Lipid-poor adenomas on unenhanced CT: does histogram analysis increase sensitivity compared with a mean attenuation threshold?

Ho, Lisa M; Paulson, Erik K; Brady, Matthew J; Wong, Terence Z; Schindera, Sebastian T (2008). Lipid-poor adenomas on unenhanced CT: does histogram analysis increase sensitivity compared with a mean attenuation threshold? AJR, American journal of roentgenology, 191(1), pp. 234-8. Leesburg, Va.: American Roentgen Ray Society 10.2214/AJR.07.3150

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OBJECTIVE: The purpose of our study was to evaluate the efficacy of CT histogram analysis for further characterization of lipid-poor adenomas on unenhanced CT. MATERIALS AND METHODS: One hundred thirty-two adrenal nodules were identified in 104 patients with lung cancer who underwent PET/CT. Sixty-five nodules were classified as lipid-rich adenomas if they had an unenhanced CT attenuation of less than or equal to 10 H. Thirty-one masses were classified as lipid-poor adenomas if they had an unenhanced CT attenuation greater than 10 H and stability for more than 1 year. Thirty-six masses were classified as lung cancer metastases if they showed rapid growth in 1 year (n = 27) or were biopsy-proven (n = 9). Histogram analysis was performed for all lesions to provide the mean attenuation value and percentage of negative pixels. RESULTS: All lipid-rich adenomas had more than 10% negative pixels; 51.6% of lipid-poor adenomas had more than 10% negative pixels and would have been classified as indeterminate nodules on the basis of mean attenuation alone. None of the metastases had more than 10% negative pixels. Using an unenhanced CT mean attenuation threshold of less than 10 H yielded a sensitivity of 68% and specificity of 100% for the diagnosis of an adenoma. Using an unenhanced CT threshold of more than 10% negative pixels yielded a sensitivity of 84% and specificity of 100% for the diagnosis of an adenoma. CONCLUSION: CT histogram analysis is superior to mean CT attenuation analysis for the evaluation of adrenal nodules and may help decrease referrals for additional imaging or biopsy.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology
UniBE Contributor:	Schindera, Sebastian Tobias
ISSN:	0361-803X
ISBN:	18562751
Publisher:	American Roentgen Ray Society
Language:	English
Submitter:	Factscience Import
Date Deposited:	04 Oct 2013 15:01
Last Modified:	05 Dec 2022 14:18
Publisher DOI:	10.2214/AJR.07.3150
PubMed ID:	18562751
Web of Science ID:	000256890200039
URI:	https://boris.unibe.ch/id/eprint/26264 (FactScience: 67971)