Xie Weili, Huang Zhongren, Kuang Hongmei, Li Xiaoxing, Zhang Rixin, Zeng Wei, Jin Cheng, Zhong Junyuan, Peng Jidong, Cheng Weiling, Zhou Fuqing
Department of Radiology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
Clinical Research Center for Medical Imaging in Jiangxi Province, Nanchang, China.
Insights Imaging. 2025 Jan 10;16(1):12. doi: 10.1186/s13244-024-01885-4.
To evaluate the value of contrast-enhanced CT in diagnosing ultrasonography-unspecified adnexal torsion (AT).
Surgically confirmed patients with painful pelvic masses (n = 165) were retrospectively collected from two institutes. Two senior radiologists independently reviewed the CT images and determined the Hounsfield unit difference between non-contrast vs portal venous phases (ΔHU) in both derivation and validation samples. The cutoff value, sensitivity, specificity, predictivity, and reproducibility of the ΔHU and other visually assessed CT signs were analyzed and compared using the receiver-operating characteristic curve, multivariable regression, and inter-rater agreement assays, respectively.
Women with twisted (n = 73 [47 ± 19 years]) or untwisted (n = 92 [40 ± 15 years]) adnexal lesions were reviewed. The ΔHU ≤ 17.5 HU (AUC: 0.91 [95% CI: 0.86, 0.96]; sensitivity: 95% [95% CI: 87, 98]; and specificity: 88% [95% CI: 80, 94]) was the independent predictor of AT (OR: 137 [95% CI: 39, 481], p < 0.001). After training in ΔHU measurement, the agreement between two junior residents and the consensus increased from fair (resident-1: 0.29 [95% CI: 0.17, 0.41]; resident-2: 0.24 [95% CI: 0.1, 0.39]) to substantial (resident-1: 0.75 [95% CI: 0.65, 0.85]; resident-2: 0.72 [95% CI: 0.62, 0.83]). The post-training diagnostic accuracy (both residents: 81% [95% CI: 74, 87]) was higher than the pre-training accuracy (resident-1: 67% [95% CI: 59, 74], p = 0.007; resident-2: 66% [95% CI: 58, 73], p = 0.002).
The sign of ΔHU ≤ 17.5 HU in contrast-enhanced CT can be used to predict the ultrasonography-unspecified AT.
The decreased attenuation difference between non-contrast vs portal venous phases, a quantitative measurement-based CT sign, highlights the value of using contrast-enhanced CT as a second-line imaging approach after an equivocal ultrasonographic examination to diagnose AT in emergency settings.
The value of contrast-enhanced CT in diagnosing ultrasonography-unspecified AT is underestimated. The ΔHU ≤ 17.5 HU is the only predictor to diagnose the ultrasonography-unspecified AT. Contrast-enhanced CT can be used as a second-line imaging approach after an equivocal ultrasonographic examination.
评估增强CT在诊断超声检查未明确的附件扭转（AT）中的价值。
回顾性收集了两家机构手术确诊的盆腔疼痛性肿块患者（n = 165）。两名资深放射科医生独立审查CT图像，并确定推导样本和验证样本中非增强期与门静脉期之间的亨氏单位差异（ΔHU）。分别使用受试者工作特征曲线、多变量回归和评分者间一致性分析来分析和比较ΔHU及其他视觉评估的CT征象的截断值、敏感性、特异性、预测性和可重复性。
对患有扭转（n = 73 [47±19岁]）或未扭转（n = 92 [40±15岁]）附件病变的女性进行了评估。ΔHU≤17.5 HU（AUC：0.91 [95% CI：0.86，0.96]；敏感性：95% [95% CI：87，98]；特异性：88% [95% CI：80，94]）是AT的独立预测指标（OR：137 [95% CI：39，481]，p < 0.001）。在接受ΔHU测量培训后，两名初级住院医师之间的一致性以及与共识的一致性从一般（住院医师1：0.29 [95% CI：0.17，0.41]；住院医师2：0.24 [95% CI：0.1，0.39]）提高到了高度一致（住院医师1：0.75 [95% CI：0.65，0.85]；住院医师2：0.72 [95% CI：0.62，0.83]）。培训后的诊断准确性（两名住院医师均为：81% [95% CI：74，87]）高于培训前的准确性（住院医师1：67% [95% CI：59，74]，p = 0.007；住院医师2：66% [95% CI：58，73]，p = 0.002）。
增强CT中ΔHU≤17.5 HU的征象可用于预测超声检查未明确的AT。
非增强期与门静脉期之间衰减差异的降低，这一基于定量测量的CT征象，凸显了在超声检查不明确后，将增强CT作为二线成像方法在急诊情况下诊断AT的价值。
增强CT在诊断超声检查未明确的AT中的价值被低估。ΔHU≤17.5 HU是诊断超声检查未明确的AT的唯一预测指标。在超声检查不明确后，增强CT可作为二线成像方法。
