| Objective:To investigate the mechanism of the disease using the latest GE revolution 256 slice CT scanner,using the energy spectrum scanning mode of abdominal arteriovenous phase,the differences of energy spectrum parameters between aldosteronoma and cushing adenoma were preliminarily discussed,and the energy spectrum indexes with better diagnostic efficiency were selected,so as to better distinguish them and guide clinical treatment.Materials and methods:57 cases of adrenal adenoma had been collected,they all confirmed by laparoscopic surgery and pathology in our hospital,the lasting time were approximately two years,started in October 2018,ended in December 2020.they all divided into 30 cases of primary aldehyde adenoma group and 27 cases of cushing adenoma group.The basic rules of such grouping were based on the condequence of clinical endocrine test and clinical syndrome.First of all,the whole scan protocol can divide into two steps,all patients underent normal CT plain scans were what we need to do in the first step.Last but not least,after the first step,we need to switch on the adrenal GSI enhancement pattern,including arterial phase,when this phase had ended after 30 seconds,venous phase image will be collected.Regarding the data annalysis,we shall to find the differences about the fundamental clinical cases and rutine CT distinction in two type lesions.The spectral data of double phases of all patients were imported into GE ADW4.7 workstation for post-processing,because of the powerful function,the spectral data were exported.The data can be generally divided into a number of parts.Firstly,it can generate mono energy attenuation value in 10-keV increments,started in 40 keV,ended in 110 keV;Secondly,it can figure up Effective-Z of lesions;Thirdly,it can export base material pair concentration of double phases,usually,we choose the data in the name of 70 keV by default.Spectral curve will be depicted modeled on the mono energy attenuation value,and then figured out the slope.Lastly,for the sake of making the results more precise,we need to recalculate the standardized mono energy attenuation value of two phases,started in 40 keV,ended in 110 keV.For the quantitative data,if they abide by normal distribution,independent samples t test was conducted whose data abide by normal distribution.In the meantime,ROC curve and AUC need to be depicted when significant indicator screened out from 30 cases of primary aldehyde adenoma group and 27 cases of cushing adenoma group.Finally,importing above data to the EXCEL software,Youden index can be obtained,meanwhile,sensitivity、specificity can be screened out,and cut off value also be picked out.Results:(1)In regular CT plain scans,there were differences in the average size andaverage plain CT value between the two groups.AUC was 0.85,0.82,0.80,Youden index was 0.64,0.60,0.55,the best critical value was 13.86 mm,15.69 mm,15.57 HU,the diagnostic sensitivity was 90.00%,90.00%,85.70%.The diagnostic specificity was 76.00%,66.70%and 70.00%respectively;(2)the difference of single energy CT values at 40～80 keV in arterial phase was statistically significant,AUC at 40,50,60,70 and 80 keV was 0.80,0.79,0.88,0.76 and 0.67 respectively,Youden index was 0.51,0.57,0.66,0.51 and 0.32 respectively,and the best diagnostic cut-off values were 166.24,117.27,69.45,56.92 and 52.62 HU respectively,The sensitivity of diagnosis was 77.80%,81.50%,92.6%,74.68%,55.60%,the specificity of diagnosis was 73.30%,70.00%,73.30%,79.35%,76.70%;(3)In the term of arterial phase,there were differences of iodine,iodine(lipid)and lipid(iodine)concentration,the AUC were 0.82,0.87 and 0.77,respectively.The Youden index were 0.52,0.76 and 0.54,respectively.The best diagnostic cut-off values were 21.84(100ug/cm3),1021.97(200ug/cm3)and 18.52(mg/cm3),respectively.The sensitivity was 55.6%,80.00%and 83.30%,and the specificity was 96.70%,89.00%and 71.40%,respectively.(4)Partial standardized mono energy attenution were considered different in the term of arterial phase,the AUC at 40,50,60 and 70 keV were 0.76,0.77,0.84 and 0.74,respectively.The Youden index was 0.40,0.41,0.54 and 0.42,respectively.The best diagnostic cut-off values were 0.17,0.18,0.16 and 0.17 HU,The sensitivity was 91.62%,81.50%,77.80%,85.20%,and the specificity was 54.00%,60.00%,76.70%,57.70%.(5)Among all the energy levels,there were difference in 70 keV in the term of venous phase,correspondingly,AUC at 70 keV was 0.75,Youden index was 0.53,the best diagnostic cut-off value was 69.33 Hu,the diagnostic sensitivity was 83.30%,and the diagnostic specificity was 71.40%.(6)In the term of venous phase,there were differences of iodine,iodine(lipid),calcium(lipid)concentration and Effective-Z.The AUC were 0.78,0.79,0.79 and 0.86,respectively.The Youden index was 0.52,0.62,0.51 and 0.71,respectively.The best diagnostic cut-off values were 20.14(100ug/cm3),20.99(200ug/cm3),56.53(mg/cm3)and 8.71,respectively.The sensitivity was 93.47%,65.43%,75.36%and 97.31%,respectively.The specificity was 5 6.40%、91.86%、70.45%、92.43%.(7)There were slight difference in standardized mono energy attenution in the term of venous phase,AUC at 70 keV was 0.74,the Youden index was 0.43,cut-off value was 0.39,and specificity、sensitivity was 69.60%、76.70%,respectively.(8)In the term of arterial phase,the form and slope exist differences in two groups by calculation.AUC was 0.76,Youden index was 0.52,the best diagnostic cut-off value was 1.83,the diagnostic sensitivity was 85.20%,and the diagnostic specificity was 70.70%.Conclusion:(1)Part of the single energy CT value of spectral CT in arteriovenous phase,part of the standardized single energy CT value,part of the concentration of base material pairs,slope of spectral curve in arterial phase,plain CT value and lesion size have certain significance in the differential diagnosis of adrenal adenoma and Cushing’s adenoma.Part of the indicators have good diagnostic efficiency,which provides the imaging method for the classification of functional adrenal adenoma The new ideas and methods can better guide the clinical treatment.(2)Partial spectral parameters’ AUC reach to 0.80 and above,including 40、60 keV mono energy attenution、standardized mono energy in 60 keV、iodine(water)、iodine(lipid)concentration in the term of arterial phase and Effective-Z in the term of venous phase.The above parameters had superior diagnostic results relatively. |
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