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Quantitative parameters derived from dual-energy computed tomography for the preoperative prediction of early recurrence in patients with esophageal squamous cell carcinoma

  • Oncology
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

This study aimed to assess the efficacy of quantitative parameters derived from dual-energy computed tomography (DECT) for the preoperative prediction of early recurrence (ER) in patients with esophageal squamous cell carcinoma (ESCC).

Methods

In total, 78 patients with ESCC who underwent radical esophagectomy and DECT from June 2019 to August 2020 were enrolled in this study. Normalized iodine concentration (NIC) and electron density (Rho) in tumors were measured using arterial and venous phase images, whereas unenhanced images were used to determine the effective atomic number (Zeff). Univariate and multivariate Cox proportional hazards models were used to identify independent risk predictors of ER. Receiver operating characteristic curve analysis was performed using the independent risk predictors. ER-free survival curves were constructed using the Kaplan–Meier method.

Results

NIC in the arterial phase (A-NIC; hazards ratio [HR], 3.91; 95% confidence interval [CI], 1.79–8.56; p = 0.001) and pathological grade (PG; HR, 2.69; 95% CI, 1.32–5.49; p = 0.007) were identified as significant risk predictors of ER. The area under the curve of A-NIC for predicting ER in patients with ESCC was not significantly higher than that of PG (0.72 vs. 0.66, p = 0.441). In a stratified survival analysis, patients with high A-NIC or poorly differentiated ESCC had a higher rate of ER than those with low A-NIC or highly/moderately differentiated ESCC.

Conclusions

A-NIC derived from DECT can be used to noninvasively predict preoperative ER in patients with ESCC, with an efficacy comparable to that of pathological grade.

Clinical relevance statement

Preoperative quantitative measurement of dual-energy CT parameters can predict the early recurrence of esophageal squamous cell carcinoma and serve as an independent prognostic factor to guide clinical designation of personalized treatment.

Key Points

• Normalized iodine concentration in the arterial phase and pathological grade were independent risk predictors of early recurrence in patients with esophageal squamous cell carcinoma.

• Normalized iodine concentration in the arterial phase may be a noninvasive imaging marker for preoperatively predicting early recurrence in patients with esophageal squamous cell carcinoma.

• The efficacy of normalized iodine concentration in the arterial phase derived from dual-energy computed tomography for predicting early recurrence is comparable to that of pathological grade.

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Abbreviations

A-NIC:

Normalized iodine concentration in arterial phase

A-Rho:

Electron density in arterial phase

AUC:

Area under the curve

CI:

Confidence interval

CRT:

Chemoradiotherapy

DECT:

Dual-energy computed tomography

ER:

Early recurrence

ESCC:

Esophageal squamous cell carcinoma

G1:

Well differentiated

G2:

Moderately differentiated

G3:

Poor differentiated

ICC:

Intraclass correlation coefficient

LVI:

Lymphovascular invasion

N:

Lymph node

NPV:

Negative predictive value

PG:

Pathological grade

PPV:

Positive predictive value

ROI:

Regions of interest

V-NIC:

Normalized iodine concentration in venous phase

V-Rho:

Electron density in venous phase

Zeff :

Effective atomic number

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Acknowledgements

We thank the study participants and mentors for their participation in this study.

Funding

This study has received funding from the Natural Science Foundation of Chongqing municipality (cstc2021jcyj-msxmX0387), the Medical Scientific Research Project of Chongqing Municipal Health Commission (2022WSJK027), and the 2021 SKY Imaging Research Fund of the Chinese International Medical Foundation (Z-2014-07-2101).

Author information

Author notes

  1. Yan Liu and Fanrong Cheng contributed equally to the study.

Authors and Affiliations

  1. Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, 400030, People’s Republic of China

    Yan Liu, Fanrong Cheng, Lei Wang, Lihong Du, Hesong Shen, Xiaoxia Wang, Daihong Liu, Junli Tao & Jiuquan Zhang

  2. Department of Radiology, People’s Hospital of Rongchang District, Chongqing, 402460, People’s Republic of China

    Fanrong Cheng

  3. Department of Pathology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, 400030, People’s Republic of China

    Zhen Zeng

  4. Siemens Healthineers, Shanghai, 200126, People’s Republic of China

    Jiaxing Wu

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  1. Yan Liu
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Correspondence to Jiuquan Zhang.

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Guarantor

The scientific guarantor of this publication is Jiuquan Zhang.

Conflict of interest

One of the authors (Jiaxing Wu) of this article is an employee of Siemens Healthineers. The remaining authors declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

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No study subjects or cohorts have been previously reported.

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• Retrospective

• diagnostic or prognostic study

• Performed at one institution

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Liu, Y., Cheng, F., Wang, L. et al. Quantitative parameters derived from dual-energy computed tomography for the preoperative prediction of early recurrence in patients with esophageal squamous cell carcinoma. Eur Radiol 33, 7419–7428 (2023). https://doi.org/10.1007/s00330-023-09818-3

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  • DOI: https://doi.org/10.1007/s00330-023-09818-3

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