Achille Mileto MD, Presenter: Nothing to Disclose

Rendon C. Nelson MD, Abstract Co-Author: Consultant, General Electric Company Consultant, Nemoto Kyorindo Co, Ltd Consultant, VoxelMetrix, LLC Research support, Bracco Group Research support, Becton, Dickinson and Company Speakers Bureau, Siemens AG Royalties, Wolters Kluwer nv

Daniele Marin MD, Abstract Co-Author: Nothing to Disclose

Kingshuk Roychoudhury, Abstract Co-Author: Nothing to Disclose

Lisa Mei-ling Ho MD, Abstract Co-Author: Nothing to Disclose

To investigate whether contrast-enhanced dual energy MDCT with material decomposition analysis is able to distinguish adrenal adenomas from nonadenomatous lesions.

Thirty-eight nonconsecutive patients (22 men, 16 women; mean age, 65 years), having 47 adrenal nodules, underwent noncontrast and contrast-enhanced dual energy MDCT of the abdomen. For each adrenal nodule, noncontrast attenuation values were measured and dual energy density measurements were obtained using fat/iodine and fat/water material density basis pairs. The diagnostic performance of noncontrast MDCT and dual energy material densities for diagnosis of adenomas were assessed using a leave one out cross-validation. 

Adenomas (lipid-rich and lipid-poor) displayed significantly different mean density values (mg/cm3), compared to nonadenomas, on fat-iodine (970 ± 17.2 vs. 1011.4 ± 10.5), iodine-fat (2.5 ± 0.3 vs. 4.6 ± 1.6), fat-water (-666.7±154.8 vs.-2245 ±1090.2), and water-fat (1628.4 ±177.3 vs. 3316.2 ±1113.2) images, respectively (P<0.0001). For diagnosis of adenoma, dual energy material density analysis showed sensitivity of 96% and specificity of 100%, yielding significantly improved diagnostic performance compared to noncontrast MDCT attenuation (sensitivity, 66%; specificity 100%; P=0.04). 

Contrast-enhanced dual energy MDCT with material density analysis is able to differentiate between adrenal adenomas and nonadenomas, reflecting an improved ability for the diagnosis of lipid-poor adenoma over noncontrast MDCT.

Contrast-enhanced dual energy material density analysis allows for characterizing incidental adrenal nodules, potentially eliminating the need of additional work-up.

Mileto, A, Nelson, R, Marin, D, Roychoudhury, K, Ho, L, Dual Energy MDCT in Incidental Adrenal Nodules: Impact of Material Density Analysis on Lesion Characterization.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14011737.html