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Background <p>To determine the optimal region of interest (ROI) measurement strategy in spectral computed tomography (CT) for the preoperative prediction of perineural invasion (PNI) in gastric adenocarcinoma.</p> Methods <p>This retrospective study analyzed 91 gastric adenocarcinoma patients undergoing triple-phase (arterial, venous, and delayed phase; AP/VP/DP) contrast-enhanced spectral CT within two weeks before surgery. Patients were divided into PNI-positive and PNI-negative groups based on pathological findings. Iodine concentration (IC) values were measured using two free-hand ROI approaches: a two-dimensional ROI (2D-ROI) and a three-dimensional volumetric ROI (3D-ROI). Normalized IC (nIC) was also calculated. Consistency and correlation between the two ROI measurements were assessed. Differences in clinicopathological and CT features between the PNI-positive and PNI-negative groups were analyzed. The area under the receiver operating characteristic curve (AUC) was used to evaluate predictive performance. Logistic regression identified independent risk factors for PNI.</p> Results <p>The ICs measured by 2D and 3D-ROI showed excellent consistency (ICC = 0.803–0.853) and correlation (<i>r</i> = 0.777–0.797), though 2D-ROI yielded higher values (all <i>P</i> &lt; 0.05). 2D-ICVP, 2D-ICDP, 2D-nICVP, 2D-nICDP and 3D-nICDP, were significantly higher in PNI-positive GC (<i>P</i> &lt; 0.05). 2D-nICDP had the highest predictive AUC (0.761), outperforming other parameters (AUC = 0.622–0.670; <i>P</i> &lt; 0.05). Multivariable analysis confirmed 2D-nICDP as the only independent PNI predictor.</p> Conclusions <p>Although the consistency and correlation between 2D and 3D-ROIs were excellent, only 2D-nICDP was an independent predictor for PNI in gastric cancer (GC) and demonstrated superior predictive performance.</p>

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Comparison of 2D and 3D measured iodine concentration of gastric adenocarcinoma on spectral-CT and their relationship with perineural invasion

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月26日

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  • Tianxia Bei,
  • Xiaoqiang Yao,
  • Xuejun Chen,
  • Yue Wu,
  • Jing Li,
  • Jinrong Qu

摘要

Background

To determine the optimal region of interest (ROI) measurement strategy in spectral computed tomography (CT) for the preoperative prediction of perineural invasion (PNI) in gastric adenocarcinoma.

Methods

This retrospective study analyzed 91 gastric adenocarcinoma patients undergoing triple-phase (arterial, venous, and delayed phase; AP/VP/DP) contrast-enhanced spectral CT within two weeks before surgery. Patients were divided into PNI-positive and PNI-negative groups based on pathological findings. Iodine concentration (IC) values were measured using two free-hand ROI approaches: a two-dimensional ROI (2D-ROI) and a three-dimensional volumetric ROI (3D-ROI). Normalized IC (nIC) was also calculated. Consistency and correlation between the two ROI measurements were assessed. Differences in clinicopathological and CT features between the PNI-positive and PNI-negative groups were analyzed. The area under the receiver operating characteristic curve (AUC) was used to evaluate predictive performance. Logistic regression identified independent risk factors for PNI.

Results

The ICs measured by 2D and 3D-ROI showed excellent consistency (ICC = 0.803–0.853) and correlation (r = 0.777–0.797), though 2D-ROI yielded higher values (all P < 0.05). 2D-ICVP, 2D-ICDP, 2D-nICVP, 2D-nICDP and 3D-nICDP, were significantly higher in PNI-positive GC (P < 0.05). 2D-nICDP had the highest predictive AUC (0.761), outperforming other parameters (AUC = 0.622–0.670; P < 0.05). Multivariable analysis confirmed 2D-nICDP as the only independent PNI predictor.

Conclusions

Although the consistency and correlation between 2D and 3D-ROIs were excellent, only 2D-nICDP was an independent predictor for PNI in gastric cancer (GC) and demonstrated superior predictive performance.