ArticleBMC medical imaging2026
Leveraging the non-contrast CT component of PET/CT: an AI-driven delta-radiomics approach to monitor treatment response in metastatic 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
purpose18 F-FDG PET/CT is the standard modality for monitoring treatment response in metastatic breast cancer. This study aims to evaluate the predictive value of delta-radiomics derived solely from the low-dose, non-contrast CT component acquired during routine PET/CT imaging-without requiring an additional dedicated CT examination or extra contrast administration-for monitoring response to CDK4/6 inhibitors in de novo metastatic hormone receptor-positive (HR+)/HER2-negative breast cancer.
methodsThis retrospective study included 33 patients with bone-predominant metastatic breast cancer. Delta radiomic features were extracted from the non-contrast CT component of paired baseline and follow-up 18 F-FDG PET/CT scans. Patients were stratified into Responders (Complete or Partial Response) and Non-Responders (Stable or Progressive Disease) based on standard PERCIST criteria. We developed an integrated machine learning model using logistic regression with elastic net regularization, validated via leave-one-out cross-validation (LOOCV).
resultsThe cohort consisted of 25 Responders and 8 Non-Responders. Non-Responders exhibited distinct longitudinal increases in Delta_Pct_shape_Elongation and Delta_Pct_firstorder_90Percentile compared to Responders. The integrated model, combining these features with clinical variables, achieved an Area Under the Curve (AUC) of 0.930, significantly outperforming the baseline clinical-only model (AUC = 0.775). While the default threshold prioritized sensitivity (96.0%) with limited specificity (25.0%), post-hoc threshold optimization maximizing the Youden index demonstrated a highly balanced performance, achieving 88.0% sensitivity and 87.5% specificity.
conclusionsDelta radiomics analysis of the routinely acquired non-contrast CT component of PET/CT provides substantial incremental prognostic value over standard clinical variables. This approach demonstrates the potential of utilizing existing low-dose CT data as a cost-effective, supportive biomarker for the early prediction of therapeutic resistance.
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