Bai Xin, Lu Lin, Tong Anli, Deng Jianhua, Xu Lili, Zhang Xiaoxiao, Zhang Jiahui, Chen Li, Peng Qianyu, Guo Erjia, Wu Yongfei, Wang Yun, Xu Kai, Zhang Chao, Zhao Xi, Jin Zhengyu, Zhang Gumuyang, 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 Endocrinology, 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.
Eur Radiol Exp. 2025 Aug 29;9(1):82. doi: 10.1186/s41747-025-00621-x.
The value of virtual noncontrast (VNC) images from photon-counting computed tomography (PCCT) for evaluating adrenal lesions and diagnosing adrenal adenomas remains to be clarified.
Participants with adrenal masses who underwent unenhanced and portal venous phase PCCT were prospectively included. Portal-venous phase images were reconstructed using conventional VNC (VNC) and PureCalcium VNC (VNC). We measured two-dimensional (2D) attenuation of adrenal masses at their largest slice on true noncontrast (TNC), VNC, and VNC images. Three-dimensional (3D) attenuation and radiomic features of adrenal masses were semiautomatically extracted. These parameters were statistically compared, and diagnostic performance for adenomas was evaluated.
The study included 54 participants (27 females, mean age 45.3 years) with 68 adrenal lesions. Attenuation values on VNC were higher than those on TNC. TNC, VNC, and VNC attenuation values did not differ between 2D and 3D measurements. The intraclass correlation coefficients of first-order, shape, and texture features between TNC and VNC were 0.671, 0.822, and 0.616, respectively. The sensitivity and specificity of the proposed thresholds (VNC 25 HU, VNC 20 HU) were higher than those of the previously established threshold of 10 HU in diagnosing adenomas. There was no significant difference between VNC and VNC in diagnosing adenomas (area under the receiver operating characteristic curve: 0.841 versus 0.838, p = 0.873).
VNC algorithms from PCCT overestimated CT attenuation of adrenal lesions. Higher thresholds showed better diagnostic performance for discriminating adrenal adenomas from non-adenomas than the established 10 HU.
We investigated the application of VNC images from PCCT in adrenal disease. On VNC images, higher thresholds, superior to the accepted 10 HU, are needed for discriminating adenomas from non-adenomas, reducing the need for secondary examinations.
This study investigated the value of VNC images from PCCT in adrenal lesions. VNC reconstruction overestimated the CT attenuation of adrenal lesions. Higher thresholds on VNC images were superior to the accepted 10 HU for differentiating adenomas from non-adenomas.
光子计数计算机断层扫描（PCCT）的虚拟平扫（VNC）图像在评估肾上腺病变和诊断肾上腺腺瘤方面的价值尚待明确。
前瞻性纳入接受了平扫和门静脉期PCCT检查的肾上腺肿块患者。使用传统VNC（VNC）和纯钙VNC（VNC）重建门静脉期图像。我们在真实平扫（TNC）、VNC和VNC图像上测量了肾上腺肿块最大层面的二维（2D）衰减值。半自动提取肾上腺肿块的三维（3D）衰减值和影像组学特征。对这些参数进行统计学比较，并评估腺瘤的诊断性能。
该研究纳入了54名参与者（27名女性，平均年龄45.3岁），共68个肾上腺病变。VNC上的衰减值高于TNC上的衰减值。TNC、VNC和VNC的衰减值在2D和3D测量之间没有差异。TNC和VNC之间一阶、形状和纹理特征的组内相关系数分别为0.671、0.822和0.616。在诊断腺瘤时，所提出的阈值（VNC 25 HU，VNC 20 HU）的敏感性和特异性高于先前确定的10 HU阈值。VNC和VNC在诊断腺瘤方面没有显著差异（受试者操作特征曲线下面积：0.841对0.838，p = 0.873）。
PCCT的VNC算法高估了肾上腺病变的CT衰减值。较高的阈值在区分肾上腺腺瘤与非腺瘤方面比既定的10 HU显示出更好的诊断性能。
我们研究了PCCT的VNC图像在肾上腺疾病中的应用。在VNC图像上，需要高于公认的10 HU的阈值来区分腺瘤与非腺瘤，从而减少二次检查的必要性。
本研究调查了PCCT的VNC图像在肾上腺病变中的价值。VNC重建高估了肾上腺病变的CT衰减值。VNC图像上较高的阈值在区分腺瘤与非腺瘤方面优于公认的10 HU。
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