The value of radiomics based on dual-energy CT for differentiating benign from malignant solitary pulmonary nodules

OBJECTIVE: To investigate the value of monochromatic dual-energy CT (DECT) images based on radiomics in differentiating benign from malignant solitary pulmonary nodules. MATERIALS AND METHODS: This retrospective study was approved by the institutional review board, and informed consent was waived. Pathologically confirmed lung nodules smaller than 3 cm with integrated arterial phase and venous phase (AP and VP) gemstone spectral imaging were retrospectively identified. After extracting the radiomic features of each case, principal component analysis (PCA) was used for feature selection, and after training with the logistic regression method, three classification models (Model(AP), Model(VP) and Model(Combination)) were constructed. The performance was assessed by the area under the receiver operating curve (AUC), and the efficacy of the models was validated using an independent cohort. RESULTS: A total of 153 patients were included and divided into a training cohort (n = 107) and a validation cohort (n = 46). A total of 1130 radiomic features were extracted from each case. The PCA method selected 22, 25 and 35 principal components to construct the three models. The diagnostic accuracy of Model(AP), Model(VP) and Model(Combination) was 0.8043, 0.6739, and 0.7826 in the validation set, with AUCs of 0.8148 (95% CI 0.682–0.948), 0.7485 (95% CI 0.602–0.895), and 0.8772 (95% CI 0.780–0.974), respectively. The DeLong test showed that there were significant differences in the AUCs between Model(AP) and Model(Combination) (P = 0.0396) and between Model(VP) and Model(Combination) (P = 0.0465). However, the difference in AUCs between Model(AP) and Model(VP) was not significant (P = 0.5061). These results demonstrate that Model(Combination) shows a better performance than the other models. Decision curve analysis proved the clinical utility of this model. CONCLUSIONS: We developed a radiomics model based on monochromatic DECT images to identify solitary pulmonary nodules. This model could serve as an effective tool for discriminating benign from malignant pulmonary nodules in patients. The combination of arterial phase and venous phase imaging could significantly improve the model performance.