The Value of Nonenhanced Single-Source Dual-Energy CT for Differentiating Metastases From Adenoma in Adrenal Glands

Rationale and Objectives To evaluate the value of the nonenhanced single-source dual-energy computed tomography (ssDECT) in differentiating metastases from adenomas in adrenal glands. Materials and Methods This retrospective study was approved by our Institutional Review Board, and written informed consent was waived. One hundred twelve patients (66 men:46 women; mean age, 58 years) with 63 adrenal metastases (AMs) and 64 adrenal adenomas (AAs) underwent a plain dual-energy spectral CT imaging from August 2011 to December 2013 were included. The fat (water) density (DFa [Wa]) from the material decomposition (MD) images and CT number and effective atomic number (eff-Z) from the virtual monochromatic spectral (VMS) image sets were measured for the AMs and AAs. The spectral Hounsfield unit (HU) curve (CT number as a function of photon energy from 40 to 140 keV) was generated, and its slope (K) was calculated. The difference of these parameters between AMs and AAs was statistically compared by the Wilcoxon rank sum test. Receiver operating characteristic curve (ROC) curves were used to compare the diagnostic efficacies of these measures in the identification of AAs and AMs. The distribution of spectral HU curve was analyzed using the chi-square test in terms of its slope K: ascending (K > 0.1), straight (−0.1 ≤ K ≤ 0.1), and descending (K  Results 1) The CT number (medium, range) of metastases (50.47, 29.93 HU at 40 keV and 29.00, 9.36 HU at 140 keV) was significantly higher than that of adenomas (−0.76, 33.04 to 13.73, 18.96 HU) at each energy level from 40 to 140 keV ( P P P 2  = 56.63; P Conclusions The nonenhanced ssDECT enables a multiparametric approach to provide an excellent sensitivity for identifying AMs from AAs.