Universität zu Köln

Cao, Jinjin, Lennartz, Simon ORCID: 0000-0002-3254-4809, Parakh, Anushri, Joseph, Evita, Blake, Michael, Sahani, Dushyant and Kambadakone, Avinash (2021). Dual-layer dual-energy CT for characterization of adrenal nodules: can virtual unenhanced images replace true unenhanced acquisitions? Abdom. Radiol., 46 (9). S. 4345 - 4353. NEW YORK: SPRINGER. ISSN 2366-0058

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Abstract

Purpose To investigate the diagnostic performance of dual-layer dual-energy CT (dlDECT) in the evaluation of adrenal nodules. Methods In this retrospective study, 66 patients with triphasic dlDECT (unenhanced, venous phase (VP), delayed phase (DP)) for suspected adrenal lesions were included. Virtual unenhanced images (VUE) were derived from VP acquisitions. Reference diagnoses were established with true unenhanced (TUE) attenuation, absolute washout, follow-up imaging and pathological data. Attenuation for adrenal lesions and abdominal tissues was acquired on TUE, VUE, VP and DP images. VUE and TUE attenuation were compared in all included tissues. Characterization of adrenal nodules based on TUE and VUE attenuation was investigated. ROC analysis was used to determine an adjusted threshold for diagnosing lipid-rich adenomas. Results Seventy-three adrenal nodules (mean size: 18.9 +/- 8.9 mm) were identified in 66 patients (38 females, 28 males; age: 61 +/- 13 years) including adenoma (n = 65), metastases (n = 2), pheochromocytoma (n = 3), adrenocortical carcinoma (n = 1) and myelolipoma (n = 2). Mean attenuation of all included tissues except for the abdominal aorta (p = 0.11) was significantly higher in VUE compared to TUE images, including the attenuation of adrenal nodules (20.0 +/- 17.2 vs. 7.1 +/- 19.8; p < 0.05). Classification of adrenal adenomas as lipid-rich based on VUE attenuation <= 10 HU yielded a sensitivity/specificity of 0.2/1.0, while an adjusted threshold of <= 22 HU yielded a sensitivity/specificity of 0.82/0.85. Conclusion dlDECT-derived VUE images overestimated attenuation in adrenal nodules, resulting in low sensitivity for diagnosis of lipid-rich adenomas using the established 10 HU threshold. Based on an adjusted threshold (<= 22 HU) a higher sensitivity was attained, yet at the expense of a lower specificity, warranting further validation.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Cao, Jinjin UNSPECIFIED UNSPECIFIED UNSPECIFIED Lennartz, Simon UNSPECIFIED orcid.org/0000-0002-3254-4809 UNSPECIFIED Parakh, Anushri UNSPECIFIED UNSPECIFIED UNSPECIFIED Joseph, Evita UNSPECIFIED UNSPECIFIED UNSPECIFIED Blake, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Sahani, Dushyant UNSPECIFIED UNSPECIFIED UNSPECIFIED Kambadakone, Avinash UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-587627
DOI:	10.1007/s00261-021-03062-3
Journal or Publication Title:	Abdom. Radiol.
Volume:	46
Number:	9
Page Range:	S. 4345 - 4353
Date:	2021
Publisher:	SPRINGER
Place of Publication:	NEW YORK
ISSN:	2366-0058
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language Radiology, Nuclear Medicine & Medical Imaging Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/58762