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Objective:To explore the correlation between the spectral computed tomography (CT) imaging parameters and the Ki-67 labeling index in lung adenocarcinoma.Methods:Spectral CT imaging parameters [iodine concentrations of lesions (ICLs) in the arterial phase (ICLa)and venous phase (ICLv),normalized IC in the aorta (NICa/NICv),slope of the spectral HU curve (λHUa/λHUv)and monochromatic CT number enhancement on 40 keV and 70 keV images (CT40keVa/v,CT70keVa/v)] in 34 lung adenocarcinomas were analyzed,and common molecular markers,including the Ki-67 labeling index,were detected with immunohistochemistry.Different Ki-67 labeling indexes were measured and grouped into four grades according to the number of positive-stained cells (grade 0,≤1％;l％＜grade 1≤10％;10％＜grade 2≤30％;and grade 3,＞30％).One-way analysis of variance (ANOVA) was used to compare the four different grades,and the Bonferroni method was used to correct the P value for multiple comparisons.A Spearman correlation analysis was performed to further research a quantitative correlation between the Ki-67 labeling index and spectral CT imaging parameters.Results:CT40keVa,CT40keVv,CT70keVa and CT70keVv increased as the grade increased,and CT70keVa and CT70keVv were statistically significant (P＜0.05).These four parameters and the Ki-67 labeling index showed a moderate positive correlation with lung adenocarcinoma nodules.ICL,NIC and λHU in the arterial and venous phases were not significantly different among the four grades.Conclusions:The spectral CT imaging parameters CT40keVa,CT40keVv,CT70keVa and CT70keVv gradually increased with Ki-67 expression and showed a moderate positive correlation with lung adenocarcinomas.Therefore,spectral CT imaging parameter-enhanced monochromatic CT numbers at 70 keV may indicate the extent of proliferation of lung adenocarcinomas.