Utility of T2-weighted MRI to Differentiate Adrenal Metastases from Lipid-Poor Adrenal Adenomas

Tu, Wendy; Abreu‐Gomez, Jorge; Udare, Amar; Alrashed, Abdulmohsen; Schieda, Nicola

doi:10.1148/rycan.2020200011

Cited by 21 publications

(10 citation statements)

References 58 publications

(78 reference statements)

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“…Lesions that lost signal intensity on opposed-phase images compared with inphase images and demonstrated hypo-or isointensity to the liver on T1-images and iso-or slight hyperintensity to the liver on T2-images were diagnosed as adenomas. 7,10 Confirmation of the diagnosis of adenoma was made by calculating the signal intensity index calculated (>16.5%) [(signal intensity on in-phase imaging − signal intensity on opposed-phase imaging)/(signal intensity on in-phase imaging)] × 100%. 40 Patients without signal intensity loss on MRI (n = 5) underwent additional washout CT, resulting in the diagnosis of adrenal adenoma.…”

Section: Main Pointsmentioning

confidence: 99%

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Differentiation of adrenal adenomas from adrenal metastases in single-phased staging dual-energy CT and radiomics

Winkelmann¹,

Gassenmaier²,

Walter³

et al. 2022

Diagn Interv Radiol

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Differentiation of incidental adrenal lesions remains a challenge in diagnostic imaging, especially on single-phase portal venous computed tomography (CT) in the oncological setting. The aim of the study was to explore the ability of dual-energy CT (DECT)-based iodine quantification and virtual non-contrast (VNC) imaging and advanced radiomic analysis of DECT for differentiation of adrenal adenomas from metastases. METHODSA total of 46 patients with 49 adrenal lesions underwent clinically indicated staging DECT and magnetic resonance imaging. Median values of quantitative parameters such as VNC, fat fraction, and iodine density in DECT images were collected and compared between adenomas and metastases using non-parametric tests. Magnetic resonance imaging, washout CT, and clinical follow-up were used as a reference standard. Diagnostic accuracy was assessed by calculating receiver operating characteristics. A DECT tumor analysis prototype software was used for semiautomatic segmentation of adrenal lesions and extraction of radiomic features. A radiomics prototype was used to analyze the data with multiple logistic regression and random forest classification to determine the area under the curve (AUC). RESULTSThe study cohort (60.87% women; mean age: 66.91 ± 12.93 years) consisted of 32 adenomas and 17 metastases. DECT-based VNC imaging (AUC = 0.89) and fat quantification (AUC = 0.86) differentiate between adrenal adenomas and metastases with high diagnostic accuracy (P < .001). Analysis of radiomic features revealed that DECT features such as VNC imaging and fat fraction (AUC = 0.87-0.89; < .001) and radiomic features such as 90th percentile and total energy (AUC = 0.88-0.93; P < .001) differentiate with high diagnostic accuracy between adrenal adenomas and metastases. Random forest classification revealed an AUC of 0.83 for separating adrenal adenomas from metastases. CONCLUSIONVirtual non-contrast imaging and fat quantification as well as extraction of radiomic features accurately differentiate between adrenal adenomas and metastases on single-phase oncologic staging DECT. A drenal lesions are common incidental findings in radiological diagnostics, especially in computed tomography (CT). Rarely, primary adrenal lesions are symptomatic or malignant; adrenal lesions detected in healthy patients are mostly benign. 1,2 Although benign adenomas are the most frequently detected adrenal lesions, the risk of malignancy in patients with an underlying tumor disease increases significantly. 2-4 A triplephase contrast-enhanced CT protocol is currently used to characterize adrenal lesions on the basis of its contrast wash-out comparing unenhanced, portalvenous, and delayed phase. 5,6 A noninvasive option for the differentiation of both benign and malignant adrenal lesions is magnetic resonance imaging (MRI) and, in particular, the use of chemical shift imaging, to detect intracytoplasmic lipid, which is characteristic for adenomas. 7 In lipidpoor adenomas, the utility of chemical shift MRI is limited and washout CT has high...

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Section: Main Pointsmentioning

confidence: 99%

“…is limited because they may also show washout in the adenoma range. 7 A previous study by Tu et al 10 showed promising results for distinguishing adrenal metastases from benign lipid-poor adenomas using T2-weighted MRI and logistic regression models combining T2-weighted signal intensity and T2-weighted heterogeneity.…”

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confidence: 99%

Differentiation of adrenal adenomas from adrenal metastases in single-phased staging dual-energy CT and radiomics

Winkelmann¹,

Gassenmaier²,

Walter³

et al. 2022

Diagn Interv Radiol

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“…In general, computed tomography (CT) is better than magnetic resonance imaging (MRI) for lesion assessment. This kind of examination not only overcomes the influence of respiratory motion artefacts and obtains high-quality images but also has the advantages of a fast scanning speed and a low price (12,13). On the basis of conventional CT, dual-energy spectral detector CT (SDCT) provides more parameters that can be used to evaluate lesions, which can be used for better evaluation of adrenal lesions.…”

Section: Introductionmentioning

confidence: 99%

Dual-energy spectral detector computed tomography differential diagnosis of adrenal adenoma and pheochromocytoma: Changes in the energy level curve, a phenomenon caused by lipid components?

et al. 2023

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Background and objectivesPheochromocytoma and adrenal adenoma are common space-occupying lesions of the adrenal gland, and incorrect surgery may lead to adrenal crisis. We used a new method, dual-energy spectral detector computed tomography (SDCT), to differentiate between the two.Materials and methodsWe analysed the imaging images of patients with SDCT scans and pathologically confirmed adrenal adenomas (n=70) and pheochromocytomas (n=15). The 40, 70, and 100 KeV virtual monoenergetic images (VMIs) were reconstructed based on the SCDT arterial phase, and the correlation between the arterial/venous phase iodine concentration (AP-IC/VP-IC), the effective atomic number (Z-effect), the slope of the Hounsfield unit attenuation plot (VMI slope) and the pathological results was tested. The Shapiro−Wilk test was used to determine whether the above data conformed to a normal distribution. For parameters with P greater than 0.05, Student’s t test was used, and the Mann−Whitney test was used for the remaining parameters. A ROC curve was drawn based on the results.ResultsStudent’s t test showed that the 40 KeV VMI and the VMI slope were both statistically significant (P<0.01). The Mann−Whitney U test showed that ID-A was statistically significant (P=0.004). ROC curve analysis showed that 40 keV VMI (AUC=0.818), AP-IC (AUC=0.736), difference (AUC=0.817) and VMI-Slope (0.817) could be used to differentiate adrenal adenoma from pheochromocytoma.ConclusionThe effect of lipid components on SDCT parameters can be used to differentiate adrenal adenoma from pheochromocytoma.

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“…When using CT, tumor heterogeneity and size have been found to be consistently useful features between malignant and benign adrenal masses. For instance, previous reports from Ho et al, [ 39 ] Tu et al, [ 40 , 42 ] and Schieda et al [ 43 ] found that malignant adrenal tumors were larger and more heterogeneous than benign ones. In our study, large masses (mean diameter of the lesion >4 cm) and heterogeneous lesions (obvious necrosis) were excluded; therefore, LD and SD showed no significant differences between L-PAA and ASSM.…”

Section: Discussionmentioning

confidence: 99%

Radiomics approach based on biphasic CT images well differentiate “early stage” of adrenal metastases from lipid-poor adenomas: A STARD compliant article

Cao

2022

Medicine

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The aim of the study was to develop an optimal radiomics model based on abdominal contrast-enhanced computed tomography (CECT) for pre-operative differentiation of "early stage" adrenal metastases from lipid-poor adenomas (LPAs). This retrospective study included 188 patients who underwent abdominal CECT (training cohort: LPAs, 68; metastases, 64; validation cohort: LPAs,29; metastases,27). Abdominal CECT included plain, arterial, portal, and venous imaging. Clinical and CECT radiological features were assessed and significant features were selected. Radiomic features of the adrenal lesions were extracted from four-phase CECT images. Significant radiomics features were selected using the least absolute shrinkage and selection operator (LASSO) and multivariable logistic regression. The clinical-radiological, unenhanced radiomics, arterial radiomics, portal radiomics, venous radiomics, combined radiomics, and clinical-radiological-radiomics models were established using a support vector machine (SVM). The DeLong test was used to compare the areas under the receiver operating characteristic curves (AUCs) of all models. The AUCs of the unenhanced (0.913), arterial (0.845), portal (0.803), and venous (0.905) radiomics models were all higher than those of the clinical-radiological model (0.788) in the testing dataset. The AUC of the combined radiomics model (incorporating plain and venous radiomics features) was further improved to 0.953, which was significantly higher than portal radiomics model (P = .033) and clinical-radiological model (P = .009), with the highest accuracy (89.13%) and a relatively stable sensitivity (91.67%) and specificity (86.36%). As the optimal model, the combined radiomics model based on biphasic CT images is effective enough to differentiate "early stage" adrenal metastases from LPAs by reducing the radiation dose.Abbreviations: AIs = adrenal incidentalomas, AUC = area under the receiver operating characteristic curve, CECT = contrastenhanced computed tomography, CT-pre = pre-enhanced CT value, CT-v = venous-phase CT value, HU = Hounsfield units, ICC = intra-class correlation coefficient, LASSO = least absolute shrinkage and selection operator, LD = long diameter, LPAs = lipid-poor adenomas, SD = short diameter, SVM = support vector machine, VOI = volume of interest.

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Utility of T2-weighted MRI to Differentiate Adrenal Metastases from Lipid-Poor Adrenal Adenomas

Cited by 21 publications

References 58 publications

Differentiation of adrenal adenomas from adrenal metastases in single-phased staging dual-energy CT and radiomics

Differentiation of adrenal adenomas from adrenal metastases in single-phased staging dual-energy CT and radiomics

Dual-energy spectral detector computed tomography differential diagnosis of adrenal adenoma and pheochromocytoma: Changes in the energy level curve, a phenomenon caused by lipid components?

Radiomics approach based on biphasic CT images well differentiate “early stage” of adrenal metastases from lipid-poor adenomas: A STARD compliant article

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