肺癌中高强化肾上腺病变：平扫与 1 分钟增强 CT 可靠预测良性病变。
Hyperattenuating adrenal lesions in lung cancer: biphasic CT with unenhanced and 1-min enhanced images reliably predicts benign lesions.
机构信息
Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
出版信息
Eur Radiol. 2021 Aug;31(8):5948-5958. doi: 10.1007/s00330-020-07648-1. Epub 2021 Jan 18.
OBJECTIVES
To investigate usefulness of biphasic computed tomography (CT) in characterizing hyperattenuating adrenal lesions in lung cancer.
METHODS
This retrospective study included 239 patients with lung cancer who underwent adrenal CT for hyperattenuating (> 10 Hounsfield unit) adrenal lesions. Adrenal CT comprised unenhanced and 1-min and 15-min enhanced images. We dichotomized adrenal lesions depending on benign or metastatic lesions. Reference standard for benignity was histologic confirmation or ≥ 6-month stability on follow-up CT. Two independent readers analyzed absolute (APW) or relative percentage wash-out (RPW) using triphasic CT, and enhancement ratio (ER) or percentage wash-in (PWI) using biphasic CT (i.e., unenhanced and 1-min enhanced CT). Criteria for benignity were as follows: criteria 1, (a) APW ≥ 60% or (b) RPW ≥ 40%, and criteria 2, (a) ER > 3 and (b) PWI > 200%. We analyzed area under the curve (AUC) and accuracy for benignity, and inter-reader agreement.
RESULTS
Proportion of benign adrenal lesion was 71.1% (170/239). For criteria 1 and 2, AUCs were 0.872 (95% confidence interval [CI], 0.822-0.911) and 0.886 (95% CI, 0.838-0.923), respectively, for reader 1 (p = 0.566) and 0.816 (95% CI, 0.761-0.863) and 0.814 (95% CI, 0.759-0.862), respectively, for reader 2 (p = 0.955), and accuracies were 87.9% (210/239) and 86.2% (206/239), respectively, for reader 1 (p = 0.479) and 81.2% (194/239) and 80.3% (192/239), respectively, for reader 2 (p = 0.763). Weighted kappa was 0.725 (95% CI, 0.634-0.816) for criteria 1 and 0.736 (95% CI, 0.649-0.824) for criteria 2.
CONCLUSION
Biphasic CT can reliably characterize hyperattenuating adrenal lesions in patients with lung cancer.
KEY POINTS
• Criteria from biphasic computed tomography (CT) for diagnosing benign adrenal lesions were enhancement ratio of > 3 and percentage wash-in of > 200%. • In the analysis by two independent readers, area under the curve between criteria 1 and 2 was not significantly different (0.872 and 0.886 for reader 1; 0.816 and 0.814, for reader 2; p > 0.05 for each comparison). • Wash-in characteristics from biphasic CT are helpful to predict benign adrenal lesions in lung cancer.
目的
探讨双能 CT （computed tomography，CT）在肺癌高强化肾上腺病变中的应用价值。
方法
本回顾性研究纳入了 239 例肺癌患者，这些患者均因高强化（> 10 个 Hounsfield 单位）肾上腺病变而行肾上腺 CT 检查。肾上腺 CT 包括平扫和 1 分钟及 15 分钟增强图像。我们根据良性或转移性病变将肾上腺病变分为两类。良性病变的参考标准为组织学证实或随访 CT 上≥ 6 个月的稳定性。两名独立的读者使用三相 CT 分析绝对（APW）或相对百分比洗脱（RPW），使用双能 CT 分析增强比（ER）或百分比摄取（PWI）（即平扫和 1 分钟增强 CT）。良性病变的标准如下：标准 1：（a）APW≥60%或（b）RPW≥40%；标准 2：（a）ER>3 和（b）PWI>200%。我们分析了良性病变的曲线下面积（AUC）和准确性，以及两位读者的一致性。
结果
良性肾上腺病变的比例为 71.1%（170/239）。对于标准 1 和标准 2，读者 1 的 AUC 分别为 0.872（95%置信区间 [CI]，0.822-0.911）和 0.886（95% CI，0.838-0.923）（p = 0.566），读者 2 的 AUC 分别为 0.816（95% CI，0.761-0.863）和 0.814（95% CI，0.759-0.862）（p = 0.955），准确性分别为 87.9%（210/239）和 86.2%（206/239）（p = 0.479），读者 2 的准确性分别为 81.2%（194/239）和 80.3%（192/239）（p = 0.763）。标准 1 的加权 Kappa 值为 0.725（95% CI，0.634-0.816），标准 2 的加权 Kappa 值为 0.736（95% CI，0.649-0.824）。
结论
双能 CT 可可靠地对肺癌患者的高强化肾上腺病变进行特征描述。
重点
• 用于诊断良性肾上腺病变的双能 CT 标准为增强比> 3 和摄取百分比> 200%。• 在两位独立读者的分析中，标准 1 和标准 2 的 AUC 之间没有显著差异（读者 1 为 0.872 和 0.886；读者 2 为 0.816 和 0.814；p > 0.05）。• 双能 CT 的摄取特征有助于预测肺癌中的良性肾上腺病变。
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