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Comparison of CT Histogram Analysis and Chemical Shift MRI in the Characterization of Indeterminate Adrenal Nodules

Kartik S. Jhaveri1, Fenella Wong2, Sangeet Ghai3 and Masoom A. Haider1

1 Department of Medical Imaging, University Health Network and Mount Sinai Hospital, Princess Margaret Hospital, 610 University Ave., Toronto, ON M5G 2M9, Canada.
2 Department of Diagnostic Radiology, Christie Hospital NHS Trust, Withington, Manchester M20 4BX, United Kingdom.
3 Main X-ray Department, City General Hospital, Stoke-on-Trent ST4 6QG, United Kingdom.


Figure 1
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  		Fig. 1A —Adrenal adenoma in 31-year-old man. Unenhanced CT scan shows region of interest (ROI) has attenuation of 15 H.

 

Figure 2
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  		Fig. 1B —Adrenal adenoma in 31-year-old man. CT histogram analysis reveals ROI has significant number of negative pixels (> 10%).

 

Figure 3
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  		Fig. 2A —Adrenal metastasis in 58-year-old man. Unenhanced CT shows region of interest (ROI) has attenuation of 28 H.

 

Figure 4
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  		Fig. 2B —Adrenal metastasis in 58-year-old man. No negative pixels were recorded in ROI on CT histogram analysis.

 

Figure 5
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  		Fig. 3 —Scatterplot shows correlation between decreasing CT attenuation and increasing percentage of negative pixels. Note that no nonadenomas (gray squares) show more than 10% negative pixels. Significant overlap exists below threshold of 10% negative pixels (left of vertical dashed line). Black diamonds = adenomas.

 

Figure 6
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  		Fig. 4 —Scatterplot shows MRI characterizes greater number of nodules as adenoma (black diamonds) than CT histogram analysis: upper left area of graph formed between vertical dashed line at 10% negative pixel threshold of CT histogram and horizontal dotted line of 20% MR signal intensity drop shows additional nodules characterized on MRI. Gray squares = nonadenomas.

 

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