Distinguishing adrenal adenomas from nonadenomas: combined use of diagnostic parameters of unenhanced and short 5-minute dynamic enhanced CT protocol.

Abstract:

PURPOSE:To retrospectively examine the diagnostic values of individual parameters obtained from unenhanced and 35-second and 5-minute contrast material-enhanced (enhanced) computed tomography (CT) in distinguishing adenomas, particularly lipid-poor adenomas, from nonadenomas and to determine the best diagnostic method by using these parameters. MATERIALS AND METHODS:This retrospective study had institutional review board approval; the need for informed consent was waived. The study population consisted of 61 patients (20 men and 41 women; mean age, 58 years) with 68 adrenal masses (53 adenomas and 15 nonadenomas). In each patient, unenhanced CT was followed by 35-second and 5-minute enhanced CT. Adenomas were classified as 30 lipid-rich (10 HU) adenomas by using unenhanced attenuation. The diagnostic parameters were tumor size, unenhanced attenuation, 35-second and 5-minute enhanced attenuation, wash-in and washout attenuation, percentage enhancement washout ratio (PEW), and relative PEW (RPEW). The sensitivity, specificity, and accuracy for diagnosing adenomas were calculated by using a threshold level of each parameter determined by the least sum of false-positive and false-negative cases and a combination of the threshold levels with 100% specificity. RESULTS:The best results were obtained by using a combination of the threshold levels with 100% (15 of 15) specificity (presence of at least one of the following criteria for diagnosing adenomas: unenhanced attenuation of or=45%, and RPEW of >or=31%). Sensitivity was 94% (50 of 53) or 87% (20 of 23) and accuracy was 96% (65 of 68) or 92% (35 of 38) for diagnosing total adrenal adenomas or lipid-poor adenomas, respectively. CONCLUSION:Combining the diagnostic parameters of the CT protocol can yield diagnostic results comparable to those with previously reported longer dynamic enhanced CT protocols.

journal_name

Radiology

journal_title

Radiology

authors

Kamiyama T,Fukukura Y,Yoneyama T,Takumi K,Nakajo M

doi

10.1148/radiol.2502080302

subject

Has Abstract

pub_date

2009-02-01 00:00:00

pages

474-81

issue

2

eissn

0033-8419

issn

1527-1315

pii

2502080302

journal_volume

250

pub_type

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