Characterization of Small Incidental Indeterminate Hypoattenuating Hepatic Lesions: Added Value of Single-Phase Contrast-Enhanced Dual-Energy CT Material Attenuation Analysis
Characterization of Small Incidental Indeterminate Hypoattenuating Hepatic Lesions: Added Value of Single-Phase Contrast-Enhanced Dual-Energy CT Material Attenuation Analysis
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DOI：
10.2214/ajr.17.19170
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发表时间：
2018-09-01
影响因子：
5
通讯作者：
Marin, Daniele
中科院分区：
文献类型：
--
作者：
Patel, Bhavik N.;Rosenberg, Michael;Marin, Daniele
客观的。本研究的目的是确定与传统的单能 CT 评估相比，单相对比增强双能 CT (DECT) 材料衰减分析是否可以改善小型（< 2.0 cm）偶然不确定的低衰减肝脏病变的表征。材料和方法。这项回顾性研究涉及 55 名患者（24 名男性和 31 名女性；平均 [+/- SD] 年龄，63.9 +/- 15.3 岁），其中有 77 个偶然的低密度肝脏病变（59 个良性病变和 18 个恶性病变），测量范围为 0.5-2.0 cm，这些患者接受了单相增强腹部 DECT 治疗疼痛。对于每个病变，使用混合的 120 kVp 等效图像和对比度图图像获得衰减测量值。 DECT 材料衰减图像用于碘定量。使用平滑引导生成能够最好地区分良性病变和恶性病变的最佳病变衰减和碘浓度阈值。使用 Wilcox 秩和检验比较优化阈值的诊断准确性。结果。当使用混合 120-kVp 和对比图图像时，最佳区分良性和恶性病变的最佳平均（+/- 标准误差）衰减阈值分别为 50.2 +/- 5.2 HU 和 11.5 +/- 2.0 HU。良性病变 (0.6 +/- 0.4 mg I/mL) 和恶性病变 (1.7 +/- 0.4 mg I/mL) 之间的碘浓度（以每毫升碘毫克数表示）存在显着差异 (p < 0.0001)。区分良性和恶性病变的最佳碘浓度是 1.2 +/- 0.1 mg I/mL。与混合图像（分别为 0.89、0.70 和 0.81）和对比图图像（分别为 0.94、0.64、0.77）相比，碘浓度的敏感性、特异性和 AUC 值最高（分别为 0.94、0.93 和 0.97）。结论。与传统的衰减测量相比，使用单相对比增强 DECT 材料衰减图像进行碘定量可改善小型（< 2 cm）偶然的不确定低衰减肝脏病变的表征。
OBJECTIVE. The objective of this study is to determine whether single-phase contrast-enhanced dual-energy CT (DECT) material attenuation analysis improves the characterization of small (< 2.0 cm) incidental indeterminate hypoattenuating hepatic lesions, compared with conventional single-energy CT evaluation.MATERIALS AND METHODS. This retrospective study involved 55 patients (24 men and 31 women; mean [+/- SD] age, 63.9 +/- 15.3 years) with 77 incidental hypoattenuating hepatic lesions (59 benign and 18 malignant lesions) measuring 0.5-2.0 cm who underwent single-phase contrast-enhanced DECT of the abdomen for pain. For each lesion, attenuation measurements were obtained using blended 120-kVp-equivalent images and contrast map images. DECT material attenuation images were used for iodine quantification. Optimal lesion attenuation and iodine concentration threshold values that best distinguished benign lesions from malignant lesions were generated using smooth bootstrapping. The diagnostic accuracy of the optimized thresholds was compared using the Wilcox rank sum test.RESULTS. The optimal mean (+/- standard error) attenuation threshold values that best differentiated benign and malignant lesions were 50.2 +/- 5.2 HU and 11.5 +/- 2.0 HU when blended 120-kVp and contrast map images, respectively, were used. The iodine concentration (expressed as milligrams of iodine per milliliter) differed significantly (p < 0.0001) between benign lesions (0.6 +/- 0.4 mg I/mL) and malignant lesions (1.7 +/- 0.4 mg I/mL). The optimal iodine concentration that best distinguished between benign and malignant lesions was 1.2 +/- 0.1 mg I/mL. The sensitivity, specificity, and AUC value were highest for iodine concentration (0.94, 0.93, and 0.97, respectively), compared with blended images (0.89, 0.70, and 0.81, respectively) and contrast map images (0.94, 0.64, 0.77, respectively).CONCLUSION. Iodine quantification performed using single-phase contrast-enhanced DECT material attenuation images improves the characterization of small (< 2 cm) incidental indeterminate hypoattenuating hepatic lesions, compared with conventional attenuation measurements.