RESUMEN
Objective To investigate the differential diagnostic value of CT scan minimum attenuation values (minAVsCT) in adrenal adenomas and non-adenomas.Methods CT scan data of 89 cases of clinical and pathologically confirmed adrenal adenomas were subjected to retrospective analysis and compared with data of 46 cases involving 50 non-adenomas (25 metastases,20 pheochromocytomas,3 lymphomas,and 2 cortical carcinomas).The distributions of mean attenuation values (meanAVs) ￥ 10 Hu and minAVs ￥0 Hu and CT histogram analysis with ≥ 10％ negative pixels were observed in adrenal adenomas and non-adenomas,and the diagnostic sensitivity and specificity of these 3 methods for adenomas were calculated.Results The distributions of unenhanced meanAVs ￥ 10 Hu,minAVs ￥0 Hu,and CT histogram analysis with ≥ 10％ negative pixels among cases of adenoma and non-adenoma were 62.9％ (56/89) and 0％ (0/50) (x2=52.687,P=0.000),84.3％ (75/89) and 2％ (1/50) （x2=83.917,P=0.000),and 77.5％ (69/89) and 0％ (0/50) (x2=83.917,P=0.000),respectively.The respective diagnostic sensitivities,specificities,false negative rate (FNR),false positive rate (FPR),positive pre dictive value (PPV),negative predictive value (NPV) and accuracy of these 3 methods for adenomas were 62.9％vs 84.3％ vs 77.5％,100％ vs 98.0％ vs 100％,37.1％ vs 15.7％ vs 22.5％,0 vs 2％ vs 0,100％ vs 98.7％ vs 100％,60.2％ vs 77.8％ vs 71.4％,and 76.3％ vs 89.2％ vs 85.6％.Conclusion Although the specificity and PPV of minAVs≤0Hu is slightly less than meanAVs≤10Hu and CT histogram analysis with ≥ 10％ negative pixels,it exhibits the best sensitivity and accuracy with a simple operation,and is thus suitable for clinical application.
RESUMEN
Objective To investigate the combination of multiple CT signs in diagnosis and differential diagnosis of nodular goiters (NGs).Methods The CT images of 242 pathologically confirmed lesions (＞ 10 mm in diameter) from 188 patients with nodular goiters were retrospectively reviewed.The CT signs,including regular shape,cystic degeneration,clearer enhancement margin,strong enhancement of nodular goiters were compared with those of 236 pathologically confirmed lesions (＞ 10 mm in diameter)from 225 patients with papillary thyroid carcinomas (PTCs).The sensitivity,specificity and accuracy of different CT signs or their combination in diagnosis and differential diagnosis of NGs were analyzed.Results Regular shape was present in 208 of 242 NGs (86.0％) and in 35 of 236 PTCs (14.8％) (x2 =241.804,P =0.000).Cystic degeneration was present in 143 of 242 NGs (59.1％) and 7 of 236 PTCs (3.0％)(x2 =174.783,P =0.000).Clearer enhancement margin was present in 192 of 242 NGs (79.3 ％) and in 51 of 236 PTCs (21.6％) (x2 =159.318,P =0.000).Strong enhancement was present in 41 of 242 NGs(16.9％) and in 3 of 236 PTCs (1.3％) (x2 =35.108,P =0.000).Regular shape showed the highest sensitivity and accuracy for diagnosis of NGs (86.0％ and 85.6％),while strong enhancement showed the highest specificity (98.7％).The combination of regular shape and clearer enhancement margin showed the highest sensitivity and accuracy of 67.4％ and 80.5％,respectively.The combination of strong enhancement with any of other signs showed the highest specificity of 100.0％.The combination of regular shape,cystic degeneration and clearer enhancement margin showed the highest sensitivity,specificity and accuracy of 45.5％,99.6％ and 72.2％ respectively.The combing of 4 signs showed a sensitivity,specificity,and accuracy of 2.9％,100.0％ and 50.8％.Conclusion CT scan is effective for diagnosis of NGs,and the combination of different CT signs can significantly improve the specificity and reduce the incidence of misdiagnosis to avoid unnecessary surgery.