| Objective: To investigate the value of spectral CT in the differential diagnosis of adrenal hyperplasia and normal adrenal gland.Materials and methods: From October 2015 to July 2016,patients underwent adrenal routine CT and enhanced CT spectral imaging in the First Affiliated Hospital of Zhengzhou University were collected.Analyzed and arranged the clinical data and adrenal lesions information of patients,according to the pathological results or clinical diagnosis,the patients were divided into hyperplasia group and normal group,patients in hyperplasia group were pathologically confirmed adrenal hyperplasia,and normal group patients were confirmed by clinical diagnosis of normal adrenal.Finally,there were 30 cases of hyperplasia(16 males,14 females,ages from 22 to 66 years old and median age 44.5 years old)and 22 normal cases(9 males and 13 females,ages from 24 to 65 years old and median age 39 years old).All patients were underwent routine CT and arterial phase,venous phase enhanced spectral imaging CT in Discovery GSI CT.Spectral parameters of adrenal and abdominal aorta of two groups were measured and recorded,including monochromatic energy CT values of 40-140 ke V(intervals of 10 ke V),the effective atomic number and the concentration of base material,calculated the slope of spectral HU curve and the standarded spectral parameters and used ROC curve to analysis diagnostic efficiency of spectral parameters.The statistical methods used included two independent samples t test,Mann-Whitney U test,chi square test and ROC curve.Results:(1)The differences of 11 kinds of monoenergetic CT values,the effective atomic number and the slope of spectral HU curve in two groups in arterial phase had no statistical significance(P > 0.05);the difference of base material concentration of calcium-iodine and iodine-calcium had statistical significance(P < 0.05),other base material concentration had no significant difference(P > 0.05).ROC curve was used to analyze the concentration of calcium-iodine and iodine-calcium,the area under the curve(AUC)was 0.647 and 0.644,respectively,and their diagnostic accuracy were low.(2)There were no significant difference between the two groups of standardized CT value of single energy,effective atomic number and the base material concentration of the in the arterial phase(P > 0.05).(3)CT values of 40-60 ke V,effective atomic number and calcium-water concentration,iodine-water concentration,HAP-water concentration and the slope of spectral HU curve in two groups in venous phase had significant difference(P < 0.05),other spectral parameters were no significant difference(P > 0.05).ROC curve was used to analyze of CT values of 40-60 ke V,effective atomic number,calcium-water concentration,iodine-water concentration,HAP-water concentration and slope of spectral HU curve of venous phase,AUC were 0.802,0.789,0.733,0.780,0.674,0.759,0.720,0.783,of which the diagnostic accuracy of calcium-water concentration was low,other indexes had some diagnostic efficiency.When CT values of 40-60 ke V,effective atomic number,iodine-water concentration,HAP-water concentration and slope of spectral HU curve of venous phase used 230.23(HU),165.67(HU),103.59(HU),9.04(Z),25.20(100ug/cm3),72.83(mg/cm3),2.97 as the critical value of predicting adrenal hyperplasia,sensitivity were 93.3%,63.3%,93.3%,90.0%,90.0%,90.0%,90.0%,respectively,specificity were 63.6%,90.9%,63.6%,68.1%,63.6%,54.5%,68.2%,respectively,and Youden index were 0.569,0.542,0.569,0.581,0.536,0.445,0.582,respectively.(4)The difference of standardized 40-70 ke V CT values,effective atomic number,calcium-water concentration,iodine water concentration,and HAP-water concentration of venous phase between two groups had statistical significance(P < 0.05),other spectrum parameters had no significant difference(P > 0.05).ROC curve was used to analyze of standardized 40-70 ke V CT values,effective atomic number,calcium-water concentration,iodine-water concentration,and HAP-water concentration of venous phase,AUC were 0.766,0.786,0.711,0.641,0.665,0.639,0.677,0.666,respectively,of which only standardized CT values of 40-60 ke V had some diagnostic efficiency,other parameters had low diagnostic efficiency.When standardized CT values of 40-60 ke V used 0.56,0.57,0.57 as the critical value of predicting adrenal hyperplasia,sensitivity were 83.3%,76.7%,76.7%,respectively,specificity were 70.4%,72.7%,72.7%,respectively,and Youden index was 0.537,0.493,0.493,respectively.After the overall consideration of AUC,sensitivity,specificity and Youden index,CT value of 40 ke V and slope of spectral HU curve have best diagnostic efficiency in the venous phase.Conclusions: Spectral CT imaging cannot differentiate adrenal hyperplasia and normal adrenal in the arterial phase,while spectral CT imaging can be used to differentiate adrenal hyperplasia and normal adrenal gland in the venous phase,which provides a new method for identification of adrenal hyperplasia and normal adrenal. |
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