Universität zu Köln

Bernard, Pascale, Nelles, Christian ORCID: 0000-0002-7351-7516, Fervers, Philipp ORCID: 0000-0003-3663-3486, Schwan, Joline, Dankov, Kaloyan ORCID: 0009-0001-6632-9285, Maintz, David ORCID: 0000-0002-8942-3776, Zopfs, David ORCID: 0000-0001-9978-7453, Große Hokamp, Nils ORCID: 0000-0001-7928-0487, Persigehl, Thorsten ORCID: 0000-0001-5928-4405 and Lennartz, Simon ORCID: 0000-0001-7202-398X (2025). Adrenal lesion classification revisited: validation and adjustment of dual-energy CT derived virtual unenhanced attenuation thresholds. Abdominal Radiology, 50. pp. 5283-5291. Springer Nature. ISSN 2366-0058

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Abstract

Objectives Dual-energy CT (DECT)-derived virtual unenhanced (VUE) images have been investigated for adrenal lesion differentiation, yet previously reported thresholds vary, hampering clinical application. We aimed to test previous VUE thresholds for adrenal lesion differentiation in a large retrospective cohort, to provide a cross-validated threshold based on our data, and to investigate the influence of underlying malignancies on differentiation accuracy. Methods 290 patients with 348 adrenal lesions (169 metastases, 179 adenomas) were included. Dual-layer DECT-derived VUE thresholds from 3 previous studies were retrieved, applied to our cohort and corresponding sensitivity/specificity/accu- racy was calculated. Optimal threshold based on our data were determined using ROC-analysis with five-fold cross valida- tion. Moreover, a threshold with similar specificity to the 10 HU threshold in unenhanced images was calculated. Subgroup analysis of adrenal lesion differentiation depending on underlying malignancies was performed. Results The previously suggested thresholds were 20, 22 and 29 HU, and corresponding sensitivity/specificity/accuracy was 0.61/0.92/0.76, 0.67/0.91/0.78, and 0.82/0.59/0.71, respectively. The threshold determined from our cohort was 24.7 HU, yielding a sensitivity/specificity/accuracy of 0.76/0.81/0.79. Differentiation in disease-specific subgroups showed similar sensitivity/specificity/accuracy (Melanoma:0.78/0.84/0.79; Lung cancer:0.78/0.8/0.78; RCC:0.78/1/0.79). The VUE thresh- old to achieve a 0.98 specificity similar to the unenhanced 10 HU cutoff was 17.3 HU, yielding a sensitivity of 0.49. Conclusion Previous VUE attenuation thresholds showed a varying accuracy for differentiation between adenomas and metastases. A cross-validated VUE threshold of 24.7 HU yielded a mean accuracy of 0.79, whereas a threshold of 17.3 HU was best for achieving comparable specificity as reported for the 10 HU threshold in unenhanced images.

Item Type:	Article
Creators:	Creators Email ORCID ORCID Put Code Bernard, Pascale UNSPECIFIED UNSPECIFIED UNSPECIFIED Nelles, Christian UNSPECIFIED https://orcid.org/0000-0002-7351-7516 UNSPECIFIED Fervers, Philipp UNSPECIFIED https://orcid.org/0000-0003-3663-3486 UNSPECIFIED Schwan, Joline UNSPECIFIED UNSPECIFIED UNSPECIFIED Dankov, Kaloyan UNSPECIFIED https://orcid.org/0009-0001-6632-9285 UNSPECIFIED Maintz, David UNSPECIFIED https://orcid.org/0000-0002-8942-3776 UNSPECIFIED Zopfs, David UNSPECIFIED https://orcid.org/0000-0001-9978-7453 UNSPECIFIED Große Hokamp, Nils UNSPECIFIED https://orcid.org/0000-0001-7928-0487 UNSPECIFIED Persigehl, Thorsten UNSPECIFIED https://orcid.org/0000-0001-5928-4405 UNSPECIFIED Lennartz, Simon UNSPECIFIED https://orcid.org/0000-0001-7202-398X UNSPECIFIED
URN:	urn:nbn:de:hbz:38-800908
Identification Number:	10.1007/s00261-025-04939-3
Journal or Publication Title:	Abdominal Radiology
Volume:	50
Page Range:	pp. 5283-5291
Date:	26 April 2025
Publisher:	Springer Nature
ISSN:	2366-0058
Language:	English
Faculty:	Faculty of Medicine
Divisions:	Faculty of Medicine > Radiologische Diagnostik > Institut und Poliklinik für Radiologische Diagnostik
Subjects:	Medical sciences Medicine
['eprint_fieldname_oa_funders' not defined]:	Publikationsfonds UzK
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/80090