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11.08.2023 | Computed Tomography

Feasibility of spectral CT–derived extracellular volume fraction for differentiating aldosterone-producing from nonfunctioning adrenal nodules

verfasst von: Yang Peng, Guanglei Tang, Mengya Sun, Shuang Yu, Yanglei Cheng, Yu Wang, Weiwei Deng, Yanbing Li, Jian Guan

Erschienen in: European Radiology | Ausgabe 1/2024

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Abstract

Objective

To assess the feasibility of spectral CT–derived extracellular volume (ECV) for differentiating aldosterone-producing nodules (APN) from nonfunctioning adrenal nodules (NFN).

Methods

Sixty-nine patients with biochemically and histologically confirmed unilateral APN (34) and NFN (35) as well as 23 patients with bilateral APN (19) and NFN (27) confirmed biochemically and by adrenal vein sampling (AVS) were enrolled in this retrospective study from October 2020 to April 2022. All patients underwent contrast-enhanced spectral CT of the adrenal glands with a 10-min delayed phase. The haematocrit level was measured within 2 days of CT. An iodine density map was derived from the delayed CT. The ECV fractions of the APN and NFN were calculated and compared in the test cohort of 69 patients with unilateral adrenal nodules. The optimal cut-off value was determined to evaluate the diagnostic efficacy of the ECV fraction for differentiating APN from NFN in the validation cohort of 23 patients with bilateral adrenal nodules.

Results

The ECV fractions of the APN (11.17 ± 4.57%) were significantly lower (p < 0.001) than that of the NFN (24.79 ± 6.01%) in the test cohort. At cut-off ECV value of 17.16%, the optimal area under the receiver operating characteristic curve was 0.974 (95% confidence interval: 0.942–1) with 91.4% sensitivity, 93.9% specificity, and 92.8% accuracy in the test cohort and 89.5% sensitivity, 96.3% specificity, and 93.5% accuracy in the validation cohort for differentiating APN from NFN.

Conclusion

The spectral CT–derived ECV fraction can differentiate APN from NFN with high diagnostic performance.

Clinical relevance statement

Spectral CT–derived extracellular volume fraction could accurately differentiate between adrenal aldosterone-producing nodules and nonfunctioning nodules. It might serve as a noninvasive alternative to adrenal vein sampling in primary aldosteronism patients with bilateral adrenal nodules.

Key Points

• Conventional CT cannot differentiate aldosterone-producing adrenal nodules from nonfunctioning nodules.

• Extracellular volume of adrenal aldosterone-producing nodules was significantly lower than that of nonfunctioning nodules and normal adrenal glands. It can accurately differentiate between aldosterone-producing and nonfunctioning adrenal nodules.

• Extracellular volume may be a novel, noninvasive biomarker alternative to adrenal vein sampling for determining the functional status of bilateral adrenal nodules in patients with primary aldosteronism.

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Titel: Feasibility of spectral CT–derived extracellular volume fraction for differentiating aldosterone-producing from nonfunctioning adrenal nodules
verfasst von: Yang Peng
Guanglei Tang
Mengya Sun
Shuang Yu
Yanglei Cheng
Yu Wang
Weiwei Deng
Yanbing Li
Jian Guan
Publikationsdatum: 11.08.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 1/2024
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-023-10077-5

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Feasibility of spectral CT–derived extracellular volume fraction for differentiating aldosterone-producing from nonfunctioning adrenal nodules