Objective: This study aims to explore the association between iodine concentration (IC) in perigastric adipose tissue (PAT), quantified by dual-energy computed tomography (DECT) and serosal invasion (SI) in patients with gastric cancer post-neoadjuvant chemotherapy (NAC). Methods: Fortythree patients with T4-staged gastric cancer were enrolled. IC and standardized IC in PAT (ICPAT and SICPAT) were quantified by DECT pre and post NAC. A postoperative pathologic examination was performed to stage gastric cancer. Results: After NAC, a total of 43 participants were assigned to group A with 13 patients and group B with 30 patients according to the results of the postoperative pathologic examination. The accuracy of conventional CT in identifying SI was 74.42%. Differences of variations between pre-and post-NAC ICPAT, SICPAT, Delta ICPAT, and Delta SICPAT were observed respectively (p < 0.05). Intragroup ICPAT and SICPAT also changed significantly after NAC (p < 0.05). The area under the ROC curve was 0.929, with the threshold of Delta SICPAT reaching 0.095. The sensitivity, specificity, and accuracy of SICPAT in identifying post-NAC SI were 92.30, 86.70, and 88.37% respectively. Moreover, the 2 measurements in the same patient maintain a high level of consistency. Conclusion: These results showed that SICPAT is a reliable index for identifying post-NAC SI. (C) 2018 S. Karger AG, Basel