Objective:

To evaluate iodine-based parameters from spectral CT for estimating surgical Peritoneal Cancer Index (PCI) and predicting complete cytoreduction (R0) in ovarian cancer patients, focusing on their potential clinical utility.

Key Findings:

• Iodine-based parameters showed strong correlation with intraoperative PCI (IC: r=0.85, NIC: r=0.74, both P<0.001).
• NIC increased progressively across tumor burden categories (0.43, 0.57, 0.71; P<0.001).
• NIC had optimal performance for predicting R0 resection (AUC = 0.88, 95% CI: 0.81-0.94) with a cutoff value ≤0.55.
• A combined model (NIC + PCI + CA-125) achieved AUC = 0.93 (95% CI: 0.87-0.97) with excellent interobserver reproducibility (ICC >0.84).

Interpretation:

Spectral CT iodine quantification may serve as a valuable tool for assessing peritoneal metastasis burden and predicting surgical resectability in ovarian cancer, but requires external validation before clinical application.

Limitations:

• Retrospective design may introduce selection bias.
• Single-center study limits generalizability and diversity of the patient population.
• Need for external validation of findings before clinical application.

Conclusion:

Spectral CT iodine quantification shows promise for estimating peritoneal metastasis burden and predicting surgical outcomes, warranting further validation.