Midwest Radiology, 2355 Highway 36 West, Roseville, MN, USA.
Department of Radiology, Medical University of South Carolina, Charleston, SC, USA.
Abdom Radiol (NY). 2024 Jun;49(6):2049-2059. doi: 10.1007/s00261-024-04251-6. Epub 2024 Mar 22.
To evaluate quantitative and qualitative spermatic cord CT abnormalities and presence of unilateral or bilateral symptomatic scrotal pathology (SSP) at ultrasound.
This retrospective study included 122 male patients (mean age 47.8 years) undergoing scrotal ultrasound within 24 h of contrast-enhanced CT (n = 85), non-contrast CT (NECT, n = 32) or CT-Urogram (n = 5). CECT quantitative analysis assessed differential cord enhancement using maximum Hounsfield unit measurements. Three fellowship trained body radiologists independently assessed qualitative cord abnormalities for both CECT and NECT. Qualitative and quantitative findings were compared with the presence of SSP. Reader performance, interobserver agreement and reader confidence were assessed for NECT and CECT. Quantitative cutoff points were identified which maximized accuracy, specificity, negative predictive value, and other measures.
SSP was present in 36/122 patients (29.5%). Positive cases were unilateral in 30 (83.3%) and bilateral in 6 (16.6%). At quantitative assessment, 25% differential cord enhancement had the highest diagnostic accuracy (88.9%), with 90.5% positive predictive value, 88.4% negative predictive value, 96.8% specificity, and 70.4% sensitivity. At qualitative evaluation, CECT reader performance was excellent (aggregate AUC = 0.86; P < .001); NECT was poorly discriminatory, although remained significant (aggregate AUC = 0.67; P = .002). Readers had significantly higher confidence levels with CECT (P < .001). Qualitative inter-observer agreement was high for both CECT and NECT (ICC = 0.981 and 0.963, respectively).
Simple quantitative assessment of differential cord enhancement is highly accurate and specific for SSP at CECT. Qualitative abnormalities at CECT and NECT are also both predictors of SSP, however, CECT significantly out-performs non-contrast exams.
评估精索 CT 异常的定量和定性表现，以及超声检查中单侧或双侧症状性阴囊疾病（SSP）的存在情况。
本回顾性研究纳入了 122 名男性患者（平均年龄 47.8 岁），他们在接受对比增强 CT（n=85）、非对比 CT（NECT，n=32）或 CT 尿路造影（n=5）后 24 小时内行阴囊超声检查。CECT 定量分析使用最大 Hounsfield 单位测量值评估精索的差异增强。三位接受过 fellowship培训的体部放射科医生独立评估 CECT 和 NECT 的精索定性异常。比较定性和定量结果与 SSP 的存在情况。评估 NECT 和 CECT 的观察者性能、观察者间一致性和观察者信心。确定了最大化准确性、特异性、阴性预测值和其他指标的定量截断值。
122 例患者中，36 例（29.5%）存在 SSP。阳性病例中，单侧 30 例（83.3%），双侧 6 例（16.6%）。在定量评估中，25%的精索差异增强具有最高的诊断准确性（88.9%），阳性预测值为 90.5%，阴性预测值为 88.4%，特异性为 96.8%，敏感性为 70.4%。在定性评估中，CECT 读者的表现非常出色（综合 AUC=0.86；P<0.001）；NECT 虽然具有统计学意义（综合 AUC=0.67；P=0.002），但区分度较差。CECT 读者的信心水平明显更高（P<0.001）。CECT 和 NECT 的定性观察者间一致性均很高（ICC 分别为 0.981 和 0.963）。
CECT 对精索差异增强的简单定量评估对 SSP 具有高度的准确性和特异性。CECT 和 NECT 的定性异常均为 SSP 的预测指标，但 CECT 明显优于非对比检查。
