Department of Radiology, Unit 1473, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030.
Department of Radiology, Unit 1473, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030.
Acad Radiol. 2018 Jul;25(7):861-868. doi: 10.1016/j.acra.2017.12.005. Epub 2018 Feb 3.
To determine if combination of washout and noncontrast data from delayed adrenal computed tomography (CT) improves diagnostic performance, and demonstration of an optimizing analytical framework.
This retrospective study consisted of 97 adrenal lesions, in 96 patients, with pathologically proven adrenal lesions (75 benign; 22 malignant), who had undergone noncontrast, portal- and approximate 15-minute delayed-phase CT. Lesion CT attenuations (Hounsfield units [HU]) during each phase, and "absolute" and "relative" percent enhancement washouts (APEW and RPEW) were assessed. The optimum combination of sequential parameters and thresholds was determined by recursive partitioning analysis; resultant diagnostic performance was compared to commonly applied single-parameter criteria for malignancy (noncontrast > 10 HU, APEW < 60%, RPEW < 40%).
The above single-parameter criteria yielded sensitivities, specificities, and accuracies for malignancy of 100.0%, 41.3%, and 54.6%; 97.9%, 61.3%, and 69.1%; and 96.6%, 74.7%, and 78.4%, respectively. Recursive partitioning analysis identified noncontrast ≥24.75 HU, with subsequent APEW ≤63.49%, as the optimum sequential parameter-threshold combination, which yielded increased sensitivity, specificity, and accuracy of 100.0%, 85.3%, and 90.7%, respectively. Discrimination using the combined sequential classifier yielded statistically significant improvements in accuracy when compared to the above conventional single-parameter criteria (all P ≤ .039).
Sequential application of noncontrast and washout criteria from delayed contrast-enhanced adrenal CT can improve diagnostic performance beyond that of commonly applied single-parameter criteria. Validation of the sequential ordering and refinement of the specific threshold values warrant further study.
旨在确定延迟肾上腺 CT（CT）的洗脱和非对比数据的组合是否可以提高诊断性能，并展示一个优化的分析框架。
这项回顾性研究包括 96 例患者的 97 个肾上腺病变，这些患者均经病理证实患有肾上腺病变（75 个良性病变；22 个恶性病变），并接受了非对比、门静脉期和大约 15 分钟延迟期 CT 检查。评估了每个阶段病变的 CT 衰减值（HU），以及“绝对”和“相对”洗脱增强百分比（APEW 和 RPEW）。通过递归分区分析确定了顺序参数和阈值的最佳组合；将所得的诊断性能与恶性肿瘤的常用单参数标准（非对比>10 HU，APEW<60%，RPEW<40%）进行比较。
上述单参数标准对恶性肿瘤的敏感性、特异性和准确性分别为 100.0%、41.3%和 54.6%；97.9%、61.3%和 69.1%；96.6%、74.7%和 78.4%。递归分区分析确定非对比≥24.75 HU，随后 APEW≤63.49%为最佳顺序参数-阈值组合，其敏感性、特异性和准确性分别提高到 100.0%、85.3%和 90.7%。与上述传统单参数标准相比，使用联合顺序分类器进行鉴别可显著提高准确性（所有 P 值均≤.039）。
延迟对比增强肾上腺 CT 的非对比和洗脱标准的顺序应用可以提高诊断性能，超过常用的单参数标准。需要进一步研究顺序排序和特定阈值值的细化。
