The Value of T2 Mapping in Predicting Neoadjuvant Therapy Response, Lymphovascular Invasion, and Perineural Invasion in Esophageal Squamous Cell Carcinoma.

RATIONALE AND OBJECTIVES: To evaluate whether baseline T2-mapping MRI is associated with pathologic response to neoadjuvant therapy (nT), lymphovascular invasion (LVI) and perineural invasion (PNI) in locally advanced esophageal squamous cell carcinoma (ESCC). MATERIALS AND METHODS: This single-center retrospective study enrolled 212 ESCC patients with pre-nT 3 T MRI including T2 mapping at a university-affiliated hospital. Patients were stratified by pathologic tumor regression grade (TRG) into pathologic complete response (pCR, TRG 0) vs non-pCR (npCR, TRG ≥ 1), good response (GR, TRG ≤ 1) vs poor response (PR, TRG ≥ 2), plus LVI/PNI status. Univariate/multivariable logistic regression identified predictors, with performance assessed via ROC analysis. RESULTS: Patients were grouped as pCR (n = 56), GR (n = 81), LVI (n = 67), PNI (n = 32). T2 values were markedly higher in pCR (98.0 ± 12.2 ms vs 82.6 ± 11.5 ms, P < .001; AUC = 0.822) and GR (94.8 ± 12.6 ms vs 81.7 ± 11.7 ms, P < .001; AUC = 0.734) vs npCR and PR. Conversely, T2 values were lower in LVI (79.0 ± 12.8 ms vs 90.5 ± 12.3 ms, P < .001; AUC = 0.840) and PNI (73.6 ± 9.7 ms vs 89.1 ± 12.8 ms, P < .001; AUC = 0.844). T2 value was independently associated with all endpoints in multivariate analysis. CONCLUSION: Pre-nT T2 values were associated with pathologic response, LVI, and PNI in locally advanced ESCC, which may inform personalized treatment planning in future studies.