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Dual-energy CT in differentiating benign sinonasal lesions from malignant ones: comparison with simulated single-energy CT, conventional MRI, and DWI

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Abstract

Objectives

To explore the value of dual-energy CT (DECT) for differentiating benign sinonasal lesions from malignant ones, and to compare this finding with simulated single-energy CT (SECT), conventional MRI (cMRI), and diffusion-weighted imaging (DWI).

Methods

Patients with sinonasal lesions (38 benign and 34 malignant) who were confirmed by histopathology underwent DECT, cMRI, and DWI. DECT-derived parameters (iodine concentration (IC), effective atomic number (Eff-Z), 40–180 keV (20-keV interval), virtual non-enhancement (VNC), slope (k), and linear-mixed 0.3 (Mix-0.3)), DECT morphological features, cMRI characteristics, and ADC value of benign and malignant tumors were compared using t test or chi-square test. Receiver operating characteristic (ROC) curve was performed to evaluate the diagnostic performance, and the area under the ROC curve (AUC) was compared using the Z test to select the optimal diagnostic approach.

Results

Significantly higher DECT-derived single parameters (IC, Eff-Z, 40 keV, 60 keV, 80 keV, slope (k), Mix-0.3) were found in malignant lesions than those of benign sinonasal lesions (all p < 0.004, Bonferroni correction). Combined quantitative parameters (IC, Eff-Z, 40 keV, 60 keV, 80 keV, slope (k)) can improve the diagnostic efficiency for discriminating these two entities. Combination of DECT quantitative parameters and morphological features can further improve the overall diagnostic performance, with AUC, sensitivity, specificity, and accuracy of 0.935, 96.67%, 90.00%, and 93.52%. Moreover, the AUC of DECT was higher than those of Mix-0.3 (simulated SECT), cMRI, DWI, and cMRI+DWI.

Conclusions

Compared with simulated SECT, cMRI, and DWI, DECT appears to be a more accurate imaging technique for differentiating benign from malignant sinonasal lesions.

Key Points

• DE can differentiate benign sinonasal lesions from malignant ones based on DECT-derived qualitative parameters.

• DECT appears to be more accurate in the diagnosis of sinonasal lesions when compared with simulated SECT, cMRI, and DWI.

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Abbreviations

ADC:

Apparent diffusion coefficient

AUC:

Area under the curve

CI:

Confidence interval

cMRI:

Conventional MRI

CT:

Computed tomography

DECT:

Dual-energy CT

DWI:

Diffusion-weighted imaging

Eff-Z:

Effective atomic number

FOV:

Field of view

IC:

Iodine concentration

ICC:

Intraclass correlation coefficient

Mix-0.3:

Linear-mixed 0.3 images

MRI:

Magnetic resonance imaging

NPV:

Negative predictive value

PPV:

Positive predictive value

ROC:

Receiver operating characteristic

ROIs:

Regions of interest

SECT:

Single-energy CT

T1WI:

T1-weighted imaging

T2WI:

T2-weighted imaging

TE:

Echo time

TR:

Repetition time

VNC:

Virtual non-enhancement

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Funding

This work was supported by the Grant of Science and Technology Commission of Shanghai Municipality (No. 17411962100).

Author information

Author notes

  1. Peng Wang and Zuohua Tang contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Eye & ENT Hospital of Shanghai Medical School, Fudan University, 83 Fenyang Road, Shanghai, 200031, People’s Republic of China

    Peng Wang, Zuohua Tang, Zebin Xiao, Rujian Hong & Yuzhe Wang

  2. Department of Radiology, The Affiliated Renmin Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212002, People’s Republic of China

    Peng Wang

  3. Department of Biomedical Sciences, University of Pennsylvania, Philadelphia, 19104, USA

    Zebin Xiao

  4. The Shanghai Institution of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, 200032, People’s Republic of China

    Rong Wang & Yang Zhan

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  1. Peng Wang
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Correspondence to Zuohua Tang.

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Guarantor

The scientific guarantor of this publication is Prof. Zuohua Tang, MD, PhD, Eye and ENT Hospital of Shanghai Medical School, Fudan University.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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Wang, P., Tang, Z., Xiao, Z. et al. Dual-energy CT in differentiating benign sinonasal lesions from malignant ones: comparison with simulated single-energy CT, conventional MRI, and DWI. Eur Radiol 32, 1095–1105 (2022). https://doi.org/10.1007/s00330-021-08159-3

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