Diagnostic and Prognostic Value of Dynamic CT Time-Density Curve Parameters in Non-small Cell Lung Cancer: A Retrospective Cohort Study

Abstract

Background: Non-small cell lung cancer (NSCLC) is a commonly encountered type of lung cancer, accounting for over 85% of lung cancer cases. Objectives: This retrospective cohort study aimed to evaluate the diagnostic differences in time-density curve (TDC) parameters between malignant and benign lung lesions and to explore the associations of these parameters with clinicopathological characteristics and survival outcomes among patients with NSCLC. Patients and Methods: Consecutive patients diagnosed between July 2018 and June 2021 were included, comprising 90 pathology-confirmed, treatment-naïve NSCLC patients and 90 benign lung lesion controls. All patients underwent multi-slice computed tomography (MSCT) single-slice dynamic scanning, from which contrast enhancement ratio (CER), peak time (PT), and peak value (PV) were extracted. Diagnostic comparisons were performed between groups, and correlations with pathological features were analyzed. Prognostic performance of TDC parameters among NSCLC patients was assessed using receiver operating characteristic (ROC) analysis. Patients were followed for survival outcomes, with a median follow-up duration of 36 months. A P-value < 0.05 was considered statistically significant. Results: A total of 90 NSCLC patients (mean age 61.35 ± 6.48 years) were included, with 44 cases at tumor-node-metastasis (TNM) stage I-II and 46 at stage III-IV. Compared with benign lesions, malignant lesions exhibited a significantly delayed time-to-peak, higher peak enhancement, and greater overall enhancement. Within the NSCLC cohort, TDC parameters differed significantly across differentiation grades, TNM stages, and lymph node metastasis status (P < 0.001). The areas under the ROC curves (95% confidence interval) of PT, PV, CER, and their combination for predicting survival outcomes in NSCLC patients were 0.769 (0.657 - 0.881), 0.776 (0.664 - 0.888), 0.837 (0.750 - 0.924), and 0.919 (0.860 - 0.977), respectively. Conclusion: The MSCT-derived TDC parameters differed significantly between benign and malignant lung lesions and were correlated with pathological characteristics in NSCLC. Importantly, the prognostic associations observed in this study were restricted to the NSCLC cohort, where PT, PV, and CER showed exploratory associations with survival outcome. These findings provide preliminary, hypothesis-generating evidence supporting the potential role of TDC analysis in diagnostic assessment and risk stratification of NSCLC.