Objective: To investigate the potential of dual-energy computed tomography (DECT) plain scans in quantitatively differentiating between pulmonary malignant lesions and pneumonia masses. Methods: A total of 105 patients with lung space-occupying lesions who underwent dual-energy CT plain scan were prospectively selected, including 75 cases of malignant group confirmed by pathology (41 cases of adenocarcinoma, 22 cases of squamous cell carcinoma and 12 cases of small cell carcinoma). After repeated follow-up and review, 30 cases of inflammation group were confirmed. The dual-energy parameters (CT40 keV value, energy spectrum curve slope k 40-100 keV, water concentration, fat concentration) of each group of lesions were measured, and statistical analysis was performed to compare the parameters of each group. Results: The CT40 keV value, energy spectrum curve slope k 40-100 keV and water concentration value of the inflammation group were the highest, and the fat concentration value of the squamous cell carcinoma group was the highest. One-way analysis of variance (ANOVA) was used for each group of data, and independent sample t test was used for pairwise comparison between groups. The results showed that there were statistically significant differences in CT40 keV value, energy spectrum curve slope k 40-100 keV, water concentration and fat concentration between groups (P＜0.05). The sensitivity of water concentration ≤1 443.407 and fat concentration >600.593 in the diagnosis of squamous cell carcinoma was 95.5% and 86.4%, respectively; the specificity was 86.7% and 86.7%, respectively; the AUC was 0.938 and 0.909, respectively. The sensitivity of water concentration ≤1 343.445 and fat concentration >684.943 in the diagnosis of small cell carcinoma was 83.3% and 83.3%, respectively; the specificity was 96.7% and 90.0%, respectively; the AUC was 0.878 and 0.869, respectively. The sensitivity of water concentration >1 347.710 and fat concentration ≤684.943 in the diagnosis of adenocarcinoma was 90.2%, the specificity was 77.3%, and the AUC was 0.848 7 (P＜0.05). Conclusion: There are significant differences in the quantitative parameters of lung adenocarcinoma, squamous cell carcinoma, small cell carcinoma and inflammatory masses in the dual-energy plain scan, which has important application value for the differential diagnosis of lung adenocarcinoma, squamous cell carcinoma and inflammatory masses. In particular, the water-fat-based material pair, in the differential diagnosis of benign and malignant diagnosis, the squamous cell carcinoma-inflammation group had the highest efficiency, followed by the small cell carcinoma-inflammation group; the dual-energy parameters also have certain differential value in the pathological classification of lung cancer.
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