Diagnostic accuracy of dual-energy computed tomography angiography in the differentiation of benign and malignant pelvic masses

• Published in: European journal of radiology Vol. 150; p. 110240
• Main Authors: Ren, Zhen, Jiang, Bo, Wu, Xiong, Zhang, Zhibang, Chen, Hongliang, Cai, Haiyi, Fu, Chun
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01-05-2022
• Subjects: Angiography - methods; Computed Tomography Angiography; Diagnosis; Differential; Dual-energy CT; Female; Humans; Observer Variation; Pelvic Neoplasms; Prospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed - methods; Differential; LR; CI; ROC; kV; Computed Tomography Angiography; MPR; AUC; CT; MSCT; DSA; NPV; PPV; Dual-energy CT; Diagnosis; MIPs; VR; VMS; keV; Pelvic Neoplasms
• ISSN: 0720-048X; 1872-7727
• DOI: 10.1016/j.ejrad.2022.110240

•The dual-energy CT angiography and VMS images can provide characteristic discriminant images for distinguishing benign and malignant pelvic masses.•The study developed an optimal model for predicting benign and malignant pelvic masses.•The dual-energy CT angiography has higher accuracy than the original CT for predicting malignant and benign masses. (Response comment 5).
The dual-energy computed tomography(CT) angiography can accurately display subtle details of blood vessels and their surroundings. We aimed to apply dual-energy CT angiography and virtual monochromatic spectral(VMS) images to pelvic mass imaging and evaluate its value of distinguishing between benign and malignant pelvic masses.
The prospective study was approved by the Institutional Review Board and all participants signed informed consent forms. From August 2018 to July 2020, consecutive female patients with pelvic mass undergone dual-source third-generation CT angiography. The 40 keV VMS images were reconstructed to display mass morphology and corresponding feeding arteries. All images were evaluated by two radiologists blinded to diagnosis(with 9 years and 10 years of experience in CT reading).Disagreements were solved by consensus. The final diagnosis was using histopathology results as the gold standard. Interobserver variability was calculated using Cohen’s kappa and Quadratic Weighted Kappa. The differences between benign and malignant masses were compared using the chi-square test. Accuracy rate, sensitivity, specificity, and the area under the curve (AUC) were calculated as the primary indices for diagnostic accuracy. McNemar test was used to evaluate the difference in diagnostic accuracy between dual-energy CT angiography images and original CT images. A two-tailed P < 0.05 was considered statistically significant.
A total of 64 patients with 28 malignant masses and 47 benign masses were included. The characteristics of malignant masses showed the branch number of the main feeding artery was ≥ 3(71.4%, 20/28), the course of feeding artery(100%, 28/28) and the mass shape(85.7%, 24/28) were both irregulars. Those characteristics all had statistical differences between benign and malignant masses(all P = 0.000). The Models using the course of feeding artery as a predictor, the accuracy, sensitivity and positive likelihood ratio were 89.3% (95 % CI: 0.801, 0.947), 100% (95 % CI: 0.850, 1) and 5.875(95 % CI: 3.125, 11.044), respectively. The diagnostic accuracy of every model by dual-energy CT angiography was significantly higher than that by original CT imaging(all P = 0.000).
The dual-energy CT angiography can distinguish malignant pelvic masses from benign masses by providing characteristic images of feeding arteries and mass shape.