Assessment of dual-energy spectral CT for the characterization of incidental adrenal nodules: differential diagnosis of lipid-poor adrenal adenomas and pheochromocytomas

CHI Jing; YIN Shen-nan; DING Ning; CHEN Xiao-fang; SHEN Li; JI Yi-ding

doi:10.12117/jccmi.2019.05.005

Journal of China Clinic Medical Imaging ›› 2019, Vol. 30 ›› Issue (5) : 322-327. DOI: 10.12117/jccmi.2019.05.005

Assessment of dual-energy spectral CT for the characterization of incidental adrenal nodules: differential diagnosis of lipid-poor adrenal adenomas and pheochromocytomas

CHI Jing, YIN Shen-nan, DING Ning, CHEN Xiao-fang, SHEN Li, JI Yi-ding

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Abstract

Objective: To assess the value of dual-energy spectral CT(DEsCT) for differentiating lipid-poor adrenal adenoma and pheochromocytoma. Materials and Methods: Forty-eight nonconsecutive patients with 16 pathologically confirmed pheochromocytomas and 28 lipid-poor adrenal adenomas underwent nonenhanced and contrast enhanced dual-energy spectral CT of the abdomen. For each adrenal nodule, nonenhanced attenuation values were recorded; material decomposition images and monochromatic image sets with photon energies from 40 to 140 keV were both reconstructed, normalized iodine concentration (NIC) and normalized high-enhancing iodine concentration(NHIC) were calculated. Quantitative parameters were compared using a two-sample t test. Results: NIC values were lower in the lipid-poor adrenal adenomas than in the pheochromocytomas: 0.16±0.07 vs. 0.31±0.14 in AP(P<0.001), and 0.44±0.16 vs. 0.62±0.43 in PP(P=0.012). The quantitative NIC during AP measurements showed a sensitivity of 88%(14 of 16 pheochromocytomas) at a specifcity of 86%(24 of 28 lipid-poor adrenal adenomas), yielding improved diagnostic performance compared with nonenhanced multidetector CT attenuation(sensitivity of 100% (16 of 16 pheochromocytomas) at a specifcity of 60%(17 of 28 lesions). Conclusion: The NIC values during AP obtained in the dual-energy spectral CT images appear optimal for discriminating a lipid-poor adrenal adenoma from a pheochromocytoma, reflecting an improved ability over nonenhanced multidetector CT.

Key words

Adrenal gland neoplasms / Adenoma / Pheochromocytoma / Tomography, spiral computed

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CHI Jing, YIN Shen-nan, DING Ning, CHEN Xiao-fang, SHEN Li, JI Yi-ding. Assessment of dual-energy spectral CT for the characterization of incidental adrenal nodules: differential diagnosis of lipid-poor adrenal adenomas and pheochromocytomas[J]. Journal of China Clinic Medical Imaging. 2019, 30(5): 322-327 https://doi.org/10.12117/jccmi.2019.05.005

References

[1]Dunnick NR, Korobkin M. Imaging of adrenal incidentalomas: current status[J]. AJR, 2002, 179(3): 559-568.
[2]Mileto A, Nelson RC, Marin D, et al. Dual-Energy Multidetector CT for the Characterization of Incidental Adrenal Nodules: Diagnostic Performance of Contrast-enhanced Material Density Analysis[J]. Radiology, 2015, 274(2): 445-454.
[3]Bovio S, Cataldi A, Reimondo G, et al. Prevalence of adrenal incidentaloma in a contemporary computerized tomography series[J]. J Endocrinol Invest, 2006, 29(4): 298-302.
[4]Song JH, Chaudhry FS, Mayo-Smith WW. The incidental adrenal mass on CT: prevalence of adrenal disease in 1 049 consecutive adrenal masses in patients with no known malignancy[J]. AJR, 2008, 2009(5): 1163-1168.
[5]Cawood TJ, Hunt PJ, O'Shea D, et al. Recommended evaluation of adrenal incidentalomas is costly, has high false-positive rates and confers a risk of fatal cancer that is similar to the risk of the adrenal lesion becoming malignant; time for a rethink?[J]. Eur J Endocrinol, 2009, 161(4): 513.
[6]Boland GW, Lee MJ, Gazelle GS, et al. Characterization of adrenal masses using unenhanced CT: an analysis of the CT literature[J]. AJR, 1998, 171(1): 201-204.
[7]Caoili EM, Korobkin M, Francis IR, et al. Delayed enhanced CT of lipid-poor adrenal adenomas[J]. AJR, 2000, 175(5): 1411-1415.
[8]Park BK, Kim CK, Kim B, et al. Comparison of delayed enhanced CT and chemical shift MR for evaluating hyperattenuating incidental adrenal masses[J]. Radiology, 2007, 243(3): 760-765.
[9]Haider MA, Ghai SK, Lockwood G. Chemical Shift MR Imaging of Hyperattenuating(>10 HU) Adrenal Masses: Does It Still Have a Role?[J]. Radiology, 2004, 231(3): 711-716.
[10]Israel GM, Korobkin M, Wang C, et al. Comparison of unenhanced CT and chemical shift MRI in evaluating lipid-rich adrenal adenomas[J]. AJR, 2004, 183(1): 215.
[11]Weber AC, Lockhart ME, Weber TM, et al. Differentiation of high lipid content from low lipid content adrenal lesions using single-source rapid kilovolt (peak)-switching dual-energy multidetector CT[J]. J Comput Assis Tomogr, 2013, 37(6): 937.
[12]Cook DM, Loriaux DL. The Incidental Adrenal Mass[J]. Am J Med, 1996, 101(1): 1037-1054.
[13]Northcutt BG, Raman SP, Christopher L, et al. MDCT of adrenal masses: Can dual-phase enhancement patterns be used to differentiate adenoma and pheochromocytoma?[J]. AJR, 2013, 201(4): 834-839.
[14]Ho LM, Marin D, Neville AM, et al. Characterization of adrenal nodules with dual-energy CT: can virtual unenhanced attenuation values replace true unenhanced attenuation values?[J]. AJR, 2012, 198(4): 840-5.
[15]Gupta RT, Ho LM, Marin D, et al. Dual-energy CT for characterization of adrenal nodules: initial experience[J]. AJR, 2010, 194(6): 1479-1483.
[16]Park SH, Kim MJ, Kim JH, et al. Differentiation of Adrenal Adenoma and Nonadenoma in Unenhanced CT: New Optimal Threshold Value and the Usefulness of Size Criteria for Differentiation[J]. Korean J Radiol, 2007, 8(4): 328-335.
[17]Lin XZ, Wu ZY, Tao R, et al. Dual energy spectral CT imaging of insulinoma-Value in preoperative diagnosis compared with conventional multi-detector CT[J]. Eur J Radiol, 2012, 81(10): 2487-2494.
[18]Gnannt R, Fischer M, Goetti R, et al. Dual-energy CT for characterization of the incidental adrenal mass: preliminary observations[J]. AJR, 2012, 198(1): 138-144.
[19]Berland LL, Silverman SG, Gore RM, et al. Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee[J]. J Am Coll Radiol, 2010, 7(10): 754-773.
[20]Caoili EM, Korobkin M, Francis IR, et al. Adrenal masses: characterization with combined unenhanced and delayed enhanced CT[J]. Radiology, 2002, 222(3): 629-633.
[21]Park BK, Kim CK, Kwon GY, et al. Re-evaluation of pheochromocytomas on delayed contrast-enhanced CT: washout enhancement and other imaging features[J]. Eur Radiol, 2007, 17(11): 2804-2809.
[22]Blake MA, Kalra MK, Maher MM, et al. Pheochromocytoma: an imaging chameleon[J]. Radiographics, 2004, 24 Suppl 1(4): S87.
[23]Sangwaiya MJ, Boland GW, Cronin CG, et al. Incidental adrenal lesions: accuracy of characterization with contrast-enhanced washout multidetector CT—10-minute delayed imaging protocol revisited in a large patient cohort[J]. Radiology, 2010, 256(2): 504-510.
[24]Coursey CA, Nelson RC, Boll DT, et al. Dual-energy multidetector CT: how does it work, what can it tell us, and when can we use it in abdominopelvic imaging?[J]. Radiographics, 2010, 30(4): 1037-1055.
[25]Silva AC, Morse BG, Hara AK, et al. Dual-energy(spectral) CT: applications in abdominal imaging[J]. Radiographics, 2011, 31(4): 1031.
[26]Lawaczeck R, Arkadiev V, Diekmann F, et al. Monochromatic X-rays in digital mammography[J]. Invest Radiol, 2005, 40(1): 33.
[27]Yeh BM, Shepherd JA, Wang ZJ, et al. Dual-energy and low-kVp CT in the abdomen[J]. AJR, 2009, 193(1): 47.
[28]Marin D, Boll DT, Mileto A, et al. State of the art: dual-energy CT of the abdomen[J]. Radiology, 2014, 271(2): 327-342.
[29]Morgan DE, Weber AC, Lockhart ME, et al. Differentiation of high lipid content from low lipid content adrenal lesions using single-source rapid kilovolt(peak)-switching dual-energy multidetector CT[J]. J Comput Assist Tomogr, 2013, 37(6): 937.