Purpose The clinical and dual-layer detector spectral CT(DLCT)features of epidermal growth factor receptor(EGFR)mutation and anaplastic lymphoma kinase(ALK)rearrangement of lung adenocarcinoma were studied by DLCT multi-parameter imaging to explore a non-invasive prediction method for clinical diagnosis of lung adenocarcinoma gene expression.Materials and Methods A total of 98 cases of lung adenocarcinoma diagnosed by pathology in Gansu Provincial Hospital were prospectively collected from August 2020 to March 2022.Clinical parameters(gender,age,lesion morphology,number,mediastinal lymph node metastasis,EGFR and ALK mutations status)and DLCT parameters including slope of the spectrum curve of the arteriovenous phase(λHUA,λHUv),the standard iodine concentration of the arteriovenous phase(NICA,NICv),the 40 keV single-energy CT value of the arteriovenous phase(CTA 40 keV,CTv 40 keV),the active atomic number of the arteriovenous phases were collected,respectively.According to the expression of EGFR and ALK,all patients were divided into three groups:EGFR mutant group[EGFR(+)],ALK rearrangement group[ALK(+)],EGFR/ALK both negative group[EGFR/ALK(-)].Clinical and DLCT parameters of each group were analyzed.Results There were statistical difference in gender between the EGFR(+)group and EGFR/ALK(-)group(x2=11.010,P＜0.05).There were statistical differences in lesion morphology among the three groups(x2=12.858,P＜0.05).The value of CTv 40 keV in the EGFR(+)group was significantly higher than that in EGFR/ALK(-)group(t=1.997,P＜0.05),and the NICv in the ALK(+)group was significantly lower than that in EGFR/ALK(-)group(t=2.155,P＜0.05).The λHUv,NICv,CTv 40 keV of EGFR(+)group were significantly higher than those of ALK(+)group(t=2.613,3.149,3.218,all P＜0.05).The sensitivity and specifiicity to identify EGFR(+)and EGFR/ALK(-)adenocarcinoma were 62.7％and 70.0％,the area under curve(AUC)was 0.634(95％CI 0.516-0.756)when the CTv 40 keV value was 141.070 Hu.The sensitivity and specificity to identify ALK(+)and EGFR/ALK(-)adenocarcinoma were 76.7％and 64.2％,the AUC was 0.706(95％CI 0.536-0.853)when NICv value was 0.287.The sensitivity to identify EGFR(+)and ALK(+)adenocarcinoma were 70.6％,64.7％,72.5％and the specificity was 76.5％,76.5％,82.4％,respectively,the AUC was 0.734(95％CI 0.606-0.829),0.751(95％CI 0.610-0.832),0.773(95％CI 0.649-0.861)when the values of λHUv,NICv and CTv 40 keV were 1.335,0.320 and 132.350,respectively.Delong test showed that the AUC of CTv 40 keV and λHUv was statistically different(Z=2.327,P＜0.05),and the AUC of CTv 40 keV was 0.773.Conclusion The gender,lesion morphology and DLCT parameters(λHUv,CTv 40 keV,NICv)of lung adenocarcinoma have certain predictive value for EGFR and ALK genetic expression,which can help clinical judgment of lung adenocarcinoma gene mutation pattern.
万方数据
维普
