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Distinguishing enhancing from nonenhancing renal masses with dual-source dual-energy CT: iodine quantification versus standard enhancement measurements

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Abstract

Purpose

To compare the diagnostic accuracy of iodine quantification and standard enhancement measurements in distinguishing enhancing from nonenhancing renal masses.

Materials and methods

The Institutional Review Board approved this retrospective study conducted from data found in institutional patient databases and archives. Seventy-two renal masses were characterised as enhancing or nonenhancing using standard enhancement measurements (in HU) and iodine quantification (in mg/ml). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of standard enhancement measurements and iodine quantification were calculated from χ 2 tests of contingency with histopathology or imaging follow-up as the reference standard. Difference in accuracy was assessed by means of McNemar analysis.

Results

Sensitivity, specificity, PPV, NPV and diagnostic accuracy for standard enhancement measurements and iodine quantification were 77.7 %, 100 %, 100 %, 81.8 %, 89 % and 100 %, 94.4 %, 94.7, 100 % and 97 %, respectively. The McNemar analysis showed that the accuracy of iodine quantification was significantly better (P < 0.001) than that of standard enhancement measurements.

Conclusion

Compared with standard enhancement measurements, whole-tumour iodine quantification is more accurate in distinguishing enhancing from nonenhancing renal masses.

Key Points

• Enhancement of renal lesions is important when differentiating benign from malignant tumours.

• Dual-energy CT offers measurement of iodine uptake rather than mere enhancement values.

• Whole-tumour iodine quantification seems more accurate than standard CT enhancement measurements.

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Abbreviations

CT:

Computed tomography

HU:

Hounsfield units

RCC:

Renal cell carcinoma

MDCT:

Multidetector CT

ROI:

Region of interest

Mg/ml:

Milligram per millilitre

SD:

Standard deviation

FOV:

Field of view

TUE:

True unenhanced images

CI:

Confidence interval

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Acknowledgments

We thank Bernhard Krauss who is an employee of Siemens AG for providing the Syngo Dual Energy software. He had no control of the data in this study.

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Authors and Affiliations

  1. Department of Radiological Sciences, Policlinico “G. Martino”, Messina, Italy

    Giorgio Ascenti, Achille Mileto, Michele Gaeta, Alfredo Blandino, Emanuele Scribano, Nicola Settineri & Silvio Mazziotti

  2. Siemens AG, Healthcare Sector, Forchheim, Germany

    Bernhard Krauss

  3. Dipartimento di Scienze Radiologiche, Policlinico “G. Martino”, Via Consolare Valeria 1, 98125, Messina, Italy

    Achille Mileto

Authors
  1. Giorgio Ascenti
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  2. Achille Mileto
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  8. Silvio Mazziotti
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Correspondence to Achille Mileto.

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Ascenti, G., Mileto, A., Krauss, B. et al. Distinguishing enhancing from nonenhancing renal masses with dual-source dual-energy CT: iodine quantification versus standard enhancement measurements. Eur Radiol 23, 2288–2295 (2013). https://doi.org/10.1007/s00330-013-2811-4

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  • DOI: https://doi.org/10.1007/s00330-013-2811-4

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