European Radiology

, Volume 29, Issue 6, pp 2989–2997 | Cite as

Identification of epidermal growth factor receptor mutations in pulmonary adenocarcinoma using dual-energy spectral computed tomography

  • Meng Li
  • Li Zhang
  • Wei Tang
  • Yu-Jing Jin
  • Lin-Lin Qi
  • Ning WuEmail author



To explore the role of dual-energy spectral computed tomography (DESCT) quantitative characteristics for the identification of epidermal growth factor receptor (EGFR) mutation status in a cohort of East Asian patients with pulmonary adenocarcinoma.

Materials and methods

Patients with lung adenocarcinoma who underwent both DESCT chest examination and EGFR test were retrospectively selected from our institution’s database. The DESCT visual morphological features and quantitative parameters, including the CT number at 70 keV, normalized iodine concentration (NIC), normalized water concentration, and slopes of the spectral attenuation curves (slope λ HU [Hounsfield unit]), were evaluated or calculated. The patients were divided into two groups: the EGFR mutation group and EGFR wild-type group. Statistical analyses were performed to identify the DESCT quantitative parameters for diagnosis of EGFR mutation status.


EGFR mutations were detected in 66 (55.0%) of the 120 enrolled patients. The univariate analysis revealed that sex, smoking history, CT texture, NIC, and slope λ HU were significantly associated with EGFR mutation status (p = 0.037, 0.001, 0.047, 0.010, and 0.018, respectively). The multivariate logistic analysis revealed that smoking history (odds ratio [OR] = 3.23, p = 0.005) and NIC (OR = 58.026, p = 0.049) were the two significant predictive factors associated with EGFR mutations. Based on this analysis, the smoking history and NIC were combined to determine the predictive value for EGFR mutations with the area under the curve of 0.702.


NIC may be a potential quantitative DESCT parameter for predicting EGFR mutations in patients with pulmonary adenocarcinoma.

Key Points

• DESCT can provide multiple quantitative image parameters compared to conventional CT.

• Identification of the radio-genomic relation between DESCT and EGFR status can help to define molecular subcategories of lung adenocarcinoma, which is valuable for personalized clinical targeted therapy.

• NIC may be a potential DESCT quantitative parameter for predicting EGFR mutations in pulmonary adenocarcinoma.


Tomography, X-ray computed Epidermal growth factor receptor Lung neoplasms Adenocarcinoma 



Anaplastic lymphoma kinase


Dual-energy spectral computed tomography


Epidermal growth factor receptor


Ground-glass opacity


Gemstone spectral imaging


Kirsten rat sarcoma viral oncogene homolog


Normalized iodine concentration


Normalized water concentration


Part-solid nodule

Slope λ HU

The slope of the spectral Hounsfield unit curve


Sub-solid nodule



This study has received funding by the National Natural Science Foundation of China (Grant No. 81601494) and the PUMC Youth Fund/Fundamental Research Funds for the Central Universities (Grant No. 3332016030).

Compliance with ethical standards


The scientific guarantor of this publication is Ning Wu.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Ni Li kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• observational

• performed at one institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Meng Li
    • 1
  • Li Zhang
    • 1
  • Wei Tang
    • 1
  • Yu-Jing Jin
    • 1
  • Lin-Lin Qi
    • 1
  • Ning Wu
    • 1
    • 2
    Email author
  1. 1.Department of Diagnostic RadiologyNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
  2. 2.PET-CT Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina

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