Characterization of Incidental Renal Mass With Dual-Energy CT: Diagnostic Accuracy of Effective Atomic Number Maps for Discriminating Nonenhancing Cysts From Enhancing Masses
Characterization of Incidental Renal Mass With Dual-Energy CT: Diagnostic Accuracy of Effective Atomic Number Maps for Discriminating Nonenhancing Cysts From Enhancing Masses
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DOI：
10.2214/ajr.16.17325
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发表时间：
2017-10-01
影响因子：
5
通讯作者：
Morgan, Desiree E.
中科院分区：
文献类型：
--
作者：
Mileto, Achille;Allen, Brian C.;Morgan, Desiree E.
客观的。本研究的目的是评估从双能对比增强数据重建的有效原子序数图的诊断准确性，以区分非增强性肾囊肿和增强性肿块。材料和方法。 206 名患者（128 名男性，78 名女性；平均年龄 64 岁）在两家不同的医院接受了 CT 肾脏肿块方案（单能非增强和双能对比增强肾造影成像）。对于每组患者，两名盲法独立观察者根据对比增强双能数据对有效原子序数图进行测量。参考标准是对未增强图像和肾造影图像进行的肾脏质量评估，并通过影像学和医疗记录进行证实。通过ROC分析评估有效原子序数图的诊断准确性。结果。在非增强和增强质量之间观察到平均有效原子序数 (Z(eff)) 的显着差异（A 组，8.19 vs 9.59 Z(eff)；B 组，8.05 vs 9.19 Z(eff)；组合组，8.13 vs 9.37 Z(eff)）（p < 0.0001）。有效原子序数值为 8.36 Zeff 是最佳阈值，AUC 为 0.92 (95% CI, 0.89-0.94)，敏感性为 90.8% (158/174 [95% CI, 85.5-94.7%])，特异性为 85.2% (445/522 [95% CI, 81.9-88.2%]），总体诊断准确度为 86.6%（603/696 [95% CI，83.9-89.1%]）。结论。非增强肾囊肿，包括高衰减囊肿，可以在由双能对比增强 CT 数据生成的有效原子序数图上与增强质量区分开来。当没有用于全面评估肾脏肿块的 CT 方案时，该技术可能具有临床用途。
OBJECTIVE. The purpose of this study was to assess the diagnostic accuracy of effective atomic number maps reconstructed from dual-energy contrast-enhanced data for discriminating between nonenhancing renal cysts and enhancing masses.MATERIALS AND METHODS. Two hundred six patients (128 men, 78 women; mean age, 64 years) underwent a CT renal mass protocol (single-energy unenhanced and dual-energy contrast-enhanced nephrographic imaging) at two different hospitals. For each set of patients, two blinded, independent observers performed measurements on effective atomic number maps from contrast-enhanced dual-energy data. Renal mass assessment on unenhanced and nephrographic images, corroborated by imaging and medical records, was the reference standard. The diagnostic accuracy of effective atomic number maps was assessed with ROC analysis.RESULTS. Significant differences in mean effective atomic numbers (Z(eff)) were observed between nonenhancing and enhancing masses (set A, 8.19 vs 9.59 Z(eff); set B, 8.05 vs 9.19 Z(eff); sets combined, 8.13 vs 9.37 Z(eff)) (p < 0.0001). An effective atomic number value of 8.36 Zeff was the optimal threshold, rendering an AUC of 0.92 (95% CI, 0.89-0.94), sensitivity of 90.8% (158/174 [95% CI, 85.5-94.7%]), specificity of 85.2% (445/522 [95% CI, 81.9-88.2%]), and overall diagnostic accuracy of 86.6% (603/696 [95% CI, 83.9-89.1%]).CONCLUSION. Nonenhancing renal cysts, including hyperattenuating cysts, can be discriminated from enhancing masses on effective atomic number maps generated from dualenergy contrast-enhanced CT data. This technique may be of clinical usefulness when a CT protocol for comprehensive assessment of renal masses is not available.