Incidental findings are common in abdominal computed tomography (CT) and often warrant further investigations with economic implications as well as implications for patients.
Purpose
To evaluate the potential of dual-energy CT (DECT) in the identification and/or characterization of abdominal incidental mass lesions compared to conventional contrast-enhanced CT
Material and Methods
This retrospective study from a major tertiary hospital included 96 patients, who underwent contrast-enhanced abdominal DECT. Incidental lesions in adrenals, kidneys, liver, and pancreas were evaluated by two board-certified abdominal radiologists. Observer 1 only had access to standard CT reconstructions, while observer 2 had access to standard CT as well as DECT reconstructions. Disagreements were resolved by consensus review and used as a reference for observers using McNemar's test
Results
Observers 1 and 2 identified a total of 40 and 34 findings, respectively. Furthermore, observer 1 registered 13 lesions requiring follow-up, of which seven (two renal and five adrenal lesions) were resolved following consensus review using DECT (P = 0.008). The inter-observer agreement was near perfect (κ = 0.82).
Conclusion
DECT has the potential to improve the immediate characterization of incidental findings when compared to conventional CT for abdominal imaging.
KellyMEHeeneyARedmondCE, et al.Incidental findings detected on emergency abdominal CT scans: a 1-year review. Abdom Imaging2015;40:1853–1857.
2.
DingAEisenbergJDPandharipandePV. The economic burden of incidentally detected findings. Radiol Clin North Am2011;49:257–265.
3.
SlebockiKKrausBChangDH, et al.Incidental findings in abdominal dual-energy computed tomography: correlation between true noncontrast and virtual noncontrast images considering renal and liver cysts and adrenal masses. J Comput Assist Tomogr2017;41:294–297.
4.
GooHWGooJM. Dual-energy CT: new horizon in medical imaging. Korean J Radiol2017;18:555–569.
5.
AlbrechtMHVoglTJMartinSS, et al.Review of clinical applications for virtual monoenergetic dual-energy CT. Radiology2019;293:260–271.
6.
CarusoDDe CeccoCNSchoepfUJ, et al.Can dual-energy computed tomography improve visualization of hypoenhancing liver lesions in portal venous phase? Assessment of advanced image-based virtual monoenergetic images. Clin Imaging2017;41:118–124.
7.
McColloughCHLengSYuL, et al.REVIEW: dual-and multi-energy CT. RSNA Radiology2015;276:637–653.
8.
XuJJBoesenMRHansenSL, et al.Assessment of liver fat: dual-energy CT versus conventional CT with and without contrastDiagnostics2022;12:708.
9.
MiletoANelsonRCMarinD, et al.Dual-energy multidetector CT for the characterization of incidental adrenal nodules: diagnostic performance of contrast-enhanced material density analysis. Radiology2015;274:445–454.
10.
PatelBNVernuccioFMeyerM, et al. Dual-energy CT material density iodine quantification for distinguishing vascular from nonvascular renal lesions: normalization reduces intermanufacturer threshold variability. AJR Am J Roentgenol2019;212:366–376.
11.
GanguliISimpkinALLupoC, et al.Cascades of care after incidental findings in a US national survey of physicians. JAMA Netw Open2019;2:e1913325–e1913325.
12.
ChenL-HJinCLiJ-Y, et al.Image quality comparison of two adaptive statistical iterative reconstruction (ASiR, ASiR-V) algorithms and filtered back projection in routine liver CT. Br J Radiol2018;91:20170655.
13.
Garfield K, Leslie SW. Simple Renal Cyst. [Updated 2022 May 27]. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing, 2022 Jan. Available at: https://www.ncbi.nlm.nih.gov/books/NBK499900/
14.
LeeJMKimMKKoSH, et al.Clinical guidelines for the management of adrenal incidentaloma. Endocrinol Metab (Seoul)2017;32:200–218.
15.
LeeMJHahnPFPapanicolaouN, et al.Benign and malignant adrenal masses: CT distinction with attenuation coefficients, size, and observer analysis. Radiology1991;179:415–418.
16.
HertsBRSilvermanSGHindmanNM, et al.Management of the incidental renal mass on CT: a white paper of the ACR incidental findings committee. J Am Coll Radiol2018;15:264–273.
17.
GoreRMPickhardtPJMorteleKJ, et al.Management of incidental liver lesions on CT: a white paper of the ACR incidental findings committee. J Am Coll Radiol2017;14:1429–1437.
18.
MegibowAJBakerMEMorganDE, et al.Management of incidental pancreatic cysts: a white paper of the ACR incidental findings committee. J Am Coll Radiol2017;14:911–923.
19.
MartinSSWeidingerSCzwiklaR, et al.Iodine and fat quantification for differentiation of adrenal gland adenomas from metastases using third-generation dual-source dual-energy computed tomography. Invest Radiol2018;53:173–178.
20.
BotsikasDTriponezFBoudabbousS, et al.Incidental adrenal lesions detected on enhanced abdominal dual-energy CT: can the diagnostic workup be shortened by the implementation of virtual unenhanced images?Eur J Radiol2014;83:1746–1751.
21.
TsurusakiMSofueKHoriM, et al.Dual-energy computed tomography of the liver: uses in clinical practices and applications. Diagnostics (Basel)2021;11:161.
22.
ChuAJLeeJMLeeYJ, et al.Dual-source, dual-energy multidetector CT for the evaluation of pancreatic tumours. Br J Radiol2012;85:e891–e898.
23.
NodaYTochigiTParakhA, et al.Low keV portal venous phase as a surrogate for pancreatic phase in a pancreatic protocol dual-energy CT: feasibility, image quality, and lesion conspicuity. Eur Radiol2021;31:6898–6908.
24.
LandisJRKochGG. The measurement of observer agreement for categorical data. Biometrics1977;33:159–174.
25.
AndersenMBEbbesenDThygesenJ, et al.Impact of spectral body imaging in patients suspected for occult cancer: a prospective study of 503 patients. Eur Radiol2020;30:5539–5550.
26.
AdamSZRabinowichAKessnerR, et al.Spectral CT of the abdomen: where are we now?Insights Imaging2021;12:138.
27.
GuptaAKikanoEGBeraK, et al.Dual energy imaging in cardiothoracic pathologies: a primer for radiologists and clinicians. Eur J Radiol Open2021;8:100324.
28.
HenzlerTFinkCSchoenbergSO, et al.Dual-energy CT: radiation dose aspects. AJR Am J Roentgenol2012;199:S16–S25.
29.
CourseyCANelsonRCBollDT, et al.Dual-energy multidetector CT: how does it work, what can it tell us, and when can we use it in abdominopelvic imaging?Radiographics2010;30:1037–1055.
30.
XuJJTaudorfMUlriksenPS, et al.Gastrointestinal applications of iodine quantification using dual-energy CT: a systematic review. Diagnostics2020;10:814.
31.
WongWDMohammedMFNicolaouS, et al.Impact of dual-energy CT in the emergency department: increased radiologist confidence, reduced need for follow-up imaging, and projected cost benefit. AJR Am J Roentgenol2020;215:1528–1538.
32.
KunoHSekiyaKChapmanMN, et al.Miscellaneous and emerging applications of dual-energy computed tomography for the evaluation of intracranial pathology. Neuroimaging Clin N Am2017;27:411–427.
33.
FagerlandMWLydersenSLaakeP. The McNemar test for binary matched-pairs data: mid-p and asymptotic are better than exact conditional. BMC Med Res Methodol2013;13:91.
34.
JacobsenMCSchellingerhoutDWoodCA, et al.Intermanufacturer comparison of dual-energy CT iodine quantification and monochromatic attenuation: a phantom study. Radiology2018;287:224–234.
