Value of Quantitative Parameters of Spectral CT Combined with Arterial-phase Iodine-based Imaging Radiomics Features in the Differential Diagnosis for Lung Squamous Cell Carcinoma and Lung Adenocarcinoma
Objective To construct nomogram model based on the quantitative parameters of spectral computed tomography(CT)combined with the radiomics features of arterial-phase iodine-based imaging,and investigate the clinical value of spectral CT in the differential diagnosis of lung squamous cell carcinoma(LUSC)and lung adenocarcinoma(LU-AD).Methods A total of 89 patients with lung cancer underwent enhanced spectral CT examination,confirmed by pathological biopsy or surgery before surgery were en-rolled in this study,including 38 cases in LUAD group and 51 cases in LUSC group.The water concentration of lesions,iodine concentration(IC),normalized iodine con-centration(NIC),CT value,slope of the energy spectrum curve(K),effective-Z(Eff-Z)and normalized effective-Z(NEff-Z)in 60 keV arterial phase monochromatic images of patients in LU AD group and LUSC group were analyzed.The differential diagnosis model for LU AD and LUSC based on spectral CT features were constructed by Logistic regres-sion analysis.The arterial-phase iodine-based imaging features were extracted by ITK Snap software;intraclass correlation coemcient(ICC),recursive featureelimination(RFE)and least absolute shrinkage and selection operator(LASSO)were used to reduce the dimension and select the radiomics features,the diagnostic model based on the radiomics features were constructed by Logistic regression,and radiomics score(Rad-score)of the model was calculated,a joint model between the selected spectral CT quantitative parameters and Rad-score was established by multivariate Logistic regression analysis and the nomogram was drawn.The efficacy of spectral CT model,radiomics model and nomogram model were evaluated by receiver operating characteristic(ROC)curve,Delong test,calibration curve,Hosmer-Lemeshow test and decision curve analysis(DCA).Results There were significant differences in IC,NIC,CT value,K and NEff-Z between LU AD group and LUSC group(all P＜0.05).Multivariate Logistic regression analysis showed that IC,NIC and NEff-Z were independent influencing factors,the area under curve(AUC)of the spectral CT model for predicting LU AD and LUSC was 0.768,the accuracy,sensitivity and specificity were 70.73％,76.92％and 67.86％respectively;a total of 5 mean-ingful features,2 first-order features,2 second-order features and 1 shape feature,the efficacy AUC of the imaging his-tology model to predict LU AD and LUSC was 0.848,with an accuracy,sensitivity and specificity of 80.50％,83.33％and 75.00％respectively;the nomogram model predicted LU AD and LUSC with an efficacy AUC of 0.912 and accuracy,sensitivity and specificity of 85.00％,92.31％and 85.71％respectively.The Delong test showed that the AUC values of the nomogram model were all significantly higher than those of the radiomics model and the spectral CT model(all P＜0.05).The results of the Hosmer-Lemeshow test showed that the spectral CT model,the radiomics model and the nomo-gram model were all well fitted(x2 were 8.592,6.591 and 6.686 respectively,P were 0.378,0.581 and 0.570 respec-tively).Calibration curve analysis showed that the predicting probability curves of LU AD and LUSC predicted by the no-mogram model were closer to the ideal curves and better than those of the radiomics model and spectral CT model;DCA analysis showed that the AUC of the nomogram model was the largest,which were both higher than those of the ra-diomics model and the spectral CT model,and the net clinical benefit was higher.Conclusion Constructing a nomogram model based on quantitative parameters of spectral CT combined with the imaging radiomics features of arterial-phase io-dine-based imaging has potential application in the differential diagnosis of LUSC and LUAD.
Spectral computed tomographyArterial-phase iodine-based imagingLung squamous cell carcinomaLung adenocarcinomaNomogram model
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