The Role of Dual-Energy CT for the Assessment of Liver Metastasis Response to Treatment: Above the RECIST 1.1 Criteria.

Imaging assessment of liver lesions is fundamental to predict therapeutic response and improve patient survival rates. Dual-Energy Computed Tomography (DECT) is an increasingly used technique in the oncologic field with many emerging applications. The assessment of iodine concentration within a liver lesion reflects the biological properties of the tumor and provides additional information to radiologists that is normally invisible to the human eye. The possibility to predict tumor aggressiveness and therapeutic response based on quantitative and reproducible parameters obtainable from DECT images could improve clinical decisions and drive oncologists to choose the best therapy according to metastasis biological features. Moreover, in comparison with standard dimensional criteria, DECT provides further data on the cancer microenvironment, especially for patients treated with antiangiogenic-based drugs, in which tumor shrinkage is a late parameter of response. We investigated the predictive role of DECT in the early assessment of liver metastasis response to treatment in comparison with standard dimensional criteria during antiangiogenetic-based therapy.