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The purpose of this study was to investigate the differences in CT characteristics and disease spread patterns between  ROS1 -rearranged adenocarcinomas and epidermal growth factor receptor ( EGFR )-mutant or anaplastic lymphoma kinase ( ALK )-rearranged adenocarcinomas. Patients with stage IIIb/IV adenocarcinoma with  ROS1  rearrangement,  EGFR  mutations, or  ALK  rearrangement were retrospectively identified. Two radiologists evaluated CT features and disease spread patterns. A multivariable logistic regression model was applied to determine the clinical and CT characteristics that can discriminate between  ROS1 -rearranged and  EGFR -mutant or  ALK -rearranged adenocarcinomas. A cohort of 169 patients was identified ( ROS1  = 23,  EGFR  = 120, and  ALK  = 26). Compared to  EGFR -mutant adenocarcinomas,  ROS1 -rearranged adenocarcinomas were less likely to have air-bronchogram (p = 0.011) and pleural retraction (p = 0.048) and more likely to have pleural effusion (p = 0.025), pericardial metastases (p < 0.001), intrathoracic and extrathoracic nodal metastases (p = 0.047 and 0.023, respectively), and brain metastases (p = 0.017). Following multivariable analysis, age (OR = 1.06; 95% CI: 1.01, 1.12; p = 0.024), pericardial metastases (OR = 10.50; 95% CI: 2.10, 52.60; p = 0.005), and nodal metastases (OR = 8.55; 95% CI: 1.14, 62.52; p = 0.037) were found to be more common in  ROS1 -rearranged tumors than in non- ROS1 -rearranged tumors.  ROS1 -rearranged adenocarcinomas appeared as solid tumors and were associated with young age, pericardial metastases and advanced nodal metastases relative to tumors with  EGFR  mutations or  ALK  rearrangement.

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CT features and disease spread patterns in ROS1-rearranged lung adenocarcinomas: comparison with those of EGFR-mutant or ALK-rearranged lung adenocarcinomas