RPS 1401 - Insights into gastroesophageal disease

Author Block: J. Qu, W. Li, F. Chu; Zhengzhou/CN
Purpose: To explore the differences in spectral CT parameters among patients with esophageal squamous cell carcinoma (ESCC), categorized by different tumor regression grade (TRG) groups.
Methods or Background: This prospective study analyzed 31 patients with ESCC who underwent neoadjuvant therapy. All patients received energy-spectrum CT scans within 7 days before surgery, and the following parameters were quantified: 40KeV, 70KeV, and 100KeV CT values in the arterial (AP) and venous phase (VP), iodine concentration (IC) in the normal esophageal wall, lesion and aorta, and Z Effective values. Finally, we assessed the differences in parameters among the different TRG groups (0, 1, 2, 3).
Results or Findings: In this study, a total of 19 participants were analyzed. 6 (31.58%) were in the TRG0 group, 3 (15.79%) in the TRG1 group, 6 (31.58%) in the TRG2 group, and 4 (21.05%) in the TRG3 group. Significant differences were observed among the four groups for arterial phase K40–70 keV (F=4.86, P=0.015) and K70–100 keV (F=4.78, P=0.016). However, no significant differences were found for NICD, NICratio, venous phase K40–70 keV and venous phase K70–100 keV (P>0.05).
Conclusion: Arterial phase parameters differ significantly among TRG groups, indicating potential in predicting tumor regression, while NICD, NICratio, and venous phase parameters do not.
Limitations: One limitation of this study is the small sample size, which may affect the generalizability of the findings. Additionally, the statistical methods employed were relatively simple, which may not fully capture the complexity of the data. Future research should involve larger sample sizes and develop models to further evaluate the significant parameters, enhancing the accuracy and reliability of the results.
Funding for this study: This study has received funding by the Projects of the General Program of the National Natural Science Foundation of China
(No.82271979), Henan Province Medical Science and Technology Tackling Program Joint Construction Project (No. LHGJ20230096)，Henan Province Central Plains Talent Program (Nurturing talent Series)（No.20240220）
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The Research Ethics Committee of the Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital) has approved this study (NCT03635619). Consent to participate Written informed consent was obtained from all subjects (patients) in this study.

Author Block: J. Leonhardi, B. Schnarkowski, T. Denecke, H-J. Meyer; Leipzig/DE
Purpose: Staging in patients with oesophageal cancer is of high importance for treatment decisions. Regarding correct nodal staging, CT imaging was reported with low accuracy. Our observational retrospective study tried to elucidate the potential diagnostic benefit of the Node-RADS classification to discriminate benign from malignant lymph nodes.
Methods or Background: 126 patients (n= 15 females, 11.9%) with a mean age of 62.1 ± 10.4 years were included. Patients were surgically resected and lymph nodes were analyzed histopathologically. CT scans were acquired within one month before surgery. N = 182 lymph nodes were independently scored by two radiologists, following the Node-RADS classification. This lymph node scoring system ranges from 1 to 5, reflecting probability of malignancy (1–very low to 5–very high).
Results or Findings: 54 patients were nodal positive (42.9 %), whereas 72 patients were nodal negative (57.1 %). N1 stage was found in n= 28 cases (22.2 %), N2 in n = 20 cases (15.9 %) and N3 stage in n = 6 cases (4.8 %). The tumors were squamous cell carcinomas (36 cases), adenocarcinomas (88 cases) and mixed adenoneuroendocrine carcinomas (2 cases).
Inter-reader agreement reached k = 0.65 (p<0.001) for the overall Node-RADS scoring.
Malignancy rates for Node-RADS-scores, ranging from score 1 - 5, were as following: 30 %, 14%, 81%, 90.1%, 86.5%.
Total Node-RADS score showed statistically significant differences between N0 and N1-3 stage (N0: 2.68 ± 1.31 versus N1-3: 3.54 ± 1.11, p<0.001). ROC curve analysis yielded an AUC of 0.69, a threshold of 2 resulted in a sensitivity of 0.77 and a specificity of 0.55.
Conclusion: Node-RADS scores were associated with malignancy of lymph nodes and might help to improve staging in oesophagus carcinomas.
Limitations: For potential clinical translation there is need for external validation.
Funding for this study: This study did not receive funding of any kind.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: No. of the approval: 106-16-14032016

Author Block: T. Bei, J. Li; Zhengzhou/CN
Purpose: To investigate the value of deep learning image reconstruction algorithm (DLIR) in improving image quality of the dual-energy CT scans of gastric cancer by comparing with the adaptive statistical iterative reconstruction Veo (ASiR-V) algorithm.
Methods or Background: The original DECT images of 80 patients with surgical pathology confirmed gastric cancer between February 2023 and July 2023 were retrospectively collected. The virtual mono-energy images (VMI) and iodine images at three-phase including arterial phase, venous and delayed phase, were reconstructed using ASiR-V50% and DLIR of three strengths (DLIR‑L/M/H). Objective evaluation indicators for assessing image quality included noise (SD), signal-to-noise ratio of gastric cancer lesions (SNR lesion) and muscle signal-to-noise ratio (SNR muscle), contrast-to-noise ratio of lesions (CNR lesion), and normalized iodine concentration (NIC). Subjective evaluation indicators included image noise and image sharpness. One-way analysis of variance and Kruskal-Wallis test were performed to compare the differences of image quality among different reconstruction images.
Results or Findings: Compared with ASiR-V50%, DLIR-M and DLIR-H significantly reduced the SD value of the images (P<0.05). The SNR lesion and SNR muscle of DLIR-M and DLIR-H were significantly higher than those of ASiR-V50% (P<0.05). The CNR lesion of DLIR-H were significantly higher than those of ASiR-V50% and DLIR-L (P<0.01). But compared with ASiR-V50%, there were no statistically significant difference in the NIC values ​​of the iodine images between the groups (P>0.05). Subjective scoring results showed that the DLIR‑H images displayed the lowest noise, and the highest image sharpness, significantly higher than ASIR-V50% (P<0.05).
Conclusion: Compared with ASiR-V50%, DLIR significantly reduced the noise of DECT images of gastric cancer and improved the image quality. Among the three deep learning reconstruction algorithms , DLIR-H had the best noise reduction performance, image noise and image sharpness.
Limitations: Not applicable.
Funding for this study: National Natural Science Foundation of China（82202146）
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: This is a retrospective study

Author Block: G. Marras, F. Pisu, A. Palmisano, A. Esposito; Milan/IT
Purpose: Virtual Non-Contrast (VNC) has emerged as a potential alternative to True Non-Contrast (TNC) imaging, offering dose reduction while maintaining good tissue contrast. Photon-Counting CT (PCCT) for improved spectral separation should improve material decomposition providing accurate VNC. The aim of the present study is to evaluate the diagnostic reliability of VNC compared to TNC in PCCT images.
Methods or Background: This retrospective study included consecutive patients submitted to Contrast-Enhanced CT examination acquired with PCCT Naeotom Alpha (Iopromide or Iopamidol 370, 60 ml) from June to September 2024 for clinical indications with the availability of TNC. VNC were obtained from arterial (VNCa) and venous phases (VNCv) (Qr40, Q3).
Using PACS tool, TNC, VNCa and VNCv were aligned and for the extraction of Hounsfield Unit, Regions of interest (ROI) were drawn in right liver lobe, spleen, kidney, pancreas, aorta, omental and subcutaneous fat, paravertebral muscle, vertebral cortical and spongious bone. Co-registration and minor adjustments were made to account for breathing variations. Attenuation values were then compared using Tukey’s HSD or Dunn’s test.
Results or Findings: A total of 38 studies have been analyzed. Significant differences in mean HU values between TNC and both VNC were observed for most tissues (p<.01), except the spleen. Highest attenuation differences were found for subcutaneous/omental fat and bone cortical and spongious with HU difference higher than 15HU in more than 50% of cases for fat and 100% for bone. No significant HU differences were found between VNCa and VNCv, except in the spleen.
Conclusion: VNC obtained from PCCT provide different attenuation values compared to TNC.
Caution should be exercised in routine clinical practice.
Limitations: Higher sample size is required to confirm the present data.
Funding for this study: None
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Aimomics

Author Block: V. Sbacco, F. Puccetti, D. Palumbo, G. J. Ortu, A. Campisi, E. Mazza, F. De Cobelli, U. Elmore, R. Rosati; Milan/IT
Purpose: Sarcopenia, defined as a progressive and generalized loss of muscle mass, strength, and function, is linked to increased morbidity and mortality in several nonmalignant conditions. Recently, it has emerged as an important factor in oncology, correlating with higher chemotherapy toxicity. However, its impact on survival and surgical outcomes in cancer patients remains unclear. This study evaluates the effects of sarcopenia on the response to neoadjuvant chemotherapy (NACT), overall survival, and postoperative outcomes in gastric cancer patients.
Methods or Background: A retrospective analysis was conducted on a prospective database of patients treated between September 2017 and December 2023. All patients received NACT with the FLOT regimen followed by total or subtotal gastrectomy (open/laparoscopic). Body composition parameters, including skeletal muscle area (SM), visceral (VAT), and subcutaneous adipose tissue (SAT), were measured from CT images before and after NACT using a semi-automated segmentation software (Sliceomatic 5.0). Sarcopenia was defined by the skeletal muscle index (SMI) adjusted for gender.
Results or Findings: The study included 101 patients, predominantly male (60.4%), with distal adenocarcinoma (71.3%). Post-NACT sarcopenia was present in 65 patients (64.4%), while visceral obesity was found in 33 (32.7%). NACT-induced sarcopenia had no significant effect on postoperative outcomes, except for a higher incidence of wound complications (p=0.012). Longitudinal changes in body composition showed a correlation between sarcopenia and a poorer tumor regression grade (TRG).
Conclusion: There is a strong association between NACT administration and the onset of sarcopenia (p = 0,001) , which, however, had minimal impact on survival and clinical outcomes in our center. This underscores the importance of completing the full neoadjuvant FLOT regimen.
Limitations: Although our goal is to expand it, our cohort of patients is currently quite limited. Further exploration of sarcopenia in gastric cancer is warranted.
Funding for this study: Unfunded study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: 28/Int/2015