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Dual-layer dual-energy CT for characterization of adrenal nodules: can virtual unenhanced images replace true unenhanced acquisitions?

  • Kidneys, Ureters, Bladder, Retroperitoneum
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

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.

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Abbreviations

DECT:

Dual-energy CT

dlDECT:

Dual-layer dual-energy CT

DP:

Delayed phase

TUE:

True unenhanced images

VP:

Venous phase

VUE:

Virtual unenhanced images

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Funding

This study was funded by Philips (Grant number 2018A006560 to Avinash Kambadakone) and the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation)—LE 4401/1-1 to Simon Lennartz (Project number 426969820)

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Author notes

  1. **** Cao and Simon Lennartz are Co-first authors who contributed equally.

Authors and Affiliations

  1. Department of Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114-2696, USA

    **** Cao, Simon Lennartz, Anushri Parakh, Evita Joseph, Michael Blake & Avinash Kambadakone

  2. Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University Cologne, Kerpener Straße 62, 50937, Cologne, Germany

    Simon Lennartz

  3. Department of Radiology, University of Washington, UWMC Radiology RR218, 1959 NE Pacific St, Seattle, WA, 98195, USA

    Dushyant Sahani

Authors
  1. **** Cao
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  2. Simon Lennartz
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  4. Evita Joseph
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  7. Avinash Kambadakone
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Corresponding author

Correspondence to Avinash Kambadakone.

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Disclosures

Avinash Kambadakone: Research grants (GE and Philips Healthcare). Simon Lennartz: Research support (Philips Healthcare).

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Cao, J., Lennartz, S., Parakh, A. et al. Dual-layer dual-energy CT for characterization of adrenal nodules: can virtual unenhanced images replace true unenhanced acquisitions?. Abdom Radiol 46, 4345–4352 (2021). https://doi.org/10.1007/s00261-021-03062-3

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  • DOI: https://doi.org/10.1007/s00261-021-03062-3

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