Distinguishing benign from malignant adrenal masses: Multi-detector row CT protocol with 10-minute delay
Distinguishing benign from malignant adrenal masses: Multi-detector row CT protocol with 10-minute delay
复制标题
DOI：
10.1148/radiol.2382041514
复制
发表时间：
2006-02-01
期刊：
影响因子：
19.7
通讯作者：
Boland, GW
中科院分区：
文献类型：
--
作者：
Blake, MA;Kalra, MK;Boland, GW
目的：回顾性评价对比剂前衰减、相对洗脱百分比（RPW）和绝对洗脱百分比（APW）在多探测器行计算机断层扫描（CT）中区分良性和恶性肾上腺肿块的准确性。材料和方法：本符合HIPAA的回顾性研究获得了机构审查委员会的批准;无需知情同意。对99名患者（51名男性，48名女性;年龄范围，37-86岁）的122个肾上腺肿块进行了评价，这些患者根据研究方案进行了CT检查，并进行了病理诊断或随访成像。在给予120 mL静脉造影剂之前获得非增强图像，扫描延迟75秒。10分钟后获得延迟图像。计算RPW和APW。进行受试者工作特征（ROC）分析以比较平均衰减以及RPW和APW。首先排除嗜铬细胞瘤、骨髓脂肪瘤和囊肿进行分析。确定了特异性为良性或恶性的增强前衰减标准，然后对整个nonpheochromocytoma组的结果进行了ROC分析。结果：通过使用RPW为37.5%，不包括囊肿和骨髓脂肪瘤，所有恶性病变检测的敏感性为100%（17 1.7病变）和特异性为95%（90 95病变）。对比前衰减、RPW和APW的二项式ROC曲线下面积（A（z））值分别为0.912、0.985和0.892。对比剂前衰减小于0或大于43 HU分别表示良性和恶性实体。将这些标准纳入APW分析中，对于52.0%的阈值洗脱值，灵敏度为100%（17/17处病变），特异性为98%（93/95处病变）。这种衰减校正的APW产生最大的A。值（即0.988）。结合所有可用的信息，从协议产生了100%的敏感性（17 17病变）和98%的特异性（98 100病变）区分良性与恶性mass.Conclusion：对比剂前衰减小于0 HU superertified的洗脱配置文件中的一个单独的肾上腺肿块的评价。非钙化、非出血性肾上腺病变，增强后密度大于43 HU，应考虑为恶性肿瘤。(c)RSNA，2005年
Purpose: To retrospectively evaluate the accuracy of precontrast attenuation, relative percentage washout (RPW), and absolute percentage washout (APW) in distinguishing benign from malignant adrenal masses at multi- detector row computed tomography (CT).Materials and Methods: This HIPAA-compliant retrospective study had institutional review board approval; the need for informed consent was waived. One hundred twenty-two adrenal masses were evaluated in 99 patients (51 men, 48 women; age range, 37-86 years) who had undergone CT performed according to the study protocol and who either were given a pathologic diagnosis or underwent follow-up imaging. Unenhanced images were obtained before administration of 120 mL of an intravenous contrast agent with a 75-second scan delay. Delayed images were obtained after 10 minutes. RPW and APW were computed. Receiver operating characteristic (ROC) analysis was performed to compare mean attenuation and both RPW and APW. Analysis was first performed with the exclusion of pheochromocytomas, myelolipomas, and cysts. Precontrast attenuation criteria specific for benignity or malignancy were determined, and ROC analysis of results for the entire nonpheochromocytoma group was then performed.Results: By using an RPW of 37.5% and excluding cysts and myelolipomas, all malignant lesions were detected with a sensitivity of 100% (17 of 1.7 lesions) and a specificity of 95% (90 of 95 lesions). Area under the binomial ROC curve (A(z)) values were 0.912, 0.985, and 0.892 for precontrast attenuation, RPW, and APW, respectively. Precontrast attenuation, of less than 0 or more than 43 HU indicated benign and malignant entities, respectively. Incorporation of these criteria into the APW analysis yielded a sensitivity of 100% (17 of 17 lesions) and a specificity of 98% (93 of 95 lesions) for a threshold washout value of 52.0%. This attenuation-corrected APW generated the greatest A. value (ie, 0.988). Combining all the information available from the protocol yielded a sensitivity of 100% (17 of 17 lesions) and a specificity of 98% (98 of 100 lesions) for differentiating benign from malignant masses.Conclusion: Precontrast attenuation of less than 0 HU supercedes the washout profile in the evaluation of an individual adrenal mass. Noncalcified, nonhemorrhagic adrenal lesions with precontrast attenuation of more than 43 HU should be considered suspicious for malignancy. (c) RSNA, 2005