Early Response Assessment Of Dual-energy CT In Patients Treated With Anti-angiogenic Agents Combined With Chemotherapy For Advanced Lung Adenocarcinoma

Objectives: To explore the evaluation value of dual-energy CT(DECT)quantitative parameters for the early efficacy of anti-angiogenic agents combined with chemotherapy in advanced lung adenocarcinoma.Materials and Methods: Collected patients with locally advanced,recurred or metastatic invasive lung adenocarcinoma in our hospital from October 2018 to October2020.DECT examination was performed 1 week before treatment,2-3 weeks after treatment,14-15 weeks after treatment,according to RECIST V1.1 criteria selection of102 target lesions,import to the post-processing system,two doctors select the region of interest(ROI)on the iodine map and calculate the data(1)diameter(D);(2)iodine concentration in arterial phase(ICAP);(3)iodine concentration in venous phase(ICVP);(4)normalized iodine concentration in arterial phase(NICAP);(5)normalized iodine concentration in venous phase(NICVP);(6)arterial enhancement fraction(AEF).The measured data of the two physicians used intraclass correlation efficient(ICC)test. According to the RECIST V1.1 criteria,the D changes of the target lesions after 14-15 weeks of treatment are evaluated,and the patients are divided into responders and non-responders.Mann-Whitney tests were used to compare the differences in parameters between the two groups before treatment,.Wilcoxon tests were used to compare the differences in parameters before treatment and 2-3 weeks after treatment. Calculate the percentage change of each parameter before and and 2-3 weeks after treatment(D%,ICAP%,ICVP%,NICAP%,NICVP%,AEF%)and draw the receiver operating characteristic curve(ROC).Results: A total of 32 patients met the criteria,4 were in stage IIIB and 28 were in stage IV,with a total of 102 lesions,of which 60 were responders and 42 were non-responders.The index of the ICC test of the two doctors was greater than 0.7(P<0.01).The medians of NICAP in the responders and non-responders before treatment were 22.450% and19.300%,respectively.And the medians of NICVP in the responders and non-responders before treatment were 41.300% and 36.050%,respectively.The comparison between the two groups was statistically significant(P<0.01).The median D of lesions in the responders before treatment was 1.940 cm,the median D in the responders 2-3 weeks after treatment was 1.615 cm,the median D of non-responders lesions before treatment was 1.830 cm,and the median D of non-responders 2-3 weeks after treatment was 1.700 cm.The comparison between the two groups was statistically significant(P<0.01).In the responders,the median ICAP before treatment was 2.400 mg/ml,the median ICAP2-3 weeks after treatment was 1.200 mg/ml,the median ICVP before treatment was2.700 mg/ml;the median ICVP 2-3 weeks after treatment was 2.150 mg/ml;The median NICAP before treatment was 22.450%,and the median NICAP 2-3 weeks after treatment was 14.450%;the median NICVP before treatment was 41.300%,and the median NICVP 2-3 weeks after treatment was 28.950%;the median AEF before treatment was 86.200%,and the median AEF 2-3 weeks after treatment was65.200%,paired comparison analysis before and 2-3 weeks after treatment were statistically significant(P<0.01).ROC curve analysis D%,ICAP%,ICVP%,NICAP%,NICVP%,AEF% area under the curve(AUC)are 0.738,0.897,0.853,0.911,0.880,0.873,respectively.Youden index is 0.407,0.764,0.657,0.835,0.724,0.714,respectively.Conclusion: This study confirmed that the median IC,NIC and AEF of the responders in the dual-phase scan were significantly reduced compared with the non-responders,2-3 weeks after treatment.DECT examination parameters are helpful to evaluate the early efficacy of anti-angiogenic agents combined with chemotherapy in advanced lung adenocarcinoma.