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Validation of the modified CT criteria for identifying non-adenomas

  • Kidneys, Ureters, Bladder, Retroperitoneum
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Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

Although adrenal computed tomography (CT) percentage washout is a potentially powerful imaging technique for differentiating adrenal adenomas from non-adenomas, its application to non-adenomas can be problematic. Recently, modified criteria for diagnosing pheochromocytomas using adrenal CT were developed based on data from 199 patients with surgically proven pheochromocytomas and adenomas. However, these criteria have not been thoroughly validated. The purpose of this study was to validate the performance of the modified criteria for diagnosing non-adenomas including pheochromocytomas.

Methods

The conventional and modified criteria were applied to 266 patients from two cohorts who had surgically proven lipid-poor adenomas (155/266, 58.3%) and non-adenomas (111/266, 41.7%) and underwent adrenal CT. Two radiologists calculated the attenuation on each dynamic phase and percentage washout of adrenal masses. The final assessments based on the conventional and modified criteria were categorized into adenomas or non-adenomas. The diagnostic performance of each criterion for diagnosing non-adenomas was evaluated using the area under the receiver operating characteristic curve (AUC). False negatives and positives were also compared.

Results

The AUC for the diagnosis of non-adenomas was 0.806 for conventional criteria and 0.858 for modified criteria (p = 0.047). The false-negative rate of conventional criteria for the diagnosis of non-adenomas was 29.7%. Use of modified criteria could have reduced the false-negative rate by to 7.2%. The false-positive rate increased from 9% to 21.3% when using the modified criteria.

Conclusion

The utilization of modified criteria has the potential to identify additional non-adenomas that would otherwise be misdiagnosed as adenomas using conventional criteria alone.

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Acknowledgements

We would like to express our sincere gratitude to Dr. Sung Yoon Park for his valuable insights and guidance throughout this research.

Funding

No funds, grants, or other support was received.

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Author notes

  1. Min Hwan Kwak and Ji-Sup Yun have equally contributed co-first authors to this work.

Authors and Affiliations

  1. Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea

    Min Hwan Kwak, Chan Kyo Kim & Kyung A. Kang

  2. Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea

    Ji-Sup Yun

  3. Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea

    Ji Na Kim & Young Rae Lee

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  1. Min Hwan Kwak
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Correspondence to Chan Kyo Kim or Kyung A. Kang.

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Ethical approval was waived by the local Ethics Committee of Samsung Medical center and Kangbuk Samsung Hospital in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

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Kwak, M.H., Yun, JS., Kim, J.N. et al. Validation of the modified CT criteria for identifying non-adenomas. Abdom Radiol (2024). https://doi.org/10.1007/s00261-024-04206-x

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