门静脉期相对增强比值在诊断乏脂性肾上腺腺瘤中的作用。
Relative Enhancement Ratio of Portal Venous Phase to Unenhanced CT in the Diagnosis of Lipid-poor Adrenal Adenomas.
机构信息
From the Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
出版信息
Radiology. 2021 Nov;301(2):360-368. doi: 10.1148/radiol.2021210231. Epub 2021 Aug 31.
Background The development of an accurate, practical, noninvasive, and widely available diagnostic approach to characterize lipid-poor adrenal lesions (greater than 10 HU at unenhanced CT) remains an ongoing demand. Purpose To investigate whether combined assessment of unenhanced and portal venous phase CT allows for the differentiation of lipid-poor adrenal adenomas from nonadenomas. Materials and Methods Patients with lipid-poor adrenal lesions who underwent unenhanced and portal venous phase CT with a single-energy scanner between January 2016 and March 2020 were identified retrospectively. For each lesion, the unenhanced and contrast-enhanced attenuation were measured; the absolute enhancement (contrast-enhanced minus unenhanced attenuation [HU]) and relative enhancement ratio ([absolute enhancement divided by unenhanced attenuation] × 100%) were calculated. The sensitivity achieved at 95% specificity to distinguish adenomas from nonadenomas was determined with receiver operating characteristic curve analysis and compared among parameters with use of the McNemar test. Results A total of 220 patients (mean age ± standard deviation, 66 years ± 12; 134 men) with 131 lipid-poor adenomas and 89 nonadenomas were analyzed. The sensitivity (achieved at 95% specificity) of the relative enhancement ratio (86% [113 of 131 adenomas; 95% CI: 79, 92] at a threshold of >210%) was higher than that of unenhanced attenuation (50% [66 of 131 adenomas; 95% CI: 42, 59] at a threshold of ≤21 HU), contrast-enhanced attenuation (3% [four of 131 adenomas; 95% CI: 1, 8] at a threshold of >120 HU), and absolute enhancement (24% [32 of 131 adenomas; 95% CI: 17, 33] at a threshold of >74 HU; all < .001). The sensitivities of the relative enhancement ratio were 100% (58 of 58 adenomas; 95% CI: 94, 100), 83% (52 of 63 adenomas; 95% CI: 71, 91), and 30% (three of 10 adenomas; 95% CI: 7, 65) for adenomas measuring unenhanced attenuation of more than 10 HU up to 20 HU, 21-30 HU, and more than 30 HU, respectively. Conclusion A relative enhancement ratio threshold of greater than 210%, measured at unenhanced and portal venous phase CT, accurately differentiated lipid-poor adenomas from nonadenomas, particularly for lesions with unenhanced attenuation of 10-30 HU. © RSNA, 2021
背景 对于特征为（平扫 CT 值＞10HU）的脂质缺乏性肾上腺病变（lipid-poor adrenal lesions），开发一种准确、实用、无创且广泛适用的诊断方法仍然是目前的需求。目的 旨在探究在单能量 CT 扫描仪的平扫和门静脉期 CT 扫描中，联合评估能否有助于区分脂质缺乏性肾上腺腺瘤与非腺瘤。材料与方法 回顾性分析了 2016 年 1 月至 2020 年 3 月间，接受单能量 CT 扫描仪平扫和门静脉期 CT 扫描的脂质缺乏性肾上腺病变患者。对于每个病变，均测量平扫和增强后的衰减值；计算绝对增强值（contrast-enhanced minus unenhanced attenuation [HU]）和相对增强比（[absolute enhancement divided by unenhanced attenuation] × 100%）。使用受试者工作特征曲线分析确定在 95%特异性下区分腺瘤与非腺瘤的最佳截断值，并使用 McNemar 检验比较各参数之间的敏感性。结果 共纳入 220 例患者（平均年龄±标准差，66 岁±12 岁；男 134 例），其中 131 例为脂质缺乏性腺瘤，89 例为非腺瘤。相对增强比（阈值＞210%时，敏感性为 86%[131 例腺瘤中 113 例；95%CI：79，92]）的敏感性（在 95%特异性时）高于平扫衰减值（阈值≤21HU 时，敏感性为 50%[131 例腺瘤中 66 例；95%CI：42，59]）、增强衰减值（阈值＞120HU 时，敏感性为 3%[131 例腺瘤中 4 例；95%CI：1，8]）和绝对增强值（阈值＞74HU 时，敏感性为 24%[131 例腺瘤中 32 例；95%CI：17，33]；均＜.001）。当腺瘤的平扫衰减值分别＞10HU 至 20HU、21-30HU 和＞30HU 时，相对增强比的敏感性分别为 100%（58 例腺瘤中 58 例；95%CI：94，100）、83%（52 例腺瘤中 52 例；95%CI：71，91）和 30%（10 例腺瘤中 3 例；95%CI：7，65）。结论 在单能量 CT 扫描仪的平扫和门静脉期 CT 扫描中，测量相对增强比的截断值＞210%，可准确区分脂质缺乏性肾上腺腺瘤与非腺瘤，尤其对于平扫衰减值为 10-30HU 的病变。
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