Invest Radiol. 2018 Mar;53(3):173-178. doi: 10.1097/RLI.0000000000000425.
The aim of this study was to investigate the value of third-generation dual-source dual-energy computed tomography (DECT) iodine and fat quantification in differentiating adrenal gland adenomas from metastases.
Sixty-two patients (38 men and 24 women; mean age, 69.1 years) underwent clinically indicated DECT of the abdomen on a third-generation dual-source scanner. Examinations were retrospectively included due to detected adrenal masses. For each adrenal lesion, unenhanced and contrast-enhanced attenuation values, as well as dual-energy iodine density and fat fraction, were recorded. Additional magnetic resonance imaging data, positron emission tomography/computed tomography scans, interval imaging follow-up, and histopathological analysis were used as the reference standard for all adrenal lesions. Mean values of unenhanced and contrast-enhanced attenuation, as well as material densities, were compared between adenomas, metastases, and normal adrenal glands. Furthermore, the diagnostic accuracy of unenhanced, contrast-enhanced, and material density analysis was assessed between adrenal adenomas and metastases.
Adrenal adenomas showed significant differences regarding iodine density and fat fraction values (1.3 ± 0.4 mg/mL and 34.2% ± 12.6%) in comparison with adrenal metastases (3.2 ± 1.4 mg/mL and 10.7% ± 7.8%) and normal adrenal glands (1.7 ± 0.6 mg/mL and 18.7% ± 12.0%) (all P ≤ 0.004). Analysis of unenhanced attenuation values revealed no significant differences between healthy adrenal parenchyma (19.1 ± 15.6 HU) and adrenal metastases (26.9 ± 16.2 HU) (P = 0.135). Iodine density and fat fraction analysis showed significantly higher diagnostic accuracy for the diagnosis of adenomas (sensitivity, 97% and 89%; specificity, 96% and 89%, respectively) compared with unenhanced and contrast-enhanced evaluation (sensitivity, 65% and 58%; specificity, 73% and 85%, respectively) (P ≤ 0.023). The combined diagnostic value of iodine density and fat fraction analysis revealed a sensitivity of 97% and a specificity of 100%.
Third-generation dual-source DECT iodine and fat quantification allow for differentiation between adrenal adenomas and metastases with high diagnostic accuracy.
本研究旨在探讨第三代双源双能 CT（DECT）碘和脂肪定量在鉴别肾上腺腺瘤和转移瘤中的价值。
62 例患者（38 名男性和 24 名女性；平均年龄 69.1 岁）在第三代双源扫描仪上进行了临床推荐的腹部 DECT 检查。由于发现了肾上腺肿块，对所有检查进行了回顾性纳入。对每个肾上腺病变，记录了未增强和增强的衰减值，以及双能碘密度和脂肪分数。所有肾上腺病变均采用磁共振成像数据、正电子发射断层扫描/计算机断层扫描、间隔成像随访和组织病理学分析作为参考标准。比较了腺瘤、转移瘤和正常肾上腺之间的未增强和增强衰减值以及物质密度的平均值。此外，还评估了未增强、增强和物质密度分析在鉴别肾上腺腺瘤和转移瘤方面的诊断准确性。
与肾上腺转移瘤（3.2 ± 1.4 mg/mL 和 10.7% ± 7.8%）和正常肾上腺（1.7 ± 0.6 mg/mL 和 18.7% ± 12.0%）相比，肾上腺腺瘤的碘密度和脂肪分数值（1.3 ± 0.4 mg/mL 和 34.2% ± 12.6%）有显著差异（均 P ≤ 0.004）。未增强衰减值分析显示，健康肾上腺实质（19.1 ± 15.6 HU）与肾上腺转移瘤（26.9 ± 16.2 HU）之间无显著差异（P = 0.135）。碘密度和脂肪分数分析对腺瘤的诊断具有更高的诊断准确性（敏感性分别为 97%和 89%，特异性分别为 96%和 89%），与未增强和增强评估相比（敏感性分别为 65%和 58%，特异性分别为 73%和 85%）（P ≤ 0.023）。碘密度和脂肪分数分析的联合诊断价值显示敏感性为 97%，特异性为 100%。
第三代双源双能 CT 碘和脂肪定量可实现肾上腺腺瘤和转移瘤的高准确性鉴别。
