The purpose of this study was to investigate the utility of combining clinical and spectral computed tomography (CT) parameters for the preoperative evaluation of lymphovascular invasion (LVI) and perineural invasion (PNI) in gastric cancers (GCs).

Patients with gastric adenocarcinoma who underwent spectral-CT examination were retrospectively examined. All diagnoses were confirmed by pathology, and the patients were divided into positive and negative groups based on LVI/PNI occurrence. Clinical characteristics, including demographic information, serum tumor markers, and gastroscopic pathological information, were collected. The effective atomic number (Z_eff), iodine concentration (IC), and water concentration were measured in the arterial (AP) and venous phase (VP). Differences between the two groups were searched for using independent sample t-test, Mann–Whitney U test, or chi-square (χ²) test and diagnostic performances of the different variables were evaluated using receiver operating characteristic (ROC) curve.

A total of 121 patients (96 men, 25 women; mean age: 59 ± 8.7 [SD] years, range: 36–82 years) with gastric adenocarcinoma were included in the study. The serum level of the tumor marker CA125, as well as Z_eff and IC in the LVI/PNI-positive group, were significantly higher than in the negative group, and the histological grade and Borrmann type differed between the two groups (all P < 0.05). The discriminating capability analysis demonstrated that CA125 exhibited a favorable performance, and the VP parameters’ diagnostic efficacy was superior to that of the AP parameters. The efficacy of the combination of clinical and spectral-CT parameters was superior to that of individual parameters (all AUC > 0.85). The clinical parameters combined with Z_eff and IC in the AP and VP exhibited a high evaluation efficacy (AUC = 0.890 [95% CI: 0.826–0.955]; F₁ score = 0.888; accuracy = 84.3% [102/121; 95% CI: 76.7−89.8]; sensitivity = 86.2% [75/87; 95% CI: 76.8−92.4]; specificity = 79.4% [27/34; 95% CI: 61.6−90.1]).

Clinical and spectral-CT parameters exhibit considerable capabilities in the preoperative evaluation of LVI and PNI in GCs. The combination of clinical and spectral-CT parameters effectively predicts LVI and PNI in GCs.