Differentiation of malignant from benign adrenal masses: predictive indices on computed tomography

CT findings in 43 adrenal masses were analyzed to see which features correlated most significantly with malignancy. Size, contrast enhancement, and consistency emerged as important discriminators of malignant from benign adrenal masses. These three factors were further analyzed by logistic regression technique to examine the joint influence of computed tomographic (CT) features in prediction of malignancy. As a result of logistic regression analysis, a table of estimated probability of malignancy as a function of tumor size alone and another table of estimated probability as a joint function of size and contrast enhancement were developed. Given a similar patient sample and by using the data given, it would be possible to predict chances of malignancy in an adrenal mass if its CT features are known; for example, a 5-cm adrenal mass without enhancement has a 0.31 probability of malignancy; with enhancement, a 0.68 probability.     

Distinguishing benign from malignant adrenal masses: multi-detector row CT protocol with 10-minute delay

PURPOSE: To retrospectively evaluate the accuracy of precontrast attenuation, relative percentage washout (RPW), and absolute percentage washout (APW) in distinguishing benign from malignant adrenal masses at multi-detector row computed tomography (CT). MATERIALS AND METHODS: This HIPAA-compliant retrospective study had institutional review board approval; the need for informed consent was waived. One hundred twenty-two adrenal masses were evaluated in 99 patients (51 men, 48 women; age range, 37-86 years) who had undergone CT performed according to the study protocol and who either were given a pathologic diagnosis or underwent follow-up imaging. Unenhanced images were obtained before administration of 120 mL of an intravenous contrast agent with a 75-second scan delay. Delayed images were obtained after 10 minutes. RPW and APW were computed. Receiver operating characteristic (ROC) analysis was performed to compare mean attenuation and both RPW and APW. Analysis was first performed with the exclusion of pheochromocytomas, myelolipomas, and cysts. Precontrast attenuation criteria specific for benignity or malignancy were determined, and ROC analysis of results for the entire nonpheochromocytoma group was then performed. RESULTS: By using an RPW of 37.5% and excluding cysts and myelolipomas, all malignant lesions were detected with a sensitivity of 100% (17 of 17 lesions) and a specificity of 95% (90 of 95 lesions). Area under the binomial ROC curve (A(z)) values were 0.912, 0.985, and 0.892 for precontrast attenuation, RPW, and APW, respectively. Precontrast attenuation of less than 0 or more than 43 HU indicated benign and malignant entities, respectively. Incorporation of these criteria into the APW analysis yielded a sensitivity of 100% (17 of 17 lesions) and a specificity of 98% (93 of 95 lesions) for a threshold washout value of 52.0%. This attenuation-corrected APW generated the greatest A(z) value (ie, 0.988). Combining all the information available from the protocol yielded a sensitivity of 100% (17 of 17 lesions) and a specificity of 98% (98 of 100 lesions) for differentiating benign from malignant masses. CONCLUSION: Precontrast attenuation of less than 0 HU supercedes the washout profile in the evaluation of an individual adrenal mass. Noncalcified, nonhemorrhagic adrenal lesions with precontrast attenuation of more than 43 HU should be considered suspicious for malignancy.     

Value of combined CT parameters in distinguishing benign from malignant adrenal masses in cancer patients

The aim of this work was to evaluate the effectiveness of combined CT parameters in distinguishing benign from malignant adrenal masses in cancer patients.     

Differentiation of malignant and benign pulmonary nodules with first-pass dual-input perfusion CT

Objective

To assess diagnostic performance of dual-input CT perfusion for distinguishing malignant from benign solitary pulmonary nodules (SPNs).

Methods

Fifty-six consecutive subjects with SPNs underwent contrast-enhanced 320-row multidetector dynamic volume CT. The dual-input maximum slope CT perfusion analysis was employed to calculate the pulmonary flow (PF), bronchial flow (BF), and perfusion index $ \left( {\mathrm{PI},={{\mathrm{PF}} \left/ {{\left( {\mathrm{PF} + \mathrm{BF}} \right)}} \right.}} \right) $ . Differences in perfusion parameters between malignant and benign tumours were assessed with histopathological diagnosis as the gold standard. Diagnostic value of the perfusion parameters was calculated using the receiver-operating characteristic (ROC) curve analysis.

Results

Amongst 56 SPNs, statistically significant differences in all three perfusion parameters were revealed between malignant and benign tumours. The PI demonstrated the biggest difference between malignancy and benignancy: 0.30?±?0.07 vs. 0.51?±?0.13 , P?<?0.001. The area under the PI ROC curve was 0.92, the largest of the three perfusion parameters, producing a sensitivity of 0.95, specificity of 0.83, positive likelihood ratio (+LR) of 5.59, and negative likelihood ratio (?LR) of 0.06 in identifying malignancy.

Conclusions

The PI derived from the dual-input maximum slope CT perfusion analysis is a valuable biomarker for identifying malignancy in SPNs. PI may be potentially useful for lung cancer treatment planning and forecasting the therapeutic effect of radiotherapy treatment.

Key Points

? Modern CT equipment offers assessment of vascular parameters of solitary pulmonary nodules (SPNs) ? Dual vascular supply was investigated to differentiate malignant from benign SPNs. ? Different dual vascular supply patterns were found in malignant and benign SPNs. ? The perfusion index is a useful biomarker for differentiate malignancy from benignancy.     

CT动态增强扫描在肌肉骨骼系统良恶性肿物鉴别中的价值

目的 通过分析处理ＣＴ动态增强影像后得出边缘－中心强化速率比这一分析指标,评价其在肌肉骨骼系统良恶性肿物鉴别诊断中的应用价值。方法 对２６个肌肉骨骼系统的实性肿物进行了ＣＴ动态增强扫描检查,评价良恶性肿物间边缘－中心强化速率比的差别的统计学意义,并与最大强化速率这一分析指标做了比较。     

Differentiation of benign and malignant ampullary obstruction by multi-row detector CT

Purpose

To determine useful CT parameters to differentiate ampullary carcinomas from benign ampullary obstruction.

Materials and methods

This study included 93 patients who underwent abdominal CT, 31 patients with ampullary carcinomas, and 62 patients with benign ampullary obstruction. Two radiologists independently evaluated CT parameters then reached consensus decisions. Statistically significant CT parameters were identified through univariate and multivariate analyses.

Results

In univariate analysis, the presence of ampullary mass, asymmetric, abrupt narrowing of distal common bile duct (CBD), dilated intrahepatic bile duct (IHD), dilated pancreatic duct (PD), peripancreatic lymphadenopathy, duodenal wall thickening, and delayed enhancement were more frequently in ampullary carcinomas observed (P?<?0.05). Multivariate logistic regression analysis using significant CT parameters and clinical data from univariate analysis, and clinical symptom with jaundice (P?=?0.005) was an independent predictor of ampullary carcinomas. For multivariate analysis using only significant CT parameters, abrupt narrowing of distal CBD was an independent predictor of ampullary carcinomas (P?=?0.019). Among various CT criteria, abrupt narrowing of distal CBD and dilated IHD had highest sensitivity (77.4%) and highest accuracy (90.3%).

Conclusion

The abrupt narrowing of distal CBD and dilated IHD is useful for differentiation of ampullary carcinomas from benign entity in patients without the presence of mass.

     

Multidetector CT of the heart: spectrum of benign and malignant cardiac masses

Recent innovations in multidetector 3D CT have improved the spatial and temporal resolution of cardiac computed tomography (CT), which results in greater frequency of mass lesion identification and provides a new opportunity for more precise characterization. Although cardiac masses are rare entities, patients with cardiac masses may present with acute symptoms and may be encountered by emergency radiologists. The objectives of this article are to review the CT appearance of cardiac masses and the role of volumetric MDCT with 3D rendering to define characteristic features and provide a practical approach to formulating a differential diagnosis.     

Employing 18F-FDG PET/CT for distinguishing benign from metastatic adrenal masses

Background

Metastatic adrenal disease can occur in a wide diversity of malignancies. Distinguishing benign from metastatic adrenal masses in oncologic patients is vital.

201Tl imaging for differentiating between malignant and benign neck masses

The aim of this study was to assess the ability of 201Tl scintigraphy to differentiate between malignant and benign neck masses. Fifty-eight patients with neck masses, whose diagnoses were confirmed by histological examination, were examined. The sensitivity, specificity and accuracy of 201Tl scintigraphy were 80%, 96% and 88% respectively; when salivary gland masses were excluded, these values were 87%, 95% and 91% respectively. Our results suggest that 201Tl scintigraphy is highly reliable in determining the malignancy of neck masses, especially when salivary gland masses are excluded.     

CT象素矩阵图对鉴别肾上腺的腺瘤与恶性肿瘤的价值

目的：进一步探讨CT象素矩阵图对鉴别肾上腺腺瘤与恶性肿瘤的价值。方法：64例经临床、病理证实的肾上腺肿瘤共73个病灶,肿瘤的平扫平均CT值＞0HU。在CT平扫和增强图像上,分别应用CT象素矩阵图观察肿瘤内有无轻度负CT值区域。结果：在平扫和增强CT象素矩阵图上,分别有77％（24／31）和23％（6／26）的肾上腺腺瘤内见轻度负CT值区域,33例共42个恶性肿瘤病灶均未见此征象,特异性为100％。结论：分析CT象素矩阵图能发现病灶内最小CT值,对鉴别肾上腺的腺瘤与恶性肿瘤具有重要的价值。     

Sonography in benign and malignant renal masses

Ultrasonography and CT have allowed improved detection of renal mass lesions. Though ultrasonography is less sensitive in the characterization of the renal mass lesions, it is often the first imaging modality for evacuation of the kidneys. This article gives an overview of the benign and malignant renal mass lesions and the role of ultrasonography in their characterization.     

Differentiation between benign and malignant colon tumors using fast dynamic gadolinium-enhanced MR colonography; a feasibility study

Background

Colorectal cancer will present itself as a bowel obstruction in 16-23% of all cases. However, not all obstructing tumors are malignant and the differentiation between a benign and a malignant tumor can be difficult. The purpose of our study was to determine whether fast dynamic gadolinium-enhanced MR imaging combined with MR colonography could be used to differentiate a benign from a malignant obstructing colon tumor.

Methods

Patients with benign colon tumor stenosis, based on diverticulitis, were asked to participate in the study. The same number of patients with verified colorectal cancer was included. Both groups had to be scheduled for surgery to be included. Two blinded observers analyzed the tumors on MR by placing a region of interest in the tumor and a series of parameters were evaluated, e.g. wash-in, wash-out and time-to-peak.

Results

14 patients were included. The wash-in and wash-out rates were significantly different between the benign and malignant tumors, and a clear distinction between benign and malignant disease was therefore possible by looking only at the MR data. Furthermore, MR colography evaluating the rest of the colon past the stenosis was possible with all patients.

Conclusion

The results showed the feasibility of using fast dynamic gadolinium-enhanced MR imaging to differentiate between benign and malignant colonic tumors. With a high intra-class correlation and significant differences found on independent segments of the tumor, the method appears to be reproducible. Furthermore, the potential is big in performing a full preoperative colon evaluation even in patients with obstructing cancer. Trial number: NCT00114829.