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

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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Low-dose unenhanced computed tomography for diagnosing stone disease in obese patients

Arab Journal of Urology ◽

10.1016/j.aju.2012.02.007 ◽

2012 ◽

Vol 10 (3) ◽

pp. 279-283 ◽

Cited By ~ 8

Author(s):

Mohamed E. Abou El-Ghar ◽

Ahmed A. Shokeir ◽

Huda F. Refaie ◽

Ahmed R. El-Nahas

Keyword(s):

Computed Tomography ◽

Low Dose ◽

Stone Disease ◽

Obese Patients ◽

Unenhanced Computed Tomography

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Diagnostic performance of unenhanced computed tomography and 18 F-fluorodeoxyglucose positron emission tomography in indeterminate adrenal tumours

Clinical Endocrinology ◽

10.1111/cen.13448 ◽

2017 ◽

Vol 88 (1) ◽

pp. 30-36 ◽

Cited By ~ 12

Author(s):

Danae A Delivanis ◽

Irina Bancos ◽

Thomas D Atwell ◽

Grant D Schmit ◽

Patrick W Eiken ◽

...

Keyword(s):

Computed Tomography ◽

Positron Emission Tomography ◽

Diagnostic Performance ◽

Emission Tomography ◽

Fluorodeoxyglucose Positron Emission Tomography ◽

Adrenal Tumours ◽

Positron Emission ◽

Unenhanced Computed Tomography ◽

Fluorodeoxyglucose Positron Emission

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Implications of Changing from Intravenous Urography to Computed Tomography as the Primary Imaging Modality for Acute Renal Colic

Bulletin of The Royal College of Surgeons of England ◽

10.1308/147363513x13500508917611 ◽

2013 ◽

Vol 95 (2) ◽

pp. 1-4

Author(s):

SP McCombie ◽

BW Turney ◽

AM Rogers ◽

IJ Lau ◽

SPV Kumar

Keyword(s):

Computed Tomography ◽

Renal Impairment ◽

Renal Colic ◽

Imaging Modality ◽

Intravenous Urography ◽

Contrast Reaction ◽

Acute Renal Colic ◽

Unenhanced Computed Tomography ◽

Higher Sensitivity

Several studies have shown that unenhanced computed tomography (CT), while having a similar specificity to intravenous urography (IVU) for detecting ureterolithiasis, has a much higher sensitivity. CT is also more effective in identifying alternative pathologies and is known to be a much quicker investigation to perform. Additionally, CT can be used in patients with renal impairment and carries no risk of contrast reaction.

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Abstract 008: Novel Pathological Diagnosis Between Aldosterone Producing Adenoma And Idiopathic Hyperaldosteronism

Hypertension ◽

10.1161/hyp.64.suppl_1.008 ◽

2014 ◽

Vol 64 (suppl_1) ◽

Author(s):

Fumitoshi Satoh ◽

Yoshikiyo Ono ◽

Ryo Morimoto ◽

Masataka Kudo ◽

Yoshitsugu Iwakura ◽

...

Keyword(s):

Computed Tomography ◽

Monoclonal Antibodies ◽

Tumor Size ◽

Zona Glomerulosa ◽

Maximum Diameter ◽

Steroidogenic Enzymes ◽

The Status ◽

Aldosterone Producing Adenoma ◽

Idiopathic Hyperaldosteronism ◽

Tumor Area

The expressions of steroidogenic enzymes to produce aldosterone like CYP11B1, CYP11B2, 3BHSD1 and 3BHSD2 remain to be clarified to confirm pathological subclassification between aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism (IHA). Furthermore, we examined the correlation between APA tumor size and the status of intratumoral steroidogenic enzymes involved in aldosterone biosynthesis using immunohistochemistry. Surgically proven forty APA patients and ten IHA patients were retrospectively studied. Multi-detector computed tomography, AVS, and laparoscopic adrenalectomy were performed in all of the patients studied. The tumor area of APA at the maximum diameter of the sections was precisely measured by ImageJ software. The status of steroidogenic enzymes was immunohistochemically analyzed using monoclonal antibodies for CYP11B1, CYP11B2, 3BHSD1 and 3BHSD2, and the findings were evaluated according to the H-score system, based on both the number of immunopositive cells and relative immunointensity. Adrenal masses were not detected by computed tomography in 20 APA patients.In all of 10 IHA patients, hyperplastic zona glomerulosa was accompanied by an expression of HSD3B1. In contrast, tumor cells in all 40 APA patients were not immunopositive to HSD3B1, but strongly and dominanty expressed HSD3B2. Perhaps, due to compensatory responses to excess aldosterone, APA had an adjacent zona glomerulosa whose immunoreactivities to HSD3B1 and HSD3B2 were profoundly reduced in all 40 APA patients. Maximum tumor area obtained in the specimens was significantly correlated with preoperative plasma aldosterone concentration, urinary aldosterone excretion, the H-score of CYP11B1, and was inversely correlated with the H-score of CYP11B2. These results demonstrated that small adenomas could produce sufficient aldosterone to cause clinically overt primary aldosteronism because of the significantly higher CYP11B2 expression per tumor area. Monoclonal antibodies against HSD3B1 and HSD3B2 could be useful for immunohistochemical differentiation between APA and IHA. In addition, the relatively higher CYP11B2 expression per area in smaller APA could clinically cause PA despite their CT-undetectable tumor size.

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Comparison of 3-Segmentation Techniques for Intraventricular and Intracerebral Hemorrhages in Unenhanced Computed Tomography Scans

Journal of Computer Assisted Tomography ◽

10.1097/rct.0b013e318245c1fa ◽

2012 ◽

Vol 36 (1) ◽

pp. 109-120 ◽

Cited By ~ 5

Author(s):

Bhanu Prakash KN ◽

Jianbo Hu ◽

Timothy C. Morgan ◽

Daniel Hanley ◽

Wieslaw L. Nowinski

Keyword(s):

Computed Tomography ◽

Computed Tomography Scans ◽

Unenhanced Computed Tomography ◽

Intracerebral Hemorrhages

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Plain abdominal radiography with transabdominal native tissue harmonic imaging ultrasonography vs unenhanced computed tomography in renal colic

BJU International ◽

10.1111/j.1464-410x.2007.07048.x ◽

2007 ◽

Vol 100 (4) ◽

pp. 887-890 ◽

Cited By ~ 28

Author(s):

Michael Mitterberger ◽

Germar Michael Pinggera ◽

Leo Pallwein ◽

Johannes Gradl ◽

Gudrun Feuchtner ◽

...

Keyword(s):

Computed Tomography ◽

Renal Colic ◽

Harmonic Imaging ◽

Tissue Harmonic Imaging ◽

Abdominal Radiography ◽

Native Tissue ◽

Plain Abdominal Radiography ◽

Unenhanced Computed Tomography

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

BioMed Research International ◽

10.1155/2020/1672736 ◽

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.

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