Histological subtypes of solid-dominant invasive lung adenocarcinoma: differentiation using dual-energy spectral CT

To investigate the value of dual-energy spectral computed tomography (DESCT) for evaluating the histological subtypes of solid-dominant invasive lung adenocarcinoma (SILADC).

Sixty-seven patients with SILADC were enrolled. All patients underwent DESCT and were divided into Group I (those with a lepidic/acinar/papillary predominant pattern) and Group II (those with a solid/micropapillary predominant pattern) based on their correlation with prognosis. Patient clinicopathological characteristics, DESCT morphological features, and quantitative parameters of the tumours were compared between both groups. Multiparametric analysis was performed using binary logistic regression with DESCT findings. Receiver operating characteristic (ROC) curves were used to assess the diagnostic performance of single-parameter and multiparametric analysis.

Patient gender, lymph nodes status, pathological TNM stage, and histological differentiation significantly differed between the two groups (all p<0.05). Moreover, significant differences were observed between both groups in DESCT morphological features including tumour size, necrosis, calcification, air bronchogram, and vascular convergence sign, and quantitative parameters including K_{40-65 keV}, effective atomic number, and water concentration on unenhanced CT and iodine concentration in the arterial and venous phases (all p<0.05). Multiparametric analysis showed that tumour size, air bronchogram, K_{40-65 keV} and effective atomic number on unenhanced CT were the most effective variations for predicting the histological subtypes of SILADC and obtained an area under the ROC curve (AUC) of 0.906.

DESCT was useful for differentiating histological subtypes with different prognosis of SILADC.