The authors showed that prone thoracic contrast-enhanced PCCT detected reduced tumor burden after neoadjuvant systemic therapy in all 9 patients.
Best-practice implication: when thoracic PCCT is clinically indicated anyway, prone positioning can allow opportunistic local breast tumor and axillary assessment without extra scan time, radiation, or contrast.
The study supports using spectral reconstructions, especially monoenergetic images and iodine maps, for tumor-size and enhancement assessment, but larger studies are needed before replacing dedicated breast MRI.
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Figure 4. Patient with right-sided breast tumor (arrow) of no special type, G2, ER+/PR+/HER2-, visualized in breast MRI at initial diagnosis with T1w-subtraction after contrast administration (a) and fat-saturated T2w sequence (b). Photon-counting detector computed tomography with monoenergetic reconstruction (c, e) and iodine map (d, f) shows the tumor at initial tumor staging before NAST (c, d) and with a marked decline of tumor size after NAST (e, f). ER, Estrogen receptor; HER2, Human epidermal growth factor receptor; MRI, Magnetic resonance imaging; NAST, Neoadjuvant systemic therapy; PR, Progesterone receptor
Source: Source: Neubauer et al., European Radiology Experimental, 2025.
Protocol
Detail | Setting |
|---|
Scanner | NAEOTOM Alpha |
Scan area | Thorax / breasts / axillary regions |
Scan mode | Dual-source thoracic PCCT, prone position |
Tube voltage [kV] | 120 |
Effective mAs [mAs] | Quality reference 142 mAs |
Matrix | 1024 × 1024 |
Slice width [mm] | 2 |
Reconstruction increment [mm] | 2 |
Reconstruction kernel | Br40 |
Iterative reconstruction | QIR |
Spectral reconstruction | iodine map, virtual unenhanced |
keV level [keV] | 65 |
Contrast agent | Iopromide 370 mgI/mL |
Contrast volume | 80 mL + 0.5 mL/kg body weight, max. 140 mL |
Flow rate | 3 mL/s saline chaser; contrast flow n.a. |
Saline chaser | Yes |
Acquisition phase | Fixed 85 s delay |
Neubauer C, Nattenmüller J, Bamberg F, Windfuhr-Blum M, Neubauer J. Breast cancer assessment under neoadjuvant systemic therapy using thoracic photon-counting detector computed tomography in prone position: a pilot study. Eur Radiol Exp. 2025;9:41. doi: 10.1186/s41747-025-00576-z.
