ArticleBMC medical imaging2026
Pretreatment dual-energy CT versus diffusion-weighted imaging for predicting pathologic complete response to neoadjuvant chemotherapy in breast cancer.
Article in BMC medical imaging, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundTo 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).
methodsThis 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).
resultsSixty-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).
conclusionsPretreatment 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.
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