Decreased attenuation difference between non-contrast and portal-venous phases of CT predicts the ultrasonography-unspecified adnexal torsion.

IF 4.1 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Insights into Imaging Pub Date : 2025-01-10 DOI:10.1186/s13244-024-01885-4

Weili Xie, Zhongren Huang, Hongmei Kuang, Xiaoxing Li, Rixin Zhang, Wei Zeng, Cheng Jin, Junyuan Zhong, Jidong Peng, Weiling Cheng, Fuqing Zhou

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引用次数: 0

Abstract

Objectives: To evaluate the value of contrast-enhanced CT in diagnosing ultrasonography-unspecified adnexal torsion (AT).

Methods: Surgically confirmed patients with painful pelvic masses (n = 165) were retrospectively collected from two institutes. Two senior radiologists independently reviewed the CT images and determined the Hounsfield unit difference between non-contrast vs portal venous phases (ΔHU_PV-NC) in both derivation and validation samples. The cutoff value, sensitivity, specificity, predictivity, and reproducibility of the ΔHU_PV-NC and other visually assessed CT signs were analyzed and compared using the receiver-operating characteristic curve, multivariable regression, and inter-rater agreement assays, respectively.

Results: Women with twisted (n = 73 [47 ± 19 years]) or untwisted (n = 92 [40 ± 15 years]) adnexal lesions were reviewed. The ΔHU_PV-NC ≤ 17.5 HU (AUC: 0.91 [95% CI: 0.86, 0.96]; sensitivity: 95% [95% CI: 87, 98]; and specificity: 88% [95% CI: 80, 94]) was the independent predictor of AT (OR: 137 [95% CI: 39, 481], p < 0.001). After training in ΔHU_PV-NC measurement, the agreement between two junior residents and the consensus increased from fair (resident-1: 0.29 [95% CI: 0.17, 0.41]; resident-2: 0.24 [95% CI: 0.1, 0.39]) to substantial (resident-1: 0.75 [95% CI: 0.65, 0.85]; resident-2: 0.72 [95% CI: 0.62, 0.83]). The post-training diagnostic accuracy (both residents: 81% [95% CI: 74, 87]) was higher than the pre-training accuracy (resident-1: 67% [95% CI: 59, 74], p = 0.007; resident-2: 66% [95% CI: 58, 73], p = 0.002).

Conclusion: The sign of ΔHU_PV-NC ≤ 17.5 HU in contrast-enhanced CT can be used to predict the ultrasonography-unspecified AT.

Critical relevance statement: The decreased attenuation difference between non-contrast vs portal venous phases, a quantitative measurement-based CT sign, highlights the value of using contrast-enhanced CT as a second-line imaging approach after an equivocal ultrasonographic examination to diagnose AT in emergency settings.

Key points: The value of contrast-enhanced CT in diagnosing ultrasonography-unspecified AT is underestimated. The ΔHU_PV-NC ≤ 17.5 HU is the only predictor to diagnose the ultrasonography-unspecified AT. Contrast-enhanced CT can be used as a second-line imaging approach after an equivocal ultrasonographic examination.

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CT非对比期和门静脉期衰减差的降低预示着超声未指明的附件扭转。

目的：探讨CT造影对超声未明确附件扭转（AT）的诊断价值。方法：回顾性收集两所医院手术确诊的盆腔肿块患者165例。两位资深放射科医生独立审查了CT图像，并确定了衍生和验证样本中非造影剂期与门静脉期的Hounsfield单位差异（ΔHUPV-NC）。分别使用受试者-工作特征曲线、多变量回归和评分间一致性分析，对ΔHUPV-NC和其他目测CT体征的截止值、敏感性、特异性、预测性和再现性进行分析和比较。结果：回顾性分析了73例（47±19岁）或92例（40±15岁）附件病变。胡的ΔHUPV-NC≤17.5 (AUC: 0.91(95%置信区间CI: 0.86, 0.96);灵敏度：95% [95% CI: 87, 98]；和特异性：88% [95% CI: 80,94])是AT的独立预测因子（OR: 137 [95% CI: 39,481]）， p PV-NC测量，两个初级住院医师之间的一致性和共识从公平增加(住院医师1:0.29 [95% CI: 0.17, 0.41]；居民-2:0.24 [95% CI: 0.1, 0.39])到实质性(居民-1:0.75 [95% CI: 0.65, 0.85]；resident-2: 0.72 [95% CI: 0.62, 0.83])。训练后的诊断准确率（两位住院医师：81% [95% CI: 74,87]）高于训练前的准确率(住院医师-1:67% [95% CI: 59, 74], p = 0.007；居民-2:66% [95% CI: 58, 73], p = 0.002)。结论：增强CT ΔHUPV-NC≤17.5 HU征象可用于超声未明确AT的预测。关键相关性声明：未造影剂与门静脉相之间衰减差的减小，是一种基于定量测量的CT征象，强调了在紧急情况下，在模棱两可的超声检查后，使用增强CT作为二线成像方法诊断AT的价值。重点：对比增强CT诊断超声未明确AT的价值被低估。ΔHUPV-NC≤17.5 HU是诊断超声未指明AT的唯一预测因子。对比增强CT可作为模棱两可的超声检查后的二线成像方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Insights into Imaging Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

7.30

自引率

4.30%

发文量

182

审稿时长

13 weeks

期刊介绍： Insights into Imaging (I³) is a peer-reviewed open access journal published under the brand SpringerOpen. All content published in the journal is freely available online to anyone, anywhere! I³ continuously updates scientific knowledge and progress in best-practice standards in radiology through the publication of original articles and state-of-the-art reviews and opinions, along with recommendations and statements from the leading radiological societies in Europe. Founded by the European Society of Radiology (ESR), I³ creates a platform for educational material, guidelines and recommendations, and a forum for topics of controversy. A balanced combination of review articles, original papers, short communications from European radiological congresses and information on society matters makes I³ an indispensable source for current information in this field. I³ is owned by the ESR, however authors retain copyright to their article according to the Creative Commons Attribution License (see Copyright and License Agreement). All articles can be read, redistributed and reused for free, as long as the author of the original work is cited properly. The open access fees (article-processing charges) for this journal are kindly sponsored by ESR for all Members. The journal went open access in 2012, which means that all articles published since then are freely available online.