Szász Paulína, Kučera Petr, Čtvrtlík Filip, Langová Kateřina, Hartmann Igor, Tüdös Zbyněk
Department of Radiology, University Hospital and Faculty of Medicine and Dentistry, Palacky University, 779 00 Olomouc, Czech Republic.
Department of Medical Biophysics, Faculty of Medicine and Dentistry, Palacky University, 775 15 Olomouc, Czech Republic.
Medicina (Kaunas). 2020 Nov 9;56(11):597. doi: 10.3390/medicina56110597.
: Our aim was to verify the optimal cut-off value for unenhanced CT attenuation and the percentage of negative voxels in the volume CT histogram analysis of adrenal masses. : We retrospectively analyzed the CT data of patients who underwent an adrenalectomy in the period 2002-2019. In total, 413 adrenalectomies were performed. Out of these, 233 histologically verified masses (123 adenomas, 58 pheochromocytomas, 18 carcinomas, and 34 metastases) fulfilled the inclusion criteria and were selected for analysis. The mean unenhanced attenuation in Hounsfield units (HU) and the percentage of voxels with attenuation less than 0 HU (negative voxels) were measured in each mass. : The mean unenhanced attenuation with a cut-off value of 10 HU reached a sensitivity of 59.4% and a specificity of 99.1% for benign adenomas. The mean unenhanced attenuation with a cut-off value of 15 HU reached a sensitivity of 69.1% and a specificity of 98.2%. For the histogram analysis, a cut-off value of 10% of negative pixels reached a sensitivity of 82.9% and a specificity of 98.2%, whereas a cut-off value of 5% of negative pixels reached a sensitivity of 87.8% and a specificity of 75.5%. The percentage of negative voxels reached a slightly better area under the curve (0.919) than unenhanced attenuation (0.908). : Mean unenhanced attenuation with a cut-off value of 10 HU represents a simple tool, and the most specific one, to distinguish adrenal adenomas from non-adenomas. CT histogram analysis with cut-off values of 10% of negative voxels improves sensitivity without any loss of specificity.
我们的目的是验证肾上腺肿块容积CT直方图分析中平扫CT衰减的最佳截断值和负性体素百分比。
我们回顾性分析了2002年至2019年期间接受肾上腺切除术患者的CT数据。总共进行了413例肾上腺切除术。其中，233例经组织学证实的肿块（123例腺瘤、58例嗜铬细胞瘤、18例癌和34例转移瘤）符合纳入标准并被选入分析。测量每个肿块的平均平扫Hounsfield单位（HU）衰减以及衰减小于0 HU的体素百分比（负性体素）。
平扫衰减截断值为10 HU时，对良性腺瘤的敏感性达到59.4%，特异性达到99.1%。平扫衰减截断值为15 HU时，敏感性达到69.1%，特异性达到98.2%。对于直方图分析，负性像素截断值为10%时，敏感性达到82.9%，特异性达到98.2%；而负性像素截断值为5%时，敏感性达到87.8%，特异性达到75.5%。负性体素百分比的曲线下面积（0.919）略优于平扫衰减（0.908）。
平扫衰减截断值为10 HU是区分肾上腺腺瘤与非腺瘤的一种简单且最具特异性的工具。负性体素截断值为10%的CT直方图分析可提高敏感性且不损失任何特异性。
