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Lipid-Poor Adenomas on Unenhanced CT: Does Histogram Analysis Increase Sensitivity Compared with a Mean Attenuation Threshold?

Lisa M. Ho1, Erik K. Paulson1, Matthew J. Brady1, Terence Z. Wong1 and Sebastian T. Schindera1,2

1 Department of Radiology, Box 3808, Duke University Medical Center, Erwin Rd., Durham, NC 27710.
2 Present address: Institute for Diagnostic, Interventional and Pediatric Radiology, Inselspital Bern, University of Bern, Bern, Switzerland.


Figure 1
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  		Fig. 1A —68-year-old woman with right adrenal adenoma. Unenhanced CT scan shows region of interest (ROI) placed on lesion. Mean attenuation is –5.4 H.

 

Figure 2
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  		Fig. 1B —68-year-old woman with right adrenal adenoma. CT histogram analysis shows that for this ROI, 92 pixels measure less than 0 H. Total of 135 pixels results in 68% negative pixels calculated for this adrenal adenoma.

 

Figure 3
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  		Fig. 2 —Scatterplot illustrates correlation between mean CT attenuation and percentage of negative pixels. All metastases (squares) show less than 10% negative pixels (left of vertical dashed line). All lipid-rich adenomas (diamonds) had more than 10% negative pixels. Approximately 50% of lipid-poor adenomas (triangles) showed more than 10% negative pixels.

 

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