ArticleAbdominal radiology (New York)2025
Adrenal lesion classification revisited: validation and adjustment of dual-energy CT derived virtual unenhanced attenuation thresholds.
Article in Abdominal radiology (New York), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesDual-energy CT (DECT)-derived virtual unenhanced (VUE) images have been investigated for adrenal lesion differentiation, yet previously reported thresholds vary, hampering clinical application. We aimed to test previous VUE thresholds for adrenal lesion differentiation in a large retrospective cohort, to provide a cross-validated threshold based on our data, and to investigate the influence of underlying malignancies on differentiation accuracy.
methods290 patients with 348 adrenal lesions (169 metastases, 179 adenomas) were included. Dual-layer DECT-derived VUE thresholds from 3 previous studies were retrieved, applied to our cohort and corresponding sensitivity/specificity/accuracy was calculated. Optimal threshold based on our data were determined using ROC-analysis with five-fold cross validation. Moreover, a threshold with similar specificity to the 10 HU threshold in unenhanced images was calculated. Subgroup analysis of adrenal lesion differentiation depending on underlying malignancies was performed.
resultsThe previously suggested thresholds were 20, 22 and 29 HU, and corresponding sensitivity/specificity/accuracy was 0.61/0.92/0.76, 0.67/0.91/0.78, and 0.82/0.59/0.71, respectively. The threshold determined from our cohort was 24.7 HU, yielding a sensitivity/specificity/accuracy of 0.76/0.81/0.79. Differentiation in disease-specific subgroups showed similar sensitivity/specificity/accuracy (Melanoma:0.78/0.84/0.79; Lung cancer:0.78/0.8/0.78; RCC:0.78/1/0.79). The VUE threshold to achieve a 0.98 specificity similar to the unenhanced 10 HU cutoff was 17.3 HU, yielding a sensitivity of 0.49.
conclusionPrevious VUE attenuation thresholds showed a varying accuracy for differentiation between adenomas and metastases. A cross-validated VUE threshold of 24.7 HU yielded a mean accuracy of 0.79, whereas a threshold of 17.3 HU was best for achieving comparable specificity as reported for the 10 HU threshold in unenhanced images.
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