Characterization of Incidental Renal Mass With Dual-Energy CT: Diagnostic Accuracy of Effective Atomic Number Maps for Discriminating Nonenhancing Cysts From Enhancing Masses

Mileto, Achille; Allen, Brian C.; Pietryga, Jason A.; Farjat, Alfredo E.; Zarzour, Jessica G.; Bellini, Davide; Ebner, Lukas; Morgan, Desiree E.

doi:10.2214/ajr.16.17325

Cited by 68 publications

(38 citation statements)

References 35 publications

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“…In regards to Z eff , Mileto and colleagues 33 reported an optimal threshold of Z eff as 8.36 to discriminate enhancing renal cell carcinoma from non-enhancing cysts, including hyperattenuating cysts, with 91% sensitivity, 85.2% specificity, and 87% diagnostic accuracy 33 In the present study, Z eff !8.16 predicted malignancy with 85% sensitivity, 73% specificity, and 0.78 AUC.…”

Section: Discussionmentioning

confidence: 49%

Does dual-energy CT differentiate benign and malignant ovarian tumours?

et al. 2020

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Section: Discussionmentioning

confidence: 49%

Does dual-energy CT differentiate benign and malignant ovarian tumours?

et al. 2020

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“…This emphasizes the importance of correct patient positioning for the dual-source DE CT systems. The negative effect of larger patient size on attenuation values is known (13,29) and is related to the beam-hardening and photon-starvation phenomena.…”

Section: Discussionmentioning

confidence: 99%

“…Our final single-center retrospective study population was composed of 293 patients. The study patients are part of a large retrospective DE CT database, of which 85 patients have been reported in previously published studies (12)(13)(14) from our institution. In patients with multiple renal lesions (n = 86), up to five of the smallest lesions (1.0 cm) in each patient were included because small lesions represent the biggest challenge for characterization in clinical practice.…”

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confidence: 99%

Virtual Unenhanced Images at Dual-Energy CT: Influence on Renal Lesion Characterization

Meyer¹,

Nelson²,

Vernuccio³

et al. 2019

Radiology

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Background: Dual-energy (DE) CT allows reconstruction of virtual noncontrast (VNC) images from a single-phase contrast agentenhanced examination, potentially reducing the need for multiphasic CT to characterize renal lesions. However, data regarding diagnostic performance of VNC images for the characterization of renal lesions are limited. Purpose: To determine whether renal mass CT performed by using VNC images allows for reliable identification of renal lesions and differentiation of contrast-enhanced from unenhanced lesions, compared with unenhanced images. Materials and Methods: This is a retrospective study of 293 patients (105 women [mean age, 65 years; age range, 18-91 years] and 188 men [mean age, 66 years; age range, 23-90 years] with 379 renal lesions [craniocaudal diameter, 1.0-4.0 cm]) who underwent a single-energy unenhanced CT examination followed by a nephrographic-phase DE CT between June 2013 and October 2017 by using one of four different DE CT platforms from two vendors. VNC images were calculated by using vendor-specific algorithms. Each lesion was classified in a blinded and independent fashion by using the VNC or unenhanced image in combination with the nephrographic images. Attenuation measurements were obtained on the VNC, unenhanced, and nephrographic images. Unenhanced images and pathologic or imaging follow-up for more than 24 months served as reference standard. Results: There was strong overall agreement between VNC and unenhanced images for renal lesion characterization (Cramer V = 0.85). VNC images yielded a high diagnostic performance (area under the receiver operating characteristic curve, 0.91; 95% confidence interval: 0.86, 0.95) for facilitation of differentiation of contrast-enhanced from unenhanced renal lesions. However, there was a reduction in diagnostic performance for depicting contrast-enhanced renal lesions by using VNC compared with unenhanced images (area under the receiver operating characteristic curve, 0.91 [95% confidence interval: 0.86, 0.95] vs 0.96 [95% confidence interval: 0.93, 0.99]; P , .001). Mean absolute difference between the VNC and unenhanced attenuation was 9.2 HU 6 8.7. Conclusion: Virtual noncontrast images enabled accurate renal lesion characterization, albeit with a reduction in diagnostic performance for contrast-enhanced lesion characterization.

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“…A 10-15 HU change in attenuation can be due to incorrect placement of the region of interest, patient motion, or beam hardening from adjacent enhancing renal parenchyma (the so called "pseudoenhancement") [19]. To overcome this problem, it has been suggested to use dual-energy CT, where true unenhanced images can be replaced by virtual unenhanced images [20]. Iodine quantification and iodine-related attenuation are used to differentiate nonenhancing cysts from enhancing solid masses [20].…”

Section: Bosniak Classification System For Renal Cystsmentioning

confidence: 99%

“…To overcome this problem, it has been suggested to use dual-energy CT, where true unenhanced images can be replaced by virtual unenhanced images [20]. Iodine quantification and iodine-related attenuation are used to differentiate nonenhancing cysts from enhancing solid masses [20].…”

Section: Bosniak Classification System For Renal Cystsmentioning

confidence: 99%

CT and MR imaging of cystic renal lesions

et al. 2020

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Cystic renal lesions are a common incidental finding on routinely imaging examinations. Although a benign simple cyst is usually easy to recognize, the same is not true for complex and multifocal cystic renal lesions, whose differential diagnosis includes both neoplastic and non-neoplastic conditions. In this review, we will show a series of cases in order to provide tips to identify benign cysts and differentiate them from malignant ones.

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Characterization of Incidental Renal Mass With Dual-Energy CT: Diagnostic Accuracy of Effective Atomic Number Maps for Discriminating Nonenhancing Cysts From Enhancing Masses

Cited by 68 publications

References 35 publications

Does dual-energy CT differentiate benign and malignant ovarian tumours?

Does dual-energy CT differentiate benign and malignant ovarian tumours?

Virtual Unenhanced Images at Dual-Energy CT: Influence on Renal Lesion Characterization

CT and MR imaging of cystic renal lesions

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