Dual-energy CT for differential diagnosis of adrenal lesions

BACKGROUND: Adrenal lesion characterization remains a diagnostic challenge due to overlapping imaging features. Dual-energy CT (DECT) shows promise for identifying image-based biomarkers but requires further validation.

AIM: To evaluate the diagnostic utility of DECT in differentiating adrenal lesions.

MATERIALS AND METHODS: This retrospective single-center study analyzed DECT data. Parameters from 40/70/80 keV virtual monoenergetic images and water-iodine/fat-iodine/water-fat decomposition maps were evaluated. Statistical analysis included Kruskal-Wallis, Mann-Whitney U, ROC tests.

RESULTS: The cohort included 74 patients (median age 46.0 years (39.3–57.9), 48 women). For ACC and adenomas differentiation, mean 70 keV delayed phase attenuation showed the highest discriminative value (AUC=0.92; 95% CI: 0.81–1.00; p=0.001). For ACC and pheochromocytomas, standard deviation delayed phase water concentration (water-fat maps) achieved the highest diagnostic performance (AUC=0.89; 95% CI: 0.79–0.97; p=0.001). Maximum 70 keV delayed phase attenuation best distinguished adenomas from pheochromocytomas (AUC=0.82; 95% CI: 0.71–0.92; p<0.001).

CONCLUSION: DECT has proven its diagnostic value in the differential diagnosis of adrenal lesions.

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