Bai Xin, Xu Lili, Zhang Xiaoxiao, Zheng Huimin, Zhang Hong, Zhang Yan, Zhang Jiahui, Chen Li, Peng Qianyu, Guo Erjia, Zhang Gumuyang, Lu Lin, Jin Zhengyu, Sun Hao
Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Department of Radiology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China.
Abdom Radiol (NY). 2024 Oct 19. doi: 10.1007/s00261-024-04642-9.
To explore the potential of CT quantitative parameters in differentiating adrenal lipid-poor adenoma (LPA) from nodular hyperplasia and evaluate diagnostic performance.
Patients with LPA or nodular hyperplasia who underwent contrast-enhanced CT before adrenalectomy were analyzed retrospectively. The study included 128 patients (83 with LPA and 45 with nodular hyperplasia). Each lesion's unenhanced attenuation, portal-venous phase attenuation (CTp), and the portal-venous phase attenuation of the abdominal aorta were evaluated. We subsequently calculated absolute enhancement [a lesion's portal-venous phase attenuation minus unenhanced attenuation (in HUs)], relative enhancement (absolute enhancement divided by unenhanced attenuation), and the relative enhancement ratio [(absolute enhancement divided by abdominal aorta's portal-venous phase attenuation) ×100%]. Lesion number and size were recorded. Volume was assessed by ITK-snap software and the ratio of lesion volume to ipsilateral adrenal volume (volume ratio) was determined. Intergroup differences were analyzed using Student's t-test and chi-squared test. Logistic regression models were developed, and receiver operating characteristic (ROC) curves were constructed to determine the area under the ROC curve (AUC), sensitivity, and specificity. The model's performance was then compared against radiologists' subjective assessments, and the inter- and intra-reader agreement values among radiologists were calculated.
Portal-venous phase attenuation, volume ratio, and lesion number were independent predictors of LPA. The logistic regression model incorporating CTp, volume ratio, and lesion number achieved an AUC of 0.835, with a sensitivity of 73.5% and a specificity of 80.0%. The radiologists' diagnostic specificity and accuracy appeared to be inferior to the model. The inter-reader agreement among radiologists ranged from 0.082 to 0.535, and the intra-reader agreement of two radiologists were 0.734 and 0.583.
The portal-venous phase CT demonstrated potential in distinguishing LPA from nodular hyperplasia. The diagnostic performance of the model integrating CTp, volume ratio, and lesion number outperformed radiologists in terms of variability and reproducibility.
探讨CT定量参数在鉴别肾上腺乏脂性腺瘤（LPA）与结节样增生中的潜力，并评估其诊断效能。
回顾性分析肾上腺切除术前行增强CT检查的LPA或结节样增生患者。本研究纳入128例患者（83例LPA患者和45例结节样增生患者）。评估每个病灶的平扫衰减值、门静脉期衰减值（CTp）以及腹主动脉的门静脉期衰减值。随后我们计算了绝对强化值[病灶门静脉期衰减值减去平扫衰减值（单位为HU）]、相对强化值（绝对强化值除以平扫衰减值）以及相对强化率[（绝对强化值除以腹主动脉门静脉期衰减值）×100%]。记录病灶数量和大小。采用ITK-snap软件评估体积，并确定病灶体积与同侧肾上腺体积之比（体积比）。采用Student t检验和卡方检验分析组间差异。建立逻辑回归模型，并构建受试者操作特征（ROC）曲线以确定ROC曲线下面积（AUC）、敏感性和特异性。然后将该模型的性能与放射科医生的主观评估进行比较，并计算放射科医生之间的阅片者间一致性值和阅片者内一致性值。
门静脉期衰减值、体积比和病灶数量是LPA的独立预测因素。纳入CTp、体积比和病灶数量的逻辑回归模型的AUC为0.835，敏感性为73.5%，特异性为80.0%。放射科医生的诊断特异性和准确性似乎低于该模型。放射科医生之间的阅片者间一致性范围为0.082至0.535，两名放射科医生的阅片者内一致性分别为0.734和0.583。
门静脉期CT在鉴别LPA与结节样增生方面显示出潜力。整合CTp、体积比和病灶数量的模型在变异性和可重复性方面的诊断性能优于放射科医生。
