| Objective:To explore the the difference of energy spectrum parameters between adrenal nodular hyperplasia and lipid-poor adenoma and the efficacy of energy spectrum CT parameters in the diagnosis of adrenal nodular hyperplasia and lipid-poor adenoma.Materials and methods:From May 2017 to March 2019,patients with adrenal nodular hyperplasia and adrenocortical adenoma(CT value greater than 10HU)confirmed by pathology were retrospectively analyzed.Routine CT plain scan and enhanced energy spectrum CT scan in arterial and venous phase were performed in GE Revolution machine of the First Affiliated Hospital of Zhengzhou University.Twenty cases of nodular hyperplasia(12 males and 8 females,aged 25-64 years,median age 41 years)and 24 cases of fat-deficient adenomas(15 males and 9 females,aged 21-67 years,median age 39 years)were included in the study.The SD value CNR and subjective evaluation of 120 KVp-like images automatically generated by the best single-energy image and system were measured.The energy spectrum parameters of the adrenal gland and the abdominal aorta of the two groups included in the study included 40-140 keV single-energy CT value,effective atomic number(Effective-Z)and the concentration of each pair of basic substances at 10 keV intervals,and the arterial and venous phases were calculated.The slope of energy spectrum curve and standardized energy spectrum parameters were analyzed by ROC curve.The diagnostic efficacy of energy spectrum parameters for adrenal nodular hyperplasia was analyzed by ROC curve.The statistical methods used in this study include independent sample t test,chi-square test,Fisher exact probability method and ROC curve.Results:1.The best single-energy image quality in arterial phase was better than 120 KVp-like image,and the best single-energy image CT value in arterial phase was significantly different between nodular hyperplasia group and fat-deficient adenoma group(P < 0.05),while there was no significant difference in venous phase(P > 0.05).2.There were significant differences in single energy CT values,Effective-Z,calcium-water concentration,iodine-HAP concentration,iodine-water concentration,HAP-water concentration,water-calcium concentration,water-HAP concentration,lipid-iodine concentration and iodine-lipid concentration of 40-80 keV in arterial adrenal nodular hyperplasia group and lipid-poor adenoma group(P < 0.05),but no significant differences in other energy spectrum parameters(P > 0.05).The ROC curves of 40-80 keV single energy CT values,Effective-Z,lipid-iodine concentration,iodine-lipid concentration,iodine-water concentration,calcium-water concentration,HAP-water concentration,water-HAP concentration,water-calcium concentration,iodine-HAP concentration were drawn.The AUC values were 0.875,0.842,0.833,0.833,0.762,0.823,0.833,0.817,0.814,0.821,0.746,0.613,0.633,respectively.Except for the low accuracy of water-calcium concentration and iodine-HAP concentration diagnosis,other indicators have certain diagnostic efficacy.The AUC values of 40 keV,effective atomic number,iodine-water and lipid-iodine are relatively large,which are 0.875,0.823,0.817 and 0.833 respectively.When the arterial phase is 40 keV,the critical values of effective atomic number,iodine-water and lipid-iodine concentration are 174 HU,8.94(Z),17.74(mg/cm3),994.27(mg/cm3),respectively,the sensitivity is 80.00%,90%,60%,85%.The specificity was 87.5%,62.5%,91.67% and 75%,respectively.The Yoden index was 0.675,0.525,0.517 and 0.600.The energy spectrum curves of the arterial adrenal nodular hyperplasia group and lipid-poor adenoma group were the same as those of the descending type,but the lower keV was,the greater the difference was between the two groups.The difference of slope of energy spectrum curve between the two groups was statistically significant(P < 0.001),and the slope of adrenal nodular hyperplasia group higher than that of lipid-poor adenoma.The ROC curve of slope of energy spectrum curve of two groups in arterial phase was drawn,AUC was 0.825.When 2.74 was used as the critical value for predicting adrenal nodular hyperplasia,sensitivity,specificity and Yoden index were 90.0%,62.5% and 0.525,respectively.3.There were significant differences in 40-80 keV CT value,effective atomic number and lipid-iodine concentration,iodine-lipid concentration,iodine-water concentration,HAP-water concentration,calcium-iodine concentration and calcium-water concentration between the arterial adrenal nodular hyperplasia group and lipid-poor adenoma group(P<0.05).The standardized ROC curves of 40 keV,50 keV,60 keV,70 keV,80 keV,Effective-Z and lipid-iodine concentration,iodine-lipid concentration,iodine-water concentration,calcium-iodine concentration,calcium-water concentration and HAP-water concentration in arterial phase were 0.808,0.742,0.763,0.779,0.692,0.813,0.815,0.728,0.650,0.788 and 0.733,respectively,of which only standardized 40 keV,0.788 and 0.733 were obtained.CT values of 50 keV,60keV and 70 keV,lipid-iodine concentration,iodine-lipid concentration,iodine-water concentration,calcium-water concentration and HAP-water concentration have certain diagnostic efficacy,while the diagnostic efficacy of the remaining indicators is low.The AUC of standardized 40 keV CT value,lipid-iodine concentration and iodine-lipid concentration were relatively large,0.808,0.813 and 0.815,respectively.When arterial standardized 40 keV CT value,lipid-iodine concentration and iodine-lipid concentration were 0.278,0.57 and 1.10 as the critical values for predicting adrenal hyperplasia,the sensitivity was 80.00%,91%,81%,specificity was 75%,57.33%,76%,and Yoden index was 0.55,0.483,0.57.4.The CT values of 40 keV,50 keV,iodine-HAP and lipid-iodine concentration in the venous adrenal nodular hyperplasia group and lipid-poor adenoma group had significant differences(P < 0.05),but there was no significant difference in other spectral parameters.The ROC curves of 40 keV,50 keV,iodine-HAP and lipid-iodine concentration in venous phase were drawn.AUC were 0.713,0.688,0.650 and 0.741,respectively.The CT values of 40 keV and lipid-iodine concentration in venous phase had certain diagnostic accuracy,while the remaining indicators had no diagnostic efficacy.The sensitivity,specificity and Yoden index were 90%,56%,66.67%,70.63%,0.567 and 0.446 respectively when the CT value and lipid-iodine concentration of 40 keV in venous phase were 222.35(HU)and 995.23(mg/cm3)as the critical values for predicting adrenal nodular hyperplasia.There5.significant differences in CT value,effective atomic number and calcium-water,iodine-water concentration,HAP-water,iodine-calcium,iodine-HAP,lipid-iodine concentration between the two groups in venous phase(P < 0.05),but there was no significant difference in the parameters of residual energy spectrum(P > 0.05).The ROC curves of standardized 40 keV,50 keV,60 keV CT values,effective atomic number and calcium-water,iodine-water concentration,HAP-water,iodine-calcium,iodine-HAP,lipid-iodine concentration in venous phase were 0.763,0.750,0.658,0.742,0.654,0.750,0.750,0.671,0.713 and 0.79,respectively.Among them,only standardized 40 keV,50 keV CT values,effective atomic number,iodine-water,iodine-iodine-iodine concentrated water,0.750,0.750,0.671,0.713 and 0.79 were obtained.Degree has a certain diagnostic efficiency,and the diagnostic efficiency of the remaining indicators is low.Conclusions:1.There was significant difference in CT value between adrenal nodular hyperplasia group and lipid-poor adenoma group in arterial phase(P < 0.05),but no significant difference in CT value between venous phase(P > 0.05).2.Energy spectrum CT imaging of partial single-energy images in arteriovenous phase,basal substance pair concentration and arterial phase energy spectrum curve have certain diagnostic value for adrenal nodular hyperplasia and lip-poor adenoma.40 keV single-energy CT value in arterial phase,basal substance pair(iodine-water,lipid-iodine),slope analysis of arterial phase energy spectrum curve and standardized iodine concentration and lipid concentration have better diagnostic efficacy for both groups.3.Spectral CT imaging provides a new method for differentiating adrenal nodular hyperplasia from lip-poor adenoma. |
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