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Hyperattenuating adrenal lesions in lung cancer: biphasic CT with unenhanced and 1-min enhanced images reliably predicts benign lesions

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Abstract

Objectives

To investigate usefulness of biphasic computed tomography (CT) in characterizing hyperattenuating adrenal lesions in lung cancer.

Methods

This retrospective study included 239 patients with lung cancer who underwent adrenal CT for hyperattenuating (> 10 Hounsfield unit) adrenal lesions. Adrenal CT comprised unenhanced and 1-min and 15-min enhanced images. We dichotomized adrenal lesions depending on benign or metastatic lesions. Reference standard for benignity was histologic confirmation or ≥ 6-month stability on follow-up CT. Two independent readers analyzed absolute (APW) or relative percentage wash-out (RPW) using triphasic CT, and enhancement ratio (ER) or percentage wash-in (PWI) using biphasic CT (i.e., unenhanced and 1-min enhanced CT). Criteria for benignity were as follows: criteria 1, (a) APW ≥ 60% or (b) RPW ≥ 40%, and criteria 2, (a) ER > 3 and (b) PWI > 200%. We analyzed area under the curve (AUC) and accuracy for benignity, and inter-reader agreement.

Results

Proportion of benign adrenal lesion was 71.1% (170/239). For criteria 1 and 2, AUCs were 0.872 (95% confidence interval [CI], 0.822–0.911) and 0.886 (95% CI, 0.838–0.923), respectively, for reader 1 (p = 0.566) and 0.816 (95% CI, 0.761–0.863) and 0.814 (95% CI, 0.759–0.862), respectively, for reader 2 (p = 0.955), and accuracies were 87.9% (210/239) and 86.2% (206/239), respectively, for reader 1 (p = 0.479) and 81.2% (194/239) and 80.3% (192/239), respectively, for reader 2 (p = 0.763). Weighted kappa was 0.725 (95% CI, 0.634–0.816) for criteria 1 and 0.736 (95% CI, 0.649–0.824) for criteria 2.

Conclusion

Biphasic CT can reliably characterize hyperattenuating adrenal lesions in patients with lung cancer.

Key Points

• Criteria from biphasic computed tomography (CT) for diagnosing benign adrenal lesions were enhancement ratio of > 3 and percentage wash-in of > 200%.

• In the analysis by two independent readers, area under the curve between criteria 1 and 2 was not significantly different (0.872 and 0.886 for reader 1; 0.816 and 0.814, for reader 2; p > 0.05 for each comparison).

• Wash-in characteristics from biphasic CT are helpful to predict benign adrenal lesions in lung cancer.

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Abbreviations

APW:

Absolute percentage wash-out

CECT:

Contrast-enhanced computed tomography

CT:

Computed tomography

ER:

Enhancement ratio

FDG:

Fluorodeoxyglucose

HU:

Hounsfield unit

LOESS:

Locally estimated scatterplot smoothing

NPV:

Negative predictive value

PET:

Positron emission tomography

PPV:

Positive predictive value

PWI:

Percentage wash-in

ROI:

Region of interest

RPW:

Relative percentage wash-out

UCT:

Unenhanced computed tomography

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Acknowledgments

This study was supported by Samsung Medical Center Grant (SMO1190081).

We would like to thank Editage (www.editage.co.kr) for English language editing.

Funding

This study was supported by Samsung Medical Center Grant (SMO1190081).

Author information

Authors and Affiliations

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

    Ho Yun Lee & Sung Yoon Park

  2. Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Young Lyun Oh

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  1. Ho Yun Lee
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Corresponding author

Correspondence to Sung Yoon Park.

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The scientific guarantor of this publication is Sung Yoon Park, M.D.

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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.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

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• retrospective

• cross sectional study

• performed at one institution

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Lee, H.Y., Oh, Y.L. & Park, S.Y. Hyperattenuating adrenal lesions in lung cancer: biphasic CT with unenhanced and 1-min enhanced images reliably predicts benign lesions. Eur Radiol 31, 5948–5958 (2021). https://doi.org/10.1007/s00330-020-07648-1

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  • DOI: https://doi.org/10.1007/s00330-020-07648-1

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