• Stefania Rizzo, Francesco Petrella, Valentina Buscarino, Federica De Maria, Sara Raimondi, Massimo Barberis, Caterina Fumagalli, Gianluca Spitaleri, Cristiano Rampinelli, Filippo De Marinis, Lorenzo Spaggiari, and Massimo Bellomi.
• Department of Radiology, European Institute of Oncology, via Ripamonti 435, 20141, Milan, Italy. stefania.rizzo@ieo.it.
• Eur Radiol. 2016 Jan 1; 26 (1): 32-42.

ObjectivesTo assess the association between CT features and EGFR, ALK, KRAS mutations in non-small cell lung cancer.MethodsPatients undergoing chest CT and testing for the above gene mutations were included. Qualitative evaluation of CTs included: lobe; lesion diameter; shape; margins; ground-glass opacity; density; cavitation; air bronchogram; pleural thickening; intratumoral necrosis; nodules in tumour lobe; nodules in non-tumour lobes; pleural retraction; location; calcifications; emphysema; fibrosis; pleural contact; pleural effusion. Statistical analysis was performed to assess association of features with each gene mutation. ROC curves for gene mutations were drawn; the corresponding area under the curve was calculated. P-values <0.05 were considered significant.ResultsOf 285 patients, 60/280 (21.43 %) were positive for EGFR mutation; 31/270 (11.48 %) for ALK rearrangement; 64/240 (26.67 %) for KRAS mutation. EGFR mutation was associated with air bronchogram, pleural retraction, females, non-smokers, small lesion size, and absence of fibrosis. ALK rearrangements were associated with age and pleural effusion. KRAS mutation was associated with round shape, nodules in non-tumour lobes, and smoking.ConclusionsThis study disclosed associations between CT features and alterations of EGFR (air bronchogram, pleural retraction, small lesion size, absence of fibrosis), ALK (pleural effusion) and KRAS (round lesion shape, nodules in non-tumour lobes).Key PointsAir bronchogram, pleural retraction, small size relate to EGFR mutation in NSCLC. Pleural effusion and younger age relate to ALK mutation. Round lesion shape, nodules in non-tumour lobes relate to KRAS mutation.

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