Effects of simulated dose variation on contrast-enhanced CT-based radiomic analysis for Non-Small Cell Lung Cancer

Purpose: To examine the potential effect of CT dose variation on radiomic features in vivo using simulated contrast-enhanced CT dose reduction in patients with non-small lung cell cancer (NSCLC). Methods: In this retrospective study, we included 69 patients (25 females, 44 males, median age 66 years) with histologically proven NSCLC who underwent a whole contrast-enhanced body FDG-PET/CT for primary staging. To simulate different CT dose levels, we used an algorithm to simulate low-dose CT images based on a noise model derived from phantom experiments. The tumor lesions and reference regions in the paraspinal muscle were manually segmented to obtain three-dimensional regions of interest. Radiomic feature extraction was performed using the PyRadiomics toolbox. The median relative feature value deviation was assessed for each feature and each dose level. Results: The mean segmented tumor volume was 340 ml. T-stages of the primary tumors were primarily T3/4. For NSCLCs, the median relative feature value deviation in the lowest dose images varied for the calculated features from 52.2% to -49.5%. In general, dose-dependent deviations of feature values showed a monotonous increase or decrease with decreasing dose levels. Statistical analyses revealed significant differences between the dose levels in 91% of features. Conclusions: We examined the effects of simulated CT dose reduction on the values of radiomic features in primary NSCLC and showed significant deviations of varying degrees in numerous feature classes. This is a theoretical indicator of potential influence under real conditions, which should be taken into account in clinical use.