Rivka Kessner1,2, Nils Große Hokamp1,3, Les Ciancibello1, Nikhil Ramaiya1, Karin A Herrmann1. 1. 1 Department of Radiology, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio, USA. 2. 2 Department of Diagnostic Imaging, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 3. 3 University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, Cologne, Germany.
Abstract
OBJECTIVES: To evaluate the added value of spectral results derived from Spectral Detector CT (SDCT) to the characterization of renal cystic lesions (RCL). METHODS: This retrospective study was approved by the local Institutional review board. 70 consecutive patients who underwent abdominopelvic SDCT and had at least one RCL were included. 84 RCL were categorized as simple, complex or neoplastic based on attenuation values on single-phase post-contrast images. Attenuation values were measured in each lesion on standard conventional CT images (stCI) and virtual monoenergetic images of 40keV and 100keV. A spectral curve slope was calculated and intra lesional iodine concentration (IC) was measured using iodine-density maps. Reference standard was established using histopathologic correlation, prior and follow-up imaging. Analysis of variance (ANOVA) was used to compare between the groups. RESULTS: Mean attenuation values for benign simple and complex RCL differed significantly (42 ± 16 vs 8 ± 3 HU; p < 0.001). IC was almost identical in benign simple and complex RCL (0.23 ± 0.04 mg ml-1 vs 0.24 ± 0.04 mg ml-1), while IC in neoplastic RCL was significantly higher (2.10 ± 0.08 mg ml-1 ; p < 0.001). The mean spectral curve slope did not differ significantly between simple and complex RCL (0.30 ± 0.03 vs 0.33 ± 0.05) but was significantly higher in neoplastic RCL (2.60 ± 0.10; p < 0.001). CONCLUSIONS: Spectral results of SDCT are highly promising in distinguishing benign complex RCL from enhancing neoplastic RCL based on single-phase post-contrast imaging only. ADVANCES IN KNOWLEDGE: SDCT can assist in differentiating between benign complex and neoplastic renal cystic lesions.
OBJECTIVES: To evaluate the added value of spectral results derived from Spectral Detector CT (SDCT) to the characterization of renal cystic lesions (RCL). METHODS: This retrospective study was approved by the local Institutional review board. 70 consecutive patients who underwent abdominopelvic SDCT and had at least one RCL were included. 84 RCL were categorized as simple, complex or neoplastic based on attenuation values on single-phase post-contrast images. Attenuation values were measured in each lesion on standard conventional CT images (stCI) and virtual monoenergetic images of 40keV and 100keV. A spectral curve slope was calculated and intra lesional iodine concentration (IC) was measured using iodine-density maps. Reference standard was established using histopathologic correlation, prior and follow-up imaging. Analysis of variance (ANOVA) was used to compare between the groups. RESULTS: Mean attenuation values for benign simple and complex RCL differed significantly (42 ± 16 vs 8 ± 3 HU; p < 0.001). IC was almost identical in benign simple and complex RCL (0.23 ± 0.04 mg ml-1 vs 0.24 ± 0.04 mg ml-1), while IC in neoplastic RCL was significantly higher (2.10 ± 0.08 mg ml-1 ; p < 0.001). The mean spectral curve slope did not differ significantly between simple and complex RCL (0.30 ± 0.03 vs 0.33 ± 0.05) but was significantly higher in neoplastic RCL (2.60 ± 0.10; p < 0.001). CONCLUSIONS: Spectral results of SDCT are highly promising in distinguishing benign complex RCL from enhancing neoplastic RCL based on single-phase post-contrast imaging only. ADVANCES IN KNOWLEDGE: SDCT can assist in differentiating between benign complex and neoplastic renal cystic lesions.
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