A Helck1, N Hummel, F G Meinel, T Johnson, K Nikolaou, A Graser. 1. Institute for Clinical Radiology, University of Munich, Grosshadern Campus, Marchioninistr. 15, 81377, Munich, Germany, andreas.helck@med.uni-muenchen.de.
Abstract
PURPOSE: To evaluate whether single-phase dual-energy-CT-based attenuation measurements can reliably differentiate lipid-rich adrenal adenomas from malignant adrenal lesions. MATERIALS AND METHODS: We retrospectively identified 51 patients with adrenal masses who had undergone contrast-enhanced dual-energy-CT (140/100 or 140/80 kVp). Virtual non-contrast and colour-coded iodine images were generated, allowing for measurement of pre- and post-contrast density on a single-phase acquisition. Adrenal adenoma was diagnosed if density on virtual non-contrast images was ≤10 HU. Clinical follow-up, true non-contrast CT, PET/CT, in- and opposed-phase MRI, and histopathology served as the standard of reference. RESULTS: Based on the standard of reference, 46/57 (80.7%) adrenal masses were characterised as adenomas or other benign lesions; 9 malignant lesions were detected. Based on a cutoff value of 10 HU, virtual non-contrast images allowed for correct identification of adrenal adenomas in 33 of 46 (71%), whereas 13/46 (28%) adrenal adenomas were lipid poor with a density ≥10 HU. Based on the threshold of 10 HU on the virtual non-contrast images, the sensitivity, specificity, and accuracy for detection of benign adrenal lesions was 73%, 100%, and 81% respectively. CONCLUSION: Virtual non-contrast images derived from dual-energy-CT allow for accurate characterisation of lipid-rich adrenal adenomas and can help to avoid additional follow-up imaging. KEY POINTS: • Adrenal adenomas are a common lesion of the adrenal glands. • Differentiation of benign adrenal adenomas from malignant adrenal lesions is important. • Dual-energy based virtual non-contrast images help to evaluate patients with adrenal adenomas.
PURPOSE: To evaluate whether single-phase dual-energy-CT-based attenuation measurements can reliably differentiate lipid-rich adrenal adenomas from malignant adrenal lesions. MATERIALS AND METHODS: We retrospectively identified 51 patients with adrenal masses who had undergone contrast-enhanced dual-energy-CT (140/100 or 140/80 kVp). Virtual non-contrast and colour-coded iodine images were generated, allowing for measurement of pre- and post-contrast density on a single-phase acquisition. Adrenal adenoma was diagnosed if density on virtual non-contrast images was ≤10 HU. Clinical follow-up, true non-contrast CT, PET/CT, in- and opposed-phase MRI, and histopathology served as the standard of reference. RESULTS: Based on the standard of reference, 46/57 (80.7%) adrenal masses were characterised as adenomas or other benign lesions; 9 malignant lesions were detected. Based on a cutoff value of 10 HU, virtual non-contrast images allowed for correct identification of adrenal adenomas in 33 of 46 (71%), whereas 13/46 (28%) adrenal adenomas were lipid poor with a density ≥10 HU. Based on the threshold of 10 HU on the virtual non-contrast images, the sensitivity, specificity, and accuracy for detection of benign adrenal lesions was 73%, 100%, and 81% respectively. CONCLUSION: Virtual non-contrast images derived from dual-energy-CT allow for accurate characterisation of lipid-rich adrenal adenomas and can help to avoid additional follow-up imaging. KEY POINTS: • Adrenal adenomas are a common lesion of the adrenal glands. • Differentiation of benign adrenal adenomas from malignant adrenal lesions is important. • Dual-energy based virtual non-contrast images help to evaluate patients with adrenal adenomas.
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