Development and validation of a dual-energy CT-based model to estimate the malignant probability of distal gastric wall thickening

Background: This study developed and validated a viable model for the preoperative diagnosis of malignant distal gastric wall thickening based on dual-energy spectral computed tomography (DEsCT). Methods: The imaging data of 208 patients who were diagnosed with distal gastric wall thickening using DEsCT were retrospectively collected and divided into a training cohort (n=151) and a testing cohort (n=57). The patient's clinical data and pathological information were collated. The multivariable logistic regression model was built using 5 selected features, and subsequently, a 10-fold cross-validation was performed to identify the optimal model. A nomogram was established based on the training cohort. Finally, the diagnostic performance of the best model was compared to the existing conventional CT scheme through evaluating the discrimination ability in the testing cohort in terms of the receiver operating characteristic curve (ROC), calibration, and clinical usefulness. Results: Stepwise regression analysis identified 5 candidate variables with the smallest Akaike information criteria (AIC), namely, the venous phase spectral curve [VP_ SC; odds ratio (OR) 8.419], focal enhancement (OR 3.741), arterial phase mixed (OR 1.030), tumor site (OR 0.573), and diphasic shape change (DP_shape change; OR 2.746). The best regression model with 10-fold cross-validation consisting of VP_ SC and focal enhancement was built using the 5 candidate variables. The average area under the ROC curve (AUC) of the model from the 10-fold cross-validation was 0.803 (sensitivity of 69.2%, specificity of 94.1%, and accuracy of 74.8%). In the testing cohort, the DEsCT model identified using the regression model performed better (AUC 0.905, sensitivity 81.3%, specificity 85.4%, and accuracy 84.2%) than did the conventional CT scheme (AUC 0.852, sensitivity 80.0%, specificity 76.6%, and accuracy 77.2%). The nomogram based on the DEsCT model showed good calibration and provided a better net benefit for predicting malignancy of distal gastric wall thickening. Conclusions: Comprehensive assessment with the DEsCT-based model can be used to facilitate the individualized diagnosis of malignancy risk in patients presenting with distal gastric wall thickening.