict treatment response to NARC in EC, particularly for adenocarcinomas, where lower NIC values are linked to better outcomes. While NIC provides good predictive value, further studies with larger sample sizes are needed to confirm these findings and explore additional factors influencing outcomes.
Question Does photon-counting CT-derived iodine concentration correlate with key histopathological features in esophageal cancer and predict response to neoadjuvant radiochemotherapy? Findings Photon-counting CT-derived normalized iodine concentration in esophageal adenocarcinoma moderately predicted treatment response, despite no correlation with tumor grade or Ki-67. Clinical relevance Normalized iodine concentration values from photon-counting CT, obtained during routine staging exams, offer an objective method for predicting treatment response in esophageal adenocarcinoma, enabling more precise therapy planning and personalized patient management.
评估食管癌（EC）对新辅助放化疗（NARC）的反应一直具有挑战性，但光子计数CT（PCCT）可提供多参数数据，包括碘浓度（IC），可用于评估。本研究探讨了IC与EC组织病理学特征之间的关系，评估其在预测NARC反应中的作用。
105例EC患者中，85例（67例男性；平均年龄66.0±11.0岁）符合纳入标准，并在门静脉期接受了PCCT扫描。计算标准化碘浓度（NIC），并分析肿瘤特征，包括分期、分级和淋巴管侵犯。统计分析包括曼-惠特尼U检验、敏感性、特异性和曲线下面积（AUC）计算。评估了观察者间NIC测量的可靠性。
观察者间NIC的可靠性极佳（所有肿瘤的组内相关系数ICC = 0.99，p < 0.01）。在腺癌中，治疗反应良好者（贝克尔1a/1b：0.40±0.13）的NIC低于反应不佳者（贝克尔2/3：0.51±0.12，p = 0.01）。NIC临界值≤0.41预测良好的消退（OR = 4.77，p = 0.03；AUC = 0.704，敏感性 = 72.2%，特异性 = 64.7%）。预测反应不佳显示出中等准确性（AUC = 0.662）。
NIC值显示出极佳的观察者间一致性，并且可以预测EC对NARC的治疗反应，特别是对于腺癌，较低的NIC值与更好的结果相关。虽然NIC具有良好的预测价值，但需要更大样本量的进一步研究来证实这些发现并探索影响结果的其他因素。
问题 光子计数CT得出碘浓度与食管癌的关键组织病理学特征相关并能预测新辅助放化疗的反应吗？ 发现 食管癌中光子计数CT得出的标准化碘浓度适度预测了治疗反应，尽管与肿瘤分级或Ki-67无相关性。 临床意义 常规分期检查期间获得的光子计数CT得出的标准化碘浓度值为预测食管腺癌的治疗反应提供了一种客观方法，能够实现更精确的治疗规划和个性化患者管理。
