ORIGINAL RESEARCH article
Front. Oncol.
Sec. Cancer Imaging and Image-directed Interventions
This article is part of the Research TopicMethods and Applications of Tumour Metabolic Imaging in the Preclinical and Clinical SettingView all 7 articles
Prediction of histopathological grade in gastric cancer using Dual Energy CT-derived synthetic extracellular volume fraction
Provisionally accepted
- 1Huai'an First People's Hospital, Huai'an, China
- 2GE HealthCare China, Shanghai, China, Shanghai, China
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Purpose To investigate the relationship between the synthetic extracellular volume (ECV) fraction and the hematocrit (HCT)-based ECV fraction in gastric cancer patients and to evaluate its potential utility in predicting the pathological grade of gastric cancer. Methods Data from the derivation cohort consisting of 142 patients who underwent nonenhanced abdominal CT examination were collected, and the CT values of the abdominal aorta (CTA) and inferior vena cava (CTV) were measured separately. Using linear regression between CT attenuations and conventional hematocrit (HCTcon), calculation formulas were derived for the synthetic hematocrit of the abdominal aorta (HCTsyn, A) and the inferior vena cava (HCTsyn, V). A validation cohort of 62 gastric adenocarcinoma patients with dual-energy CT was analyzed to calculate synthetic ECV (ECVsyn, A and ECVsyn, V) using the derived formulas. Differences between synthetic and conventional ECV(ECVcon), and their efficacy in differentiating pathological grades, were compared. Results Derived formulas: HCTsyn,A% = 1.152×CTA - 12.311; HCTsyn,V% = 1.142×CTV - 11.229. In validation, HCTsyn,A and HCTsyn,V showed no significant difference from HCTcon (all P>0.05). HCTcon was strongly correlated with HCTsyn, A (r = 0.898, P < 0.01) and HCTsyn, V (r = 0.826, P < 0.01). ECVsyn,A and ECVsyn,V also did not differ from ECVcon (all P>0.05). ECVcon was strongly correlated with ECVsyn, A (r = 0.990, P < 0.01) and ECVsyn, V (r = 0.983, P < 0.01). All ECV metrics exhibited excellent and comparable efficiency in differentiating pathological grades. Conclusions Synthetic ECV performs comparably to conventional ECV and predicts gastric cancer pathological grading effectively.
Keywords: Dual-energy CT, extracellular volume fraction, gastric cancer, Grade of pathology, Hematocrit, Synthesis of ECV
Received: 18 Aug 2025; Accepted: 28 Nov 2025.
Copyright: © 2025 Zhou, Chen, Li, Sun and GUO. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Lili GUO
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