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Development of a dual-energy spectral CT based nomogram for the preoperative discrimination of mutated and wild-type KRAS in patients with colorectal cancer

  • Author Footnotes
    1 These authors are co-first authors who contributed equally to this study.
    Yuntai Cao
    Footnotes
    1 These authors are co-first authors who contributed equally to this study.
    Affiliations
    Second Clinical School, Lanzhou University, Lanzhou, China

    Key Laboratory of Medical Imaging, Gansu Province, Lanzhou, China

    Department of Radiology, Affiliated Hospital of Qinghai University, Xining, China

    Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
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  • Author Footnotes
    1 These authors are co-first authors who contributed equally to this study.
    Guojin Zhang
    Footnotes
    1 These authors are co-first authors who contributed equally to this study.
    Affiliations
    Second Clinical School, Lanzhou University, Lanzhou, China

    Key Laboratory of Medical Imaging, Gansu Province, Lanzhou, China
    Search for articles by this author
  • Author Footnotes
    1 These authors are co-first authors who contributed equally to this study.
    Haihua Bao
    Footnotes
    1 These authors are co-first authors who contributed equally to this study.
    Affiliations
    Department of Radiology, Affiliated Hospital of Qinghai University, Xining, China
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  • Shenghui Zhang
    Affiliations
    Department of Physics, University of Illinois at Chicago, Chicago, USA
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  • Jing Zhang
    Affiliations
    Second Clinical School, Lanzhou University, Lanzhou, China

    Key Laboratory of Medical Imaging, Gansu Province, Lanzhou, China
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  • Zhiyong Zhao
    Affiliations
    Second Clinical School, Lanzhou University, Lanzhou, China

    Key Laboratory of Medical Imaging, Gansu Province, Lanzhou, China
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  • Wenjuan Zhang
    Affiliations
    Second Clinical School, Lanzhou University, Lanzhou, China

    Key Laboratory of Medical Imaging, Gansu Province, Lanzhou, China
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  • Weixia Li
    Affiliations
    Department of Radiology, Affiliated Hospital of Qinghai University, Xining, China
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  • Xiaohong Yan
    Affiliations
    Department of Critical Medicine, Affiliated Hospital of Qinghai University, Xining, China
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  • Junlin Zhou
    Correspondence
    Corresponding author at: Department of Radiology, Lanzhou University Second Hospital, Cuiyingmen No. 82, Chengguan District, Lanzhou 730030, China.
    Affiliations
    Key Laboratory of Medical Imaging, Gansu Province, Lanzhou, China

    Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
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  • Author Footnotes
    1 These authors are co-first authors who contributed equally to this study.
Published:September 05, 2020DOI:https://doi.org/10.1016/j.clinimag.2020.08.023

      Highlights

      • Slope kAP, Eff-ZAP, NICVP, ATL/LTL and PFI were independent predictors for KRAS mutation.
      • A DESCT based nomogram was developed to predict individual KRAS mutation probability.
      • The nomogram had excellent performance with an AUC of 0.848 and excellent calibration.
      • DCA showed that our nomogram has outstanding clinical utility.

      Abstract

      Purpose

      To develop a dual-energy spectral CT (DESCT) nomogram for the preoperative identification of KRAS mutation in patients with colorectal cancer (CRC).

      Method

      One hundred and twenty-four patients who underwent energy spectrum CT pre-operatively were recruited and split into mutated KRAS group (n = 50) and wild-type KRAS group (n = 74). DESCT parameters, including monochromatic CT value, iodine concentration, water concentration, and effective atomic number were measured independently by two reviewers in the arterial, venous, and delayed phases. Normalized iodine concentration (NIC) and slope k of the spectral HU curve were calculated. Evaluate other imaging features such as ATL/LTL ratio, tumor gross pattern, pericolorectal fat invasion (PFI) was also performed by these reviewers. Independent predictors for KRAS mutation were screened out using logistic regression, and these predictors were presented as a nomogram. The receiver operating characteristic (ROC) curve, calibration curve and decision curve analysis (DCA) were used to evaluate the clinical usefulness of the nomogram.

      Results

      The slope k in the arterial phase, effective atomic number in the arterial phase, NIC in the venous phase, ATL/LTL ratio and PFI were significant independent predictors for KRAS mutation. Based on these independent predictors, a quantitative nomogram was developed to predict individual KRAS mutation probability. The nomogram had excellent performance with an AUC of 0.848 and excellent calibration. DCA showed that our nomogram has outstanding clinical utility.

      Conclusions

      This study demonstrates that a DESCT based nomogram has potential value for individual preoperative identification of KRAS mutation in CRC patients.

      Abbreviations:

      AP (arterial phase), ATL (axial tumor length), CRC (colorectal cancer), DP (delayed phase), DESCT (dual-energy spectral CT), Eff-Z (effective atomic number), IC (iodine concentration), KRAS (Kirsten rat sarcoma), LTL (longitudinal tumor length), NIC (normalized iodine concentration), PFI (Pericolorectal fat invasion), VP (venous phase), WC (water concentration)

      Keywords

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