title: Comparison of CT histogram analysis and chemical shift MRI in the characterization of indeterminate adrenal nodules.
abstract: OBJECTIVE
  Adrenal nodules having an attenuation of more than 10 H on unenhanced CT are considered indeterminate. The purpose of this study was to compare CT histogram analysis and chemical shift MRI in the characterization of indeterminate adrenal nodules.
  
  
  METHODS
  Thirty-nine adrenal masses that were indeterminate on CT were identified in 37 patients. Histogram analysis was performed on unenhanced CT from a region of interest (ROI) that recorded mean attenuation, number of pixels, and percentage of negative pixels. MR signal intensity drop between the in- and opposed-phase images was measured for the masses. Analyses to determine whether correlations existed among the mean CT attenuation, percentage of negative pixels, and MR signal intensity drop were performed. A final diagnosis was obtained by pathology results, follow-up of more than 6 months, or adrenal washout CT findings.
  
  
  RESULTS
  Negative pixels were present in 25 of 28 adenomas and nine of 11 nonadenomas. A threshold of more than 10% negative pixels for the diagnosis of adenoma provided a sensitivity of 46% and specificity of 100%. A threshold of more than 20% MR signal intensity drop yielded a sensitivity of 71% and specificity of 100%. An increase in the percentage of negative pixels was correlated with a decrease in mean CT attenuation. Using MRI, observers characterized seven additional nodules as adenomas compared with CT histogram analysis (McNemar test, chi2 = 5.1429; p = 0.023).
  
  
  CONCLUSIONS
  CT histogram analysis with a threshold of a 10% negative pixel presence increases sensitivity for the characterization of adenomas compared with analysis of the mean CT attenuation alone. The use of chemical shift MRI with a threshold of 20% signal intensity drop results in a higher sensitivity than CT histogram analysis.
authors.affiliation: Department of Medical Imaging, University Health Network and Mount Sinai Hospital, Princess Margaret Hospital, 610 University Ave., Toronto, ON M5G 2M9, Canada. kartik.jhaveri@uhn.on.ca
authors.forename: Kartik S
authors.initials: KS
authors.lastname: Jhaveri
authors.forename: Fenella
authors.initials: F
authors.lastname: Wong
authors.forename: Sangeet
authors.initials: S
authors.lastname: Ghai
authors.forename: Masoom A
authors.initials: MA
authors.lastname: Haider
mesh_terms: D000236:Adenoma / Q000175:diagnosis / Q000000981:diagnostic imaging; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000556:secondary; D000311:Adrenal Glands / Q000000981:diagnostic imaging / Q000473:pathology; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed