scholarly journals Computed tomography criteria for discrimination of adrenal adenomas and adrenocortical carcinomas: analysis of the German ACC registry

2015 ◽  
Vol 172 (4) ◽  
pp. 415-422 ◽  
Author(s):  
Stephan Petersenn ◽  
Paul-Ajoy Richter ◽  
Thomas Broemel ◽  
Christian O Ritter ◽  
Timo Deutschbein ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Roc Analysis ◽  
Ct Scans ◽  
Adrenal Tumors ◽  
Hounsfield Units ◽  
Unenhanced Ct ◽  
Median Tumor Size ◽  
Lower Specificity ◽  
Unenhanced Computed Tomography ◽  
Adrenocortical Carcinomas

ObjectiveThresholds of 2–20 hounsfield units (HU) in unenhanced computed tomography (CT) are suggested to discriminate benign adrenal tumors (BATs) from malignant adrenal tumors. However, these studies included only low numbers of adrenocortical carcinomas (ACCs). This study defines a HU threshold by inclusion of a large cohort of ACCs.DesignRetrospective, blinded, comparative analysis of CT scans from 51 patients with ACCs (30 females, median age 49 years) and 25 patients with BATs (12 females, median age 64 years) diagnosed during the period of 2005–2010 was performed.MethodsTumor density was evaluated in unenhanced CT by two blinded investigators.ResultsMedian tumor size was 9 cm (range 2.0–20) for ACCs vs 4 cm (2.0–7.5) for BATs (P<0.0001). In ACCs, the median unenhanced HU value was 34 (range 14–74) in comparison with 5 (−13 to 40) in BATs (P<0.0001). ROC analysis revealed a HU of 21 as threshold with the best diagnostic accuracy (sensitivity 96%, specificity 80%, and AUC 0.89). However, two ACCs that were 5 and 6 cm in size would have been missed. Setting the threshold to 13.9 allowed for 100% sensitivity, but a lower specificity of 68%.ConclusionsThis first large study on ACCs confirmed that the vast majority of ACCs have unenhanced HU >21. However, to avoid misdiagnosing an ACC as benign, a threshold of 13 should be used.

The Value of “Liver Windows” Settings in the Detection of Small Renal Cell Carcinomas on Unenhanced Computed Tomography

2014 ◽  
Vol 65 (1) ◽  
pp. 71-76 ◽  
Author(s):  
Kamal Sahi ◽  
Stuart Jackson ◽  
Edward Wiebe ◽  
Gavin Armstrong ◽  
Sean Winters ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Soft Tissue ◽  
Renal Cell ◽  
Roc Analysis ◽  
Ct Images ◽  
Operating Characteristics ◽  
Renal Cell Carcinomas ◽  
Unenhanced Ct ◽  
Single Slice ◽  
Unenhanced Computed Tomography

Objective To assess if “liver window” settings improve the conspicuity of small renal cell carcinomas (RCC). Methods Patients were analysed from our institution's pathology-confirmed RCC database that included the following: (1) stage T1a RCCs, (2) an unenhanced computed tomography (CT) abdomen performed ≤ 6 months before histologic diagnosis, and (3) age ≥ 17 years. Patients with multiple tumours, prior nephrectomy, von Hippel-Lindau disease, and polycystic kidney disease were excluded. The unenhanced CT was analysed, and the tumour locations were confirmed by using corresponding contrast-enhanced CT or magnetic resonance imaging studies. Representative single-slice axial, coronal, and sagittal unenhanced CT images were acquired in “soft tissue windows” (width, 400 Hounsfield unit (HU); level, 40 HU) and liver windows (width, 150 HU; level, 88 HU). In addition, single-slice axial, coronal, and sagittal unenhanced CT images of nontumourous renal tissue (obtained from the same cases) were acquired in soft tissue windows and liver windows. These data sets were randomized, unpaired, and were presented independently to 3 blinded radiologists for analysis. The presence or absence of suspicious findings for tumour was scored on a 5-point confidence scale. Results Eighty-three of 415 patients met the study criteria. Receiver operating characteristics (ROC) analysis, t test analysis, and kappa analysis were used. ROC analysis showed statistically superior diagnostic performance for liver windows compared with soft tissue windows (area under the curve of 0.923 vs 0.879; P = .0002). Kappa statistics showed “good” vs “moderate” agreement between readers for liver windows compared with soft tissue windows. Conclusion Use of liver windows settings improves the detection of small RCCs on the unenhanced CT.

OPPORTUNISTIC EVALUATION OF BONE MINERAL DENSITY BY PET-CT IN HODGKIN LYMPHOMA PATIENTS

2019 ◽  
Vol 25 (9) ◽  
pp. 869-876 ◽  
Author(s):  
Bar Cohen ◽  
Nurith Hiller ◽  
Auryan Szalat ◽  
Vladimir Vainstein
Keyword(s):  
Computed Tomography ◽  
Bone Mineral Density ◽  
Hodgkin Lymphoma ◽  
Bone Mineral ◽  
Ct Scans ◽  
Mineral Density ◽  
Hounsfield Units ◽  
Positron Emission ◽  
Pet Ct ◽  
Ct Attenuation

Objective: Bone density loss and increased risk for osteoporosis are of concern in Hodgkin lymphoma (HL) patients. Routinely performed positron emission tomography–computed tomography (PET-CT) scans could be informative in assessing bone mineral density (BMD). Methods: This retrospective study included 80 adults with newly diagnosed HL treated with standard first-line chemotherapy regimens. PET-CT scans performed at diagnosis (PET-CT1), at the end of chemotherapy (PET-CT2), and at follow-up after remission (PET-CT3) were used to assess BMD changes by measuring lumbar vertebrae CT attenuation. A CT attenuation threshold of 160 Hounsfield units was used to define abnormal BMD. Results: Following chemotherapy, comparison of PET-CT2 with PET-CT1 revealed a mean (standard deviation) 14.2% (10.4%) BMD reduction ( P<.001). On PET-CT3 performed at 14.6 (3.25) months after the last course of chemotherapy, a slight improvement (4.6% [10.4%]) in comparison to PET-CT2 was noted. Twelve patients (15%) converted from normal baseline BMD on PET-CT1 to abnormal BMD after chemotherapy on PET-CT2. Age, baseline BMD, and steroid cumulative dose were associated with BMD decline and risk for abnormal BMD after chemotherapy. No clinical fractures were reported, and only one rib fracture was incidentally captured (1.25%). Conclusion: HL patients treated with common first-line chemotherapies demonstrate a significant decline in bone density on routine PET-CT scans. Opportunistic use of PET-CT scan has the potential to detect HL patients at high risk for developing osteoporosis and to guide clinicians regarding monitoring and intervention. Abbreviations: BMD = bone mineral density; CT = computed tomography; DXA = dual-energy X-ray absorptiometry; HL = Hodgkin lymphoma; HU = Hounsfield units; L = lumbarvertebra; PET-CT = positron emission tomography-computed tomography; T = thoracic vertebra

scholarly journals Additional Diagnostic Value of Unenhanced Computed Tomography plus Diffusion-Weighted Imaging Combined with Routine Magnetic Resonance Imaging Findings of Early-Stage Gliblastoma

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Hexiang Wang ◽  
Zhenyou Liu ◽  
Yong Zhang ◽  
Feng Hou ◽  
Weiwei Fu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Magnetic Resonance ◽  
Mr Imaging ◽  
Diffusion Weighted Imaging ◽  
Early Stage ◽  
Diagnostic Value ◽  
Imaging Findings ◽  
Hyperintense Lesion ◽  
Unenhanced Ct ◽  
Unenhanced Computed Tomography

Purpose. This study was performed to determine whether diffusion-weighted imaging (DWI) plus unenhanced computed tomography (CT) of the brain increases the diagnostic value of routine magnetic resonance (MR) imaging findings of early-stage glioblastoma. Methods. Postcontrast MR images of eight unenhanced lesions that had been pathologically diagnosed as glioblastoma were retrospectively examined. The location, margin, signal intensity, and attenuation on MR imaging and CT were assessed. Results. On MR imaging, all lesions were ill-defined, small, and isointense to hypointense on T1-weighted images and hyperintense on T2-weighted images. Four patients had perilesional edema. In seven patients, DWI showed an inhomogeneous hyperintense lesion (n = 1) or isointense lesion with a hyperintense region (n = 6). On unenhanced CT, all masses presented as a hypoattenuated lesion with a hyperattenuated region (n = 7) or isoattenuated region (n = 1). The hyperattenuated region (n = 6) or isoattenuated region (n = 1) on CT appeared on DWI as an inhomogeneous hyperintense lesion (n = 1), isointense lesion with a hyperintense region (n = 3), or ring-like peritumoral hyperintensity (n = 3). Conclusions. MR imaging was the most sensitive imaging method for depicting early-stage glioblastoma. The CT finding of a hyperattenuated or isoattenuated region combined with the DWI finding of the same region containing an inhomogeneous hyperintense lesion or isointense lesion with a hyperintense region may be a specific diagnostic sign for early-stage glioblastoma. DWI plus unenhanced CT added diagnostic value to the routine MR imaging findings of early-stage glioblastoma.

scholarly journals Unenhanced computed tomography as a diagnostic tool in suspected pulmonary hypertension: a retrospective cross-sectional pilot study

2021 ◽  
Vol 6 ◽  
pp. 249
Author(s):  
Ze Ming Goh ◽  
Christopher S. Johns ◽  
Tarik Julius ◽  
Samual Barnes ◽  
Krit Dwivedi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pulmonary Hypertension ◽  
Characteristic Curve ◽  
Right Atrial ◽  
Heart Catheterization ◽  
Great Vessel ◽  
Cross Sectional ◽  
Specialist Registrar ◽  
Unenhanced Ct ◽  
Unenhanced Computed Tomography

Background: Computed tomography pulmonary angiography (CTPA) has been proposed to be diagnostic for pulmonary hypertension (PH) in multiple studies. However, the utility of the unenhanced CT measurements diagnosing PH has not been fully assessed.  This study aimed to assess the diagnostic utility and reproducibility of cardiac and great vessel parameters on unenhanced computed tomography (CT) in suspected pulmonary hypertension (PH). Methods: In total, 42 patients with suspected PH who underwent unenhanced CT thorax and right heart catheterization (RHC) were included in the study. Three observers (a consultant radiologist, a specialist registrar in radiology, and a medical student) measured the parameters by using unenhanced CT. Diagnostic accuracy of the parameters was assessed by area under the receiver operating characteristic curve (AUC). Inter-observer variability between the consultant radiologist (primary observer) and the two secondary observers was determined by intra-class correlation analysis (ICC). Results: Overall, 35 patients were diagnosed with PH by RHC while 7 patients were not. Main pulmonary arterial (MPA) diameter was the strongest (AUC 0.79 to 0.87) and the most reproducible great vessel parameter. ICC comparing the MPA diameter measurement of the consultant radiologist to the specialist registrar’s and the medical student’s were 0.96 and 0.92, respectively. Right atrial area was the cardiac measurement with highest accuracy and reproducibility (AUC 0.76 to 0.79; ICC 0.980, 0.950) followed by tricuspid annulus diameter (AUC 0.76 to 0.79; ICC 0.790, 0.800). Conclusions: MPA diameter and right atrial areas showed high reproducibility. Diagnostic accuracies of these were within the range of acceptable to excellent, and might have clinical value. Tricuspid annular diameter was less reliable and less diagnostic and was therefore not a recommended diagnostic measurement.

scholarly journals Estimation of nephron number in living humans by combining unenhanced computed tomography with biopsy-based stereology

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Takaya Sasaki ◽  
Nobuo Tsuboi ◽  
Yusuke Okabayashi ◽  
Kotaro Haruhara ◽  
Go Kanzaki ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Arterial Phase ◽  
Nephron Number ◽  
Living Kidney Donors ◽  
Explanatory Variables ◽  
Cortical Volume ◽  
Unenhanced Ct ◽  
Enhanced Ct ◽  
Phase Images ◽  
Unenhanced Computed Tomography

Abstract Methods for estimating nephron number in a clinical setting may be useful for predicting renal outcomes. This study aimed to establish such a method using unenhanced computed tomography (CT) and biopsy-based stereology. Patients or living kidney donors simultaneously subjected to enhanced and unenhanced CT examinations were randomly assigned to development and validation groups. The enhanced CT-measured arterial phase and the venous phase images of kidneys were regarded as the true values for cortical volume and parenchymal volume, respectively. Linear multiple regression analysis was used to create models for estimating cortical volume using explanatory variables including unenhanced CT-measured parenchymal volume. Nephron number was determined as the product of cortical volume and the glomerular density in biopsies of donors. Five equations for estimating cortical volume were created and verified. In donors, estimated nephron number by unenhanced CT was consistent with that by enhanced CT, with minimal errors in all models (636–655 ± 210–219 vs. 648 ± 224 × 103/kidney). Clinical characteristics combined with parenchymal volume did not improve the equation over parenchymal volume alone. These results support the feasibility of estimating nephron number by a combination of unenhanced CT and biopsy-based stereology, with a possible application for renal disease patients who are often not suitable for contrast media.

scholarly journals Exploring the Functionality of Mesh-to-Mesh Value Comparison in Pair-Matching and Its Application to Fragmentary Remains

Biology ◽  
2021 ◽  
Vol 10 (12) ◽  
pp. 1303
Author(s):  
Zoe McWhirter ◽  
Mara A. Karell ◽  
Ali Er ◽  
Mustafa Bozdag ◽  
Oguzhan Ekizoglu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Roc Analysis ◽  
Three Dimensional ◽  
Turkish Population ◽  
New Method ◽  
Ct Scans ◽  
Different Types ◽  
Pair Matching ◽  
Commingled Remains

Many cases encountered by forensic anthropologists involve commingled remains or isolated elements. Common methods for analysing these contexts are characterised by limitations such as high degrees of subjectivity, high cost of application, or low proven accuracy. This study sought to test mesh-to-mesh value comparison (MCV), a relatively new method for pair-matching skeletal elements, to validate the claims that the technique is unaffected by age, sex and pathology. The sample consisted of 160 three-dimensional clavicle models created from computed tomography (CT) scans of a contemporary Turkish population. Additionally, this research explored the application of MVC to match fragmented elements to their intact counterparts by creating a sample of 480 simulated fragments, consisting of three different types based on the region of the bone they originate from. For comparing whole clavicles, this resulted in a sensitivity value of 87.6% and specificity of 90.9% using ROC analysis comparing clavicles. For the fragment comparisons, each type was compared to the entire clavicles of the opposite side. The results included a range of sensitivity values from 81.3% to 87.6%. Overall results are promising and the MVC technique seems to be a useful technique for matching paired elements that can be accurately applied to a Modern Turkish sample.

Selective Densitometry of the Lumbar Spine

2013 ◽  
Author(s):  
Bryant Chu ◽  
Jeremi Leasure ◽  
Dimitriy Kondrashov
Keyword(s):  
Computed Tomography ◽  
Bone Mineral Density ◽  
Lumbar Spine ◽  
Lumbar Vertebrae ◽  
Ct Scans ◽  
Screw Loosening ◽  
Mineral Density ◽  
Hounsfield Units ◽  
Pedicle Screw Loosening ◽  
Posterior Elements

Bone mineral density (BMD) has been identified as a major factor in spine construct strength, with failures resulting in pedicle screw loosening and pullout2. Computed tomography (CT) scans have been shown to effectively measure BMD1,4. Previous research has utilized this linear correlation of CT Hounsfield Units (HU) to BMD in order to determine BMD as a function of anatomic location within cervical vertebrae1; however, the lumbar spine has not yet been reported on. The goal of this study was to describe BMD of anatomical regions within lumbar vertebrae using the correlation between HU and BMD. It was hypothesized that posterior elements of the spine would exhibit significantly different BMD than the vertebral body. This was tested through means comparison of BMD for each anatomical region.

scholarly journals Quantitative Computed Tomography in Elderly Depressed Patients

1983 ◽  
Vol 143 (2) ◽  
pp. 124-127 ◽  
Author(s):  
Robin J. Jacoby ◽  
Raymond J. Dolan ◽  
Raymond Levy ◽  
Robert Baldy
Keyword(s):  
Computed Tomography ◽  
Brain Tissue ◽  
Analysis Of Variance ◽  
Senile Dementia ◽  
Quantitative Computed Tomography ◽  
Ct Scans ◽  
Healthy Controls ◽  
Hounsfield Units ◽  
Brain Areas ◽  
Depressed Patients

SummaryAn index of brain tissue density was obtained from the CT scans of 37 elderly depressed patients by measuring Hounsfield Units (HU) in 12 predefined brain areas. Comparisons were made with 23 patients suffering from senile dementia and 36 healthy controls. As a group the depressed patients resembled the dements more than the controls, although analysis of variance indicated differences between all three groups, controls showing the highest HU values and dements the lowest. In the depressed patients ventricular dilatation, which had already been shown to predict increased mortality, was also associated with lower HU levels. The significance of these and other findings is discussed.

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