Evaluate the efficacy of minimum attenuation value in differentiation of adrenal adenomas from nonadenomas on unenhanced CT

Zhu, Miaoping; Qu, Jiali; Han, Zhijiang

doi:10.1016/j.clinimag.2015.09.006

Cited by 5 publications

(6 citation statements)

References 10 publications

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“…The results showed that the minimum attenuation value of each selected nodule was negative (ranging from −59.3 to −10.3 HU), suggesting that the nodule contained fatty components, and the mean attenuation value ranged from −17.2 to 12.0 HU. It has been reported that the mean and minimum attenuation values can be used to identify adenomas, and our results are consistent with these reports (31,32). Our analysis is limited to unenhanced CT images because we aimed to determine whether this analysis based on unenhanced CT images alone was adequate to make an acceptable distinction.…”

Section: Discussionsupporting

confidence: 87%

A Clinical-Radiomic Nomogram Based on Unenhanced Computed Tomography for Predicting the Risk of Aldosterone-Producing Adenoma

Zhang

Wang

et al. 2021

Front. Oncol.

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PurposeTo develop and validate a clinical-radiomic nomogram for the preoperative prediction of the aldosterone-producing adenoma (APA) risk in patients with unilateral adrenal adenoma.Patients and MethodsNinety consecutive primary aldosteronism (PA) patients with unilateral adrenal adenoma who underwent adrenal venous sampling (AVS) were randomly separated into training (n = 62) and validation cohorts (n = 28) (7:3 ratio) by a computer algorithm. Data were collected from October 2017 to June 2020. The prediction model was developed in the training cohort. Radiomic features were extracted from unenhanced computed tomography (CT) images of unilateral adrenal adenoma. The least absolute shrinkage and selection operator (LASSO) regression model was used to reduce data dimensions, select features, and establish a radiomic signature. Multivariable logistic regression analysis was used for the predictive model development, the radiomic signature and clinical risk factors integration, and the model was displayed as a clinical-radiomic nomogram. The nomogram performance was evaluated by its calibration, discrimination, and clinical practicability. Internal validation was performed.ResultsSix potential predictors were selected from 358 texture features by using the LASSO regression model. These features were included in the Radscore. The predictors included in the individualized prediction nomogram were the Radscore, age, sex, serum potassium level, and aldosterone-to-renin ratio (ARR). The model showed good discrimination, with an area under the receiver operating characteristic curve (AUC) of 0.900 [95% confidence interval (CI), 0.807 to 0.993], and good calibration. The nomogram still showed good discrimination [AUC, 0.912 (95% CI, 0.761 to 1.000)] and good calibration in the validation cohort. Decision curve analysis presented that the nomogram was useful in clinical practice.ConclusionsA clinical-radiomic nomogram was constructed by integrating a radiomic signature and clinical factors. The nomogram facilitated accurate prediction of the probability of APA in patients with unilateral adrenal nodules and could be helpful for clinical decision making.

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Section: Discussionsupporting

confidence: 87%

A Clinical-Radiomic Nomogram Based on Unenhanced Computed Tomography for Predicting the Risk of Aldosterone-Producing Adenoma

Zhang

Wang

et al. 2021

Front. Oncol.

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“…The smaller the AV mean and the larger distribution areas, the greater the incidence of adenoma. We previously used AV mean ≤ 0 HU as the threshold for diagnosing adenoma, with a sensitivity of 90.1% and a specificity of 96.8% ( 11 ).…”

Section: Discussionmentioning

confidence: 99%

“…The software automatically obtained the percentage of negative pixels in ROI. In the present study, AV mean and AV min were measured by a 4-point method, that is, the maximum transverse diameter and the longitudinal diameter were made on the maximum axial plane of the tumor to obtain the intersection point, the midpoint from the intersection point to the edge of the tumor was taken as the measurement point, and the ROI was 19 ~ 24 mm² ( 11 ) ( Figures 2 – 5 ). When each ROI was selecting, it was attempted to avoid necrotic, hemorrhagic, and calcified areas.…”

Section: Methodsmentioning

confidence: 99%

“…However, the acquisition of CTH is complicated and requires a special post-processing workstation, which is difficult to be popularized and applied in imaging diagnostic terminals. In 2015, we, for the first time, used AV mean ≤ 0 HU in the differential diagnosis of adrenal adenoma and non-adenoma ( 11 ), and the results showed that the sensitivity and accuracy of AV mean ≤ 0 HU were significantly higher than those of AV mean ≤ 10 HU, and the specificity was slightly lower than that of AV mean ≤ 10 HU. It is noteworthy that if AV mean , CTH, and AV min can be combined to achieve complementary advantages, it may improve the differential diagnosis of adrenal adenoma by CT plain to a certain extent, avoid unnecessary radiation exposure and adverse reactions of contrast agents, and reduce the patient’s visiting time and medical expenses.…”

Section: Introductionmentioning

confidence: 99%

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Differential diagnostic value of plain CT scan in adrenal adenoma and non-adenoma: A two-center control study of mean attenuation value, minimum attenuation value, and CT histogram

Han

Wu²,

Wei³

et al. 2022

Front. Endocrinol.

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ObjectivesTo investigate the value of mean attenuation value (AVmean), minimum attenuation value (AVmin), and CT histogram (CTH) for the differential diagnosis of adrenal adenoma and non-adenoma in two medical centers.MethodsThe plain CT data of 403 cases of adrenal adenoma and 141 cases of non-adenoma in center A were retrospectively analyzed, and compared with data of 86 cases of adenoma and 71 cases of non-adenoma in center B. All cases were confirmed by pathology or clinical follow-up. The diagnostic efficacy of AVmean ≤ 10 Hounsfield units (HU), AVmin ≤ 0 HU, and CTH negative pixels ≥ 10% for adrenal adenoma, and AVmin and CTH for adenoma with AVmean > 10Hu were compared between the two medical centers.ResultsIn medical centers A and B, the AUC of AVmean for the differential diagnosis of adenoma and non-adenoma was 0.956 and 0.956, respectively, and the corresponding sensitivity, specificity, and accuracy were, 0.591 and 0.663, 1.000 and 1.000, 0.697, and 0.815, respectively, when the threshold was ≤ 10 HU. The AUC of AVmin was 0.941 and 0.958, respectively, and the corresponding sensitivity, specificity, and accuracy were 0.869 and 0.826, 0.986, and 0.972, 0.899, and 0.892, respectively, when the threshold was ≤ 0 HU. The AUC of CTH negative pixels was 0.948 and 0.952, respectively, and the corresponding sensitivity, specificity, and accuracy were 0.759 and 0.674, 1.000 and 1.000, 0.822, and 0.822, respectively, when the threshold was ≥ 10%. Among adenoma with AVmean >10 HU, the best threshold of AVmin in center A and center B were -0.250HU and 2.375HU, and the corresponding AUC, sensitivity and specificity were 0.858 and 0.846, 0.691 and 0.586, 0.986 and 0.958; the best threshold of CTH in center A and center B were 0.895% and 0.775%, and the corresponding AUC, sensitivity and specificity were 0.873 and 0.822, 0.818 and 0.724, 0.837 and 0.915.ConclusionAVmean, AVmin, and CTH are all important parameters for differentiating adrenal adenoma from non-adenoma. Even for adenomas with AVmean > 10 HU, AVmin and CTH still had high diagnostic efficiency. The three parameters are complementary, assisting clinicians to develop personalized treatments.

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“…The sensitivity analysis in a subset of 14 studies reporting on 828 pheochromocytomas on which CT was performed after 2000 demonstrated a pooled proportion of unenhanced attenuation values greater than 10 HU of 0.990 (95% CI, 0.982-0.996). 15,21,27,28,38,39,[41][42][43]48,[50][51][52][53] The second sensitivity analysis included 6 studies that reported 120 pheochromocytomas from true adrenal incidentaloma populations. 21,35,[40][41][42]53 The pooled proportion in this analysis was 0.989 (95% CI, 0.963-0.999).…”

Section: Diagnostic Accuracymentioning

confidence: 99%

Diagnostic Accuracy of Computed Tomography to Exclude Pheochromocytoma: A Systematic Review, Meta-analysis, and Cost Analysis

Buitenwerf

Berends

Asselt

et al. 2019

Mayo Clinic Proceedings

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Evaluate the efficacy of minimum attenuation value in differentiation of adrenal adenomas from nonadenomas on unenhanced CT

Cited by 5 publications

References 10 publications

A Clinical-Radiomic Nomogram Based on Unenhanced Computed Tomography for Predicting the Risk of Aldosterone-Producing Adenoma

A Clinical-Radiomic Nomogram Based on Unenhanced Computed Tomography for Predicting the Risk of Aldosterone-Producing Adenoma

Differential diagnostic value of plain CT scan in adrenal adenoma and non-adenoma: A two-center control study of mean attenuation value, minimum attenuation value, and CT histogram

Diagnostic Accuracy of Computed Tomography to Exclude Pheochromocytoma: A Systematic Review, Meta-analysis, and Cost Analysis

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