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This study aimed to identify the computed tomography characteristics of treatment-naïve patients with lung adenocarcinoma and known driver mutations in  EGFR ,  KRAS , or  ALK . Patients with advanced lung adenocarcinoma (stage IIIB–IV) and known mutations in  EGFR ,  KRAS , or  ALK  were assessed. The radiological findings for the main tumor and intra-thoracic status were retrospectively analyzed in each group, and the groups’ characteristics were compared. We identified 265 treatment-naïve patients with non-small-cell carcinoma, who had  EGFR  mutations (n = 159),  KRAS  mutations (n = 55), or  ALK  rearrangements (n = 51). Among the three groups, we evaluated only patients with stage IIIB–IV lung adenocarcinoma who had  EGFR  mutations (n = 126),  KRAS  mutations (n = 35), or  ALK  rearrangements (n = 47). We found that ground-glass opacity at the main tumor was significantly more common among  EGFR -positive patients, compared to  ALK -positive patients ( p  = 0.009). Lymphadenopathy was significantly more common among  ALK -positive patients, compared to  EGFR -positive patients ( p  = 0.003). Extranodal invasion was significantly more common among  ALK -positive patients, compared to  EGFR -positive patients and  KRAS -positive patients ( p  = 0.001 and  p  = 0.049, respectively). Lymphangitis was significantly more common among  ALK -positive patients, compared to  EGFR -positive patients ( p  = 0.049). Pleural effusion was significantly less common among  KRAS -positive patients, compared to  EGFR -positive patients and  ALK -positive patients ( p  = 0.046 and  p  = 0.026, respectively). Lung metastases were significantly more common among  EGFR -positive patients, compared to  KRAS -positive patients and  ALK -positive patients ( p  = 0.007 and  p  = 0.04, respectively). In conclusion,  EGFR  mutations were associated with ground-glass opacity,  KRAS -positive tumors were generally solid and less likely to metastasize to the lung and pleura, and  ALK -positive tumors tended to present with lymphadenopathy, extranodal invasion, and lymphangitis. These mutation-specific imaging characteristics may be related to the biological differences between these cancers.

Imaging Characteristics of Driver Mutations in EGFR, KRAS, and ALK among Treatment-Naïve Patients with Advanced Lung Adenocarcinoma