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Purpose <p>To assess preoperative delayed phase dual-energy CT (DECT) parameters for predicting early peritoneal metastasis (PM), enable noninvasive risk stratification, and clarify relevant histopathologic correlates.</p> Materials and methods <p>This retrospective study included gastric cancer patients undergoing preoperative DECT and curative gastrectomy. Delayed phase DECT quantitative, qualitative, and radiomic features were analyzed for their associations with peritoneal recurrence risk via Cox regression. The hazard ratio (HR), concordance index (C‑index), and time‑dependent receiver operating characteristic curves were used to evaluate the integrated model and individual predictors. Early peritoneal recurrence was defined using a fixed 24&#xa0;month time point for risk stratification. Confusion matrices were applied to assess stratification performance across all models. Kaplan–Meier analysis with the log-rank test compared subgroup survival. Histopathologic tumor-stroma ratio (TSR) was correlated with imaging features.</p> Results <p>Of the 185 included patients (mean age, 66&#xa0;years ± 14; 145&#xa0;male), 21 developed PM. A DECT signature was constructed by independent risk factors for postoperative PM, including clinical T stage (HR = 5.86, 95% CI 1.30–26.33, <i>p</i> = 0.021), linitis plastica (HR = 12.37, 95% CI 2.61–58.72, <i>p</i> = 0.002), and extracellular volume fraction (ECV, HR = 2.94, 95% CI 1.15–7.50, <i>p</i> = 0.024). A radiomics signature was established using three key radiomic features, and an integrated model was further developed accordingly. All three models correlated significantly with peritoneal recurrence (all <i>p</i> &lt; 0.001; C-index: 0.776–0.836), but neither radiomics nor integration added benefit over DECT signature. At the fixed 2&#xa0;year endpoint, high-risk subgroups across all models showed shorter early peritoneal recurrence-free survival (log-rank: all <i>p</i> &lt; 0.001; HR: 8.53–10.63). Additionally, ECV was positively correlated with histopathologic TSR.</p> Conclusions <p>Delayed-phase DECT serves as an exploratory tool for preoperative risk stratification of early peritoneal recurrence in gastric cancer and identifies TSR as a histopathologic correlate, offering preliminary imaging evidence for clinical practice.</p>

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Delayed phase dual-energy CT for early peritoneal metastasis prediction: imaging phenotypes and tumor-stroma correlates in upfront gastrectomy candidates

  • 期刊论文

  • 发表日期：

    2026年6月26日

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  • Qiuxia Feng,
  • Yuxi Gong,
  • Shan Yin,
  • Qiong Li,
  • Lulu Xu,
  • Xisheng Liu

摘要

Purpose

To assess preoperative delayed phase dual-energy CT (DECT) parameters for predicting early peritoneal metastasis (PM), enable noninvasive risk stratification, and clarify relevant histopathologic correlates.

Materials and methods

This retrospective study included gastric cancer patients undergoing preoperative DECT and curative gastrectomy. Delayed phase DECT quantitative, qualitative, and radiomic features were analyzed for their associations with peritoneal recurrence risk via Cox regression. The hazard ratio (HR), concordance index (C‑index), and time‑dependent receiver operating characteristic curves were used to evaluate the integrated model and individual predictors. Early peritoneal recurrence was defined using a fixed 24 month time point for risk stratification. Confusion matrices were applied to assess stratification performance across all models. Kaplan–Meier analysis with the log-rank test compared subgroup survival. Histopathologic tumor-stroma ratio (TSR) was correlated with imaging features.

Results

Of the 185 included patients (mean age, 66 years ± 14; 145 male), 21 developed PM. A DECT signature was constructed by independent risk factors for postoperative PM, including clinical T stage (HR = 5.86, 95% CI 1.30–26.33, p = 0.021), linitis plastica (HR = 12.37, 95% CI 2.61–58.72, p = 0.002), and extracellular volume fraction (ECV, HR = 2.94, 95% CI 1.15–7.50, p = 0.024). A radiomics signature was established using three key radiomic features, and an integrated model was further developed accordingly. All three models correlated significantly with peritoneal recurrence (all p < 0.001; C-index: 0.776–0.836), but neither radiomics nor integration added benefit over DECT signature. At the fixed 2 year endpoint, high-risk subgroups across all models showed shorter early peritoneal recurrence-free survival (log-rank: all p < 0.001; HR: 8.53–10.63). Additionally, ECV was positively correlated with histopathologic TSR.

Conclusions

Delayed-phase DECT serves as an exploratory tool for preoperative risk stratification of early peritoneal recurrence in gastric cancer and identifies TSR as a histopathologic correlate, offering preliminary imaging evidence for clinical practice.