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Background <p>To explore the feasibility of pretreatment dual-energy CT (DECT) quantitative parameters for predicting pathologic complete response (pCR) after neoadjuvant chemotherapy in breast cancer and to compare their predictive performance with MRI-derived apparent diffusion coefficient (ADC).</p> Methods <p>This prospective study enrolled participants with invasive breast cancer receiving NAC between June 2022 and December 2023. All participants underwent pretreatment contrast-enhanced chest DECT and breast MRI. Quantitative DECT parameters (normalized iodine concentration [NIC], normalized effective atomic number [nZ<sub>eff</sub>], slope of the spectral Hounsfield unit curve [λ<sub>HU</sub>] in arterial and venous phases, and interphase differentials [ΔNIC, ΔnZ<sub>eff</sub>, Δλ<sub>HU</sub>]) and ADC values were measured and compared between pCR and non-pCR groups. Predictive performance was assessed using the area under the receiver operating characteristic curve (AUC).</p> Results <p>Sixty-five participants (mean age ± SD, 48 ± 10 years) were included; 15 (23.1%) participants achieved pCR. The venous-phase NIC (V-NIC) (0.29 ± 0.10 vs. 0.39 ± 0.13, <i>p</i> = 0.004) and ΔNIC (0.20 ± 0.10 vs. 0.26 ± 0.09, <i>p</i> = 0.03) from DECT were lower, and the ADC (0.89 ± 0.13 vs. 0.77 ± 0.13 × 10<sup>− 3</sup> mm<sup>2</sup>/s, <i>p</i> = 0.004) was higher in the pCR than the non-pCR group. ROC analysis demonstrated no significant difference in AUC between V-NIC and ADC (0.75 [95% CI: 0.51, 0.89] vs. 0.71 [95% CI: 0.58, 0.81], <i>p</i> = 0.69). Combining V-NIC and ADC (AUC: 0.79 [95% CI: 0.65, 0.90]) did not improve predictive performance compared with V-NIC or ADC alone (both <i>p</i> &gt; 0.05).</p> Conclusions <p>Pretreatment DECT-derived quantitative parameters may serve as feasible noninvasive indicators for predicting pCR after NAC in breast cancer. In this pilot cohort, the predictive performance of V-NIC was not significantly different from that of ADC; given the limited number of pCR events, these findings are preliminary and require validation in larger, independent cohorts.</p>

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Pretreatment dual-energy CT versus diffusion-weighted imaging for predicting pathologic complete response to neoadjuvant chemotherapy in breast cancer

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月10日

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  • Ying Cao,
  • Yue Cheng,
  • Yao Huang,
  • Xueqin Gong,
  • Tian Li,
  • Huifang Chen,
  • Lihong Du,
  • Jinfang Shi,
  • Xiangfei Zeng,
  • Ting Yin,
  • Xiaoxia Wang,
  • Jiuquan Zhang

摘要

Background

To explore the feasibility of pretreatment dual-energy CT (DECT) quantitative parameters for predicting pathologic complete response (pCR) after neoadjuvant chemotherapy in breast cancer and to compare their predictive performance with MRI-derived apparent diffusion coefficient (ADC).

Methods

This prospective study enrolled participants with invasive breast cancer receiving NAC between June 2022 and December 2023. All participants underwent pretreatment contrast-enhanced chest DECT and breast MRI. Quantitative DECT parameters (normalized iodine concentration [NIC], normalized effective atomic number [nZeff], slope of the spectral Hounsfield unit curve [λHU] in arterial and venous phases, and interphase differentials [ΔNIC, ΔnZeff, ΔλHU]) and ADC values were measured and compared between pCR and non-pCR groups. Predictive performance was assessed using the area under the receiver operating characteristic curve (AUC).

Results

Sixty-five participants (mean age ± SD, 48 ± 10 years) were included; 15 (23.1%) participants achieved pCR. The venous-phase NIC (V-NIC) (0.29 ± 0.10 vs. 0.39 ± 0.13, p = 0.004) and ΔNIC (0.20 ± 0.10 vs. 0.26 ± 0.09, p = 0.03) from DECT were lower, and the ADC (0.89 ± 0.13 vs. 0.77 ± 0.13 × 10− 3 mm2/s, p = 0.004) was higher in the pCR than the non-pCR group. ROC analysis demonstrated no significant difference in AUC between V-NIC and ADC (0.75 [95% CI: 0.51, 0.89] vs. 0.71 [95% CI: 0.58, 0.81], p = 0.69). Combining V-NIC and ADC (AUC: 0.79 [95% CI: 0.65, 0.90]) did not improve predictive performance compared with V-NIC or ADC alone (both p > 0.05).

Conclusions

Pretreatment DECT-derived quantitative parameters may serve as feasible noninvasive indicators for predicting pCR after NAC in breast cancer. In this pilot cohort, the predictive performance of V-NIC was not significantly different from that of ADC; given the limited number of pCR events, these findings are preliminary and require validation in larger, independent cohorts.