title: Differentiating pheochromocytoma from lipid-poor adrenocortical adenoma by CT texture analysis: feasibility study.
abstract: To investigate the feasibility of using CT texture analysis (CTTA) to differentiate pheochromocytoma from lipid-poor adrenocortical adenoma (lp-ACA).
  
  
  
  Ninety-eight pheochromocytomas and 66 lp-ACAs were included in this retrospective study. CTTA was performed on unenhanced and enhanced images. Receiver operating characteristic (ROC) analysis was performed, and the area under the ROC curve (AUC) was calculated for texture parameters that were significantly different for the objective. Diagnostic accuracies were evaluated using the cutoff values of texture parameters with the highest AUCs.
  
  
  
  Compared to lp-ACAs, pheochromocytomas had significantly higher mean gray-level intensity (Mean), entropy, and mean of positive pixels (MPP), but lower skewness and kurtosis on unenhanced images (P < 0.001). On enhanced images, these texture-quantifiers followed a similar trend where Mean, entropy, and MPP were higher, but skewness and kurtosis were lower in pheochromocytomas. Standard deviation (SD) was also significantly higher in pheochromocytomas on enhanced images. Mean and MPP quantified from no filtration on unenhanced CT images yielded the highest AUC of 0.86 ± 0.03 (95% CI 0.81-0.91) at a cutoff value of 34.0 for Mean and MPP, respectively (sensitivity = 79.6%, specificity = 83.3%, accuracy = 81.1%).
  
  
  
  It was feasible to use CTTA to differentiate pheochromocytoma from lp-ACA.
authors.affiliation: Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng District, Beijing, 100730, China.
authors.forename: Gu-Mu-Yang
authors.initials: GM
authors.lastname: Zhang
authors.affiliation: Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng District, Beijing, 100730, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Shi
authors.affiliation: Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng District, Beijing, 100730, China. sunhao_robert@126.com.
authors.forename: Hao
authors.initials: H
authors.lastname: Sun
authors.affiliation: Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng District, Beijing, 100730, China. zhengyu_jin@126.com.
authors.forename: Zheng-Yu
authors.initials: ZY
authors.lastname: Jin
authors.affiliation: Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng District, Beijing, 100730, China. bjdanna95@hotmail.com.
authors.forename: Hua-Dan
authors.initials: HD
authors.lastname: Xue
mesh_terms: D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D018246:Adrenocortical Adenoma / Q000000981:diagnostic imaging* / Q000473:pathology; D000328:Adult; D000368:Aged; D003287:Contrast Media; D003937:Diagnosis, Differential; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007472:Iohexol / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000000981:diagnostic imaging* / Q000473:pathology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; D007472:Iohexol; C038192:iopromide
keywords: Adrenocortical adenoma; Computed tomography; Feasibility; Pheochromocytoma; Texture analysis