AUTHOR=Mu Ronghua , Meng Zhuoni , Guo Zixuan , Qin Xiaoyan , Huang Guangyi , Yang Xuri , Jin Hui , Yang Peng , Deng Meimei , Zhang Xiaodi , Zhu Xiqi 

TITLE=Diagnostic value of dual-layer spectral detector CT in differentiating lung adenocarcinoma from squamous cell carcinoma

JOURNAL=Frontiers in Oncology

VOLUME=Volume 12 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2022.868216

DOI=10.3389/fonc.2022.868216

ISSN=2234-943X

ABSTRACT=Background and Objective  The pathological type of non-small cell lung cancer is considered to be an important factor affecting the treatment and prognosis. The purpose of this study was to investigate the diagnostic value of spectral parameters of DLCT in determining efficacy to distinguish adenocarcinoma (AC) and squamous cell carcinoma (SC), and their combined diagnostic efficacy was also analyzed.
Methods  This is a single-center prospective study, we collected 70 patients with lung SC and 127 patients with AC confirmed by histopathological examination. Morphological parameters, plain scan CT value, biphasic enhanced CT value and spectral parameters were calculated. The diagnostic efficiency of morphological parameters, spectral parameters and spectral parameters combined with morphological parameters was obtained by statistical analysis. 
Results  In univariate analysis, 7 morphological CT features differed significantly between SC and AC, including tumor location (distribution), lobulation, spicule, air bronchogram, vacuole sign, lung atelectasis and/or obstructive pneumonia, vascular involvement (all p<0.05). In the arterial phase and venous phase, the spectral parameters of AC were higher than those of SC (AP-Zeff: 8.07±0.23 vs. 7.85±0.16; AP-ID: 1.41±0.47 vs. 0.94±0.28; AP-NID: 0.13±0.04 vs. 0.09±0.03; AP-λ: 3.42±1.10 vs. 2.33±0.96; VP-Zeff: 8.26±0.23 vs. 7.96±0.16; VP-ID: 1.18±0.51 vs. 1.16±0.30; VP-NID: 0.39±0.13 vs. 0.29±0.08; VP-λ: 4.42±1.28 vs. 2.85±0.72, p<0.001). In the multiple logistic regression analysis, among the morphological parameters, there is a high correlation between distribution, air bronchogram, al well as vacuole sign, and AC (distribution, OR: 4.370; 95% CI: 1.485-12.859, p=0.007; air bronchogram, OR: 5.339; 95% CI: 1.729-16.484, p=0.004; vacuole sign, OR: 7.330; 95% CI: 1.030-52.184, p=0.047). Receiver operating characteristic curves of the SC and AC showed that VP-λ had the best diagnostic performance, with an area under the curve (AUC) of 0.864, sensitivity and specificity of 85.8% and 74.3%, the AUC was increased to 0.946 when morphological parameters were combined, and sensitivity and specificity were 89.8% and 87.1%, respectively.
Conclusion  The quantitative parameters of the DLCT spectrum are of great value in the diagnosis of SC and AC, the combination of morphological parameters and spectral parameters is helpful to distinguish SC from AC.