Quantitative image analysis of the tumor microenvironment in esophageal cancer using dual energy CT

2024 Fiscal Year Final Research Report

• Project/Area Number: 20K08112
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Review Section: Basic Section 52040:Radiological sciences-related
• Research Institution: Kyushu University
• Principal Investigator: Nishimuta Yusuke 九州大学, 大学病院, 助教 (10635220)
• Co-Investigator(Kenkyū-buntansha): 西江 昭弘 九州大学, 医学研究院, 教授 (20457427) ; 浅山 良樹 大分大学, 医学部, 教授 (40380414) ; 甲斐 聖広 九州大学, 大学病院, 助教 (50848645) ; 鶴丸 大介 九州大学, 大学病院, 講師 (90419565)
• Project Period (FY): 2020-04-01 – 2025-03-31
• Keywords: 食道癌 / 微小環境 / Dual energy CT

Outline of Final Research Achievements

Using contrast-enhanced CT scans and clinical data from 309 patients with esophageal squamous cell carcinoma collected between 2018 and 2024, we sought to develop imaging biomarkers that characterize the tumor microenvironment. Standard texture metrics showed no significant association with therapeutic response; however, analysis of the extracellular volume fraction (CT-ECV) derived from equilibrium-phase iodine density images revealed significantly lower values in responders. At an optimal threshold of 42.1 %, CT-ECV achieved an AUC of 0.89, with 87.5 % sensitivity and 85.7 % specificity. Patients with low CT-ECV had a favorable 1-year progression-free survival of 87.5 %, whereas those with high CT-ECV had a poor outcome of 47.3 %. These results have been presented at international conferences, including the RSNA, and a manuscript is currently under review.

Free Research Field

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Academic Significance and Societal Importance of the Research Achievements

本研究は、多層検出器 CT のみで得られる CT-ECV を用いて ESCC の治療奏功と予後を高精度に予測できることを示した。腫瘍組織全体の線維化を非侵襲的に定量化できるため、侵襲的生検の代替となりうる点で学術的価値が高い。術前に治療抵抗性を推定し高リスク患者を同定することで、個別化治療選択や不要な化学療法の回避が可能となり、患者 QOL 向上と医療資源の最適化に資する。さらに多施設検証と AI モデル統合により、画像診断の新たな標準指標として社会実装が期待される。