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Bette S, Risch F, Canalini L, Becker J, Leithner EV, Huber A, Haerting M, Jehs B, Wollny C, Schwarz F, Tehlan K, Scheurig-Muenkler C, Wendler T, Kroencke T, Decker JA. Diagnostic performance of photon-counting detector CT for differentiation between adrenal adenomas and metastases. Eur Radiol 2024; 34:5944-5953. [PMID: 38480567 PMCID: PMC11364581 DOI: 10.1007/s00330-024-10675-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/05/2024] [Accepted: 02/07/2024] [Indexed: 08/31/2024]
Abstract
OBJECTIVES Aim of this study was to assess the value of virtual non-contrast (VNC) reconstructions in differentiating between adrenal adenomas and metastases on a photon-counting detector CT (PCD-CT). MATERIAL AND METHODS Patients with adrenal masses and contrast-enhanced CT scans in portal venous phase were included. Image reconstructions were performed, including conventional VNC (VNCConv) and PureCalcium VNC (VNCPC), as well as virtual monochromatic images (VMI, 40-90 keV) and iodine maps. We analyzed images using semi-automatic segmentation of adrenal lesions and extracted quantitative data. Logistic regression models, non-parametric tests, Bland-Altman plots, and a random forest classifier were used for statistical analyses. RESULTS The final study cohort consisted of 90 patients (36 female, mean age 67.8 years [range 39-87]) with adrenal lesions (45 adenomas, 45 metastases). Compared to metastases, adrenal adenomas showed significantly lower CT-values in VNCConv and VNCPC (p = 0.007). Mean difference between VNC and true non-contrast (TNC) was 17.67 for VNCConv and 14.85 for VNCPC. Random forest classifier and logistic regression models both identified VNCConv and VNCPC as the best discriminators. When using 26 HU as the threshold in VNCConv reconstructions, adenomas could be discriminated from metastases with a sensitivity of 86.7% and a specificity of 75.6%. CONCLUSION VNC algorithms overestimate CT values compared to TNC in the assessment of adrenal lesions. However, they allow a reliable discrimination between adrenal adenomas and metastases and could be used in clinical routine in near future with an increased threshold (e.g., 26 HU). Further (multi-center) studies with larger patient cohorts and standardized protocols are required. CLINICAL RELEVANCE STATEMENT VNC reconstructions overestimate CT values compared to TNC. Using a different threshold (e.g., 26 HU compared to the established 10 HU), VNC has a high diagnostic accuracy for the discrimination between adrenal adenomas and metastases. KEY POINTS • Virtual non-contrast reconstructions may be promising tools to differentiate adrenal lesions and might save further diagnostic tests. • The conventional and a new calcium-preserving virtual non-contrast algorithm tend to systematically overestimate CT-values compared to true non-contrast images. • Therefore, increasing the established threshold for true non-contrast images (e.g., 10HU) may help to differentiate between adrenal adenomas and metastases on contrast-enhanced CT.
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Affiliation(s)
- Stefanie Bette
- Diagnostic and Interventional Radiology, University Hospital Augsburg, Faculty of Medicine, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Franka Risch
- Diagnostic and Interventional Radiology, University Hospital Augsburg, Faculty of Medicine, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Luca Canalini
- Diagnostic and Interventional Radiology, University Hospital Augsburg, Faculty of Medicine, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Judith Becker
- Diagnostic and Interventional Radiology, University Hospital Augsburg, Faculty of Medicine, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Eva V Leithner
- Diagnostic and Interventional Radiology, University Hospital Augsburg, Faculty of Medicine, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Adrian Huber
- Diagnostic and Interventional Radiology, University Hospital Augsburg, Faculty of Medicine, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Mark Haerting
- Diagnostic and Interventional Radiology, University Hospital Augsburg, Faculty of Medicine, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Bertram Jehs
- Diagnostic and Interventional Radiology, University Hospital Augsburg, Faculty of Medicine, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Claudia Wollny
- Diagnostic and Interventional Radiology, University Hospital Augsburg, Faculty of Medicine, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Florian Schwarz
- Diagnostic and Interventional Radiology, Donau-Isar-Klinikum, Perlasberger Str. 41, 94469, Deggendorf, Germany
| | - Kartikay Tehlan
- Diagnostic and Interventional Radiology, University Hospital Augsburg, Faculty of Medicine, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Christian Scheurig-Muenkler
- Diagnostic and Interventional Radiology, University Hospital Augsburg, Faculty of Medicine, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Thomas Wendler
- Diagnostic and Interventional Radiology, University Hospital Augsburg, Faculty of Medicine, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
- Institute of Digital Health, University Hospital Augsburg, Augsburg, Germany
- Computer-Aided Medical Procedures and Augmented Reality, School of Computation, Information and Technology, Technical University of Munich, Munich, Germany
| | - Thomas Kroencke
- Diagnostic and Interventional Radiology, University Hospital Augsburg, Faculty of Medicine, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany.
- Centre for Advanced Analytics and Predictive Sciences (CAAPS), University of Augsburg, Universitätsstr. 2, 86159, Augsburg, Germany.
| | - Josua A Decker
- Diagnostic and Interventional Radiology, University Hospital Augsburg, Faculty of Medicine, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
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Lennartz S, Zopfs D, Große Hokamp N. Dual-energy CT revisited: a focused review of clinical use cases. ROFO-FORTSCHR RONTG 2024; 196:794-806. [PMID: 38176436 DOI: 10.1055/a-2203-2945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Affiliation(s)
- Simon Lennartz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - David Zopfs
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nils Große Hokamp
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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