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Can single-phase dual-energy CT reliably identify adrenal adenomas?

  • Computed Tomography
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European Radiology Aims and scope Submit manuscript

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.

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References

  1. Bovio S, Cataldi A, Reimondo G et al (2006) Prevalence of adrenal incidentaloma in a contemporary computerized tomography series. J Endocrinol Invest 29:298–302

    Article  CAS  PubMed  Google Scholar 

  2. Song JH, Chaudhry FS, Mayo-Smith WW (2008) The incidental adrenal mass on CT: prevalence of adrenal disease in 1,049 consecutive adrenal masses in patients with no known malignancy. AJR Am J Roentgenol 190:1163–1168

    Article  PubMed  Google Scholar 

  3. Dunnick NR, Korobkin M (2002) Imaging of adrenal incidentalomas: current status. AJR Am J Roentgenol 179:559–568

    Article  PubMed  Google Scholar 

  4. Dunnick NR, Korobkin M, Francis I (1996) Adrenal radiology: distinguishing benign from malignant adrenal masses. AJR Am J Roentgenol 167:861–867

    Article  CAS  PubMed  Google Scholar 

  5. Young WF Jr (2007) Clinical practice. The incidentally discovered adrenal mass. N Engl J Med 356:601–610

    Article  CAS  PubMed  Google Scholar 

  6. Lam KY, Lo CY (2002) Metastatic tumours of the adrenal glands: a 30-year experience in a teaching hospital. Clin Endocrinol (Oxf) 56:95–101

    Article  Google Scholar 

  7. Young WF Jr (2000) Management approaches to adrenal incidentalomas. A view from Rochester, Minnesota. Endocrinol Metab Clin North Am 29:159–185, x

    Article  PubMed  Google Scholar 

  8. Blake MA, Cronin CG, Boland GW (2010) Adrenal imaging. AJR Am J Roentgenol 194:1450–1460

    Article  PubMed  Google Scholar 

  9. Yip L, Tublin ME, Falcone JA et al (2010) The adrenal mass: correlation of histopathology with imaging. Ann Surg Oncol 17:846–852

    Article  PubMed  Google Scholar 

  10. Legmann P (2009) Adrenal incidentaloma: management approaches: CT - MRI. J Radiol 90:426–443

    Article  CAS  PubMed  Google Scholar 

  11. Boland GW, Lee MJ, Gazelle GS et al (1998) Characterization of adrenal masses using unenhanced CT: an analysis of the CT literature. AJR Am J Roentgenol 171:201–204

    Article  CAS  PubMed  Google Scholar 

  12. Gnannt R, Fischer M, Goetti R et al (2012) Dual-energy CT for characterization of the incidental adrenal mass: preliminary observations. AJR Am J Roentgenol 198:138–144

    Article  PubMed  Google Scholar 

  13. Heye T, Nelson RC, Ho LM et al (2012) Dual-energy CT applications in the abdomen. AJR Am J Roentgenol 199:S64–70

    Article  PubMed  Google Scholar 

  14. Brown CL, Hartman RP, Dzyubak OP et al (2009) Dual-energy CT iodine overlay technique for characterization of renal masses as cyst or solid: a phantom feasibility study. Eur Radiol 19:1289–1295

    Article  CAS  PubMed  Google Scholar 

  15. De Cecco CN, Buffa V, Fedeli S et al (2010) Dual energy CT (DECT) of the liver: conventional versus virtual unenhanced images. Eur Radiol 20:2870–2875

    Article  PubMed  Google Scholar 

  16. Gupta RT, Ho LM, Marin D et al (2010) Dual-energy CT for characterization of adrenal nodules: initial experience. AJR Am J Roentgenol 194:1479–1483

    Article  PubMed  Google Scholar 

  17. Graser A, Johnson TR, Hecht EM et al (2009) Dual-energy CT in patients suspected of having renal masses: can virtual nonenhanced images replace true nonenhanced images? Radiology 252:433–440

    Article  PubMed  Google Scholar 

  18. Flohr TG, McCollough CH, Bruder H et al (2006) First performance evaluation of a dual-source CT (DSCT) system. Eur Radiol 16:256–268

    Article  PubMed  Google Scholar 

  19. Liu X, Yu L, Primak AN et al (2009) Quantitative imaging of element composition and mass fraction using dual-energy CT: three-material decomposition. Med Phys 36:1602–1609

    Article  PubMed Central  PubMed  Google Scholar 

  20. Mayo-Smith WW, Boland GW, Noto RB et al (2001) State-of-the-art adrenal imaging. Radiographics 21:995–1012

    Article  CAS  PubMed  Google Scholar 

  21. Boland GW, Blake MA, Hahn PF et al (2008) Incidental adrenal lesions: principles, techniques, and algorithms for imaging characterization. Radiology 249:756–775

    Article  PubMed  Google Scholar 

  22. Ho LM, Marin D, Neville AM et al (2012) Characterization of adrenal nodules with dual-energy CT: can virtual unenhanced attenuation values replace true unenhanced attenuation values? AJR Am J Roentgenol 198:840–845

    Article  PubMed  Google Scholar 

  23. Zhang LJ, Peng J, Wu SY et al (2010) Liver virtual non-enhanced CT with dual-source, dual-energy CT: a preliminary study. Eur Radiol 20:2257–2264

    Article  PubMed  Google Scholar 

  24. Kim YK, Park BK, Kim CK et al (2013) Adenoma characterization: adrenal protocol with dual-energy CT. Radiology 267:155–163

    Article  PubMed  Google Scholar 

  25. Toepker M, Moritz T, Krauss B et al (2012) Virtual non-contrast in second-generation, dual-energy computed tomography: reliability of attenuation values. Eur J Radiol 81:e398–405

    Article  PubMed  Google Scholar 

  26. Graser A, Becker CR, Staehler M et al (2010) Single-phase dual-energy CT allows for characterization of renal masses as benign or malignant. Invest Radiol 45:399–405

    PubMed  Google Scholar 

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Acknowledgements

The scientific guarantor of this publication is Prof. Dr. Anno Graser. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

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Authors and Affiliations

  1. Institute for Clinical Radiology, University of Munich, Grosshadern Campus, Marchioninistr. 15, 81377, Munich, Germany

    A. Helck, N. Hummel, F. G. Meinel, T. Johnson, K. Nikolaou & A. Graser

Authors
  1. A. Helck
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  2. N. Hummel
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  3. F. G. Meinel
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  4. T. Johnson
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  5. K. Nikolaou
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  6. A. Graser
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Corresponding author

Correspondence to A. Helck.

Additional information

A. Helck and N. Hummel contributed equally to this work.

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Helck, A., Hummel, N., Meinel, F.G. et al. Can single-phase dual-energy CT reliably identify adrenal adenomas?. Eur Radiol 24, 1636–1642 (2014). https://doi.org/10.1007/s00330-014-3192-z

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  • DOI: https://doi.org/10.1007/s00330-014-3192-z

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