Photon-counting computed tomography in esophageal cancer: correlation of iodine concentration with histopathology and treatment response to neoadjuvant radiochemotherapy - Report - MDSpire
Advertisement
Photon-counting computed tomography in esophageal cancer: correlation of iodine concentration with histopathology and treatment response to neoadjuvant radiochemotherapy
Photon-Counting CT Iodine Levels Predict Histopathology and NARC Response in Esophageal Cancer
Overview
This study evaluated the relationship between iodine concentration (IC) measured by photon-counting computed tomography (PCCT) and histopathological features in esophageal cancer (EC). It demonstrated that normalized iodine concentration (NIC) correlates with tumor characteristics and can predict response to neoadjuvant radiochemotherapy (NARC).
Background
Esophageal cancer is a highly aggressive malignancy with poor prognosis, requiring accurate staging and treatment response prediction. Neoadjuvant radiochemotherapy is standard for locally advanced esophageal adenocarcinoma and squamous cell carcinoma. Conventional imaging has limitations in tumor characterization. PCCT offers enhanced spatial resolution and material decomposition, enabling quantification of iodine concentration as a marker of tumor vascularity and potential treatment response.
Data Highlights
Parameter
Measurement
Details
Sample Size
105 patients
Locally advanced EC, adenocarcinoma or SCC
Imaging
PCCT with iodine maps
Thorax and abdomen, portal venous phase
Contrast Agent
1 mL/kg ACCUPAQUE 300
Injected at 2.5 mL/s, scan at 60 s post-threshold
NIC Calculation
Ratio tumor IC to aortic IC
Accounts for physiological variability
Histopathology
Ki-67, tumor grade, lymphovascular invasion
Becker classification for tumor regression
Statistical Methods
Mann–Whitney U, Spearman correlation, ROC analysis
ICC for interobserver reliability
Key Findings
Normalized iodine concentration (NIC) measured by PCCT correlates significantly with histopathological tumor features such as tumor grade and proliferation index (Ki-67).
Higher NIC values are associated with more aggressive tumor characteristics and poorer differentiation.
NIC demonstrates good interobserver reliability between radiologists (ICC assessed).
NIC can predict tumor response to neoadjuvant radiochemotherapy, with ROC analysis showing meaningful sensitivity and specificity.
Logistic regression supports NIC as an independent predictor of treatment response in esophageal cancer.
Clinical Implications
PCCT-derived NIC offers a non-invasive imaging biomarker to characterize esophageal tumors and predict response to neoadjuvant radiochemotherapy. Incorporating NIC measurements into clinical workflows may improve personalized treatment planning and prognostication. This approach could optimize patient selection for surgery and guide therapeutic strategies.
Conclusion
Photon-counting CT iodine quantification correlates with key histopathological parameters and effectively predicts neoadjuvant treatment response in esophageal cancer. NIC represents a promising imaging biomarker to enhance tumor characterization and guide clinical decision-making.
References
Ruhr-University Bochum Ethics Committee 2021–827 -- Study Approval
by Nina Pauline Haag, Pascal Bodin, Jan Robert Kröger, Julius Henning Niehoff, Saher Saeed, Berthold Gerdes, Raihanatou Ina Danebrock, Ulrich Klaus Fetzner, Jan Borggrefe, Andreas Wienke, Alexey Surov
