Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Multidetector Computed Tomography for the Assessment of Adnexal Mass: Is Unenhanced CT Scan Necessary?

  • Jung, Sung Il (Department of Radiology, Research Institute of Medical Science, Konkuk University School of Medicine) ;
  • Park, Hee Sun (Department of Radiology, Research Institute of Medical Science, Konkuk University School of Medicine) ;
  • Kim, Young Jun (Department of Radiology, Research Institute of Medical Science, Konkuk University School of Medicine) ;
  • Jeon, Hae Jeong (Department of Radiology, Research Institute of Medical Science, Konkuk University School of Medicine)
  • Received : 2013.05.13
  • Accepted : 2013.09.16
  • Published : 2014.02.01
⟨ Previous Next ⟩

Abstract

Objective: To compare the diagnostic performance and radiation dose between contrast-enhanced CT (ECT) alone, and combined unenhanced and contrast-enhanced CT (UE + ECT) for the assessment of adnexal mass. Materials and Methods: This retrospective study was approved by the Institutional Review Board. A total of 146 consecutive patients (mean age, 41.1 years) who underwent preoperative unenhanced and contrast-enhanced multidetector CT of the pelvis and had adnexal masses found at surgery were included. Two readers independently evaluated the likelihood of adnexal malignancy on a 5-point scale on two different imaging datasets (ECT alone and UE + ECT). The area under the receiver operating characteristic curve (AUC) was used to evaluate diagnostic performance. Radiation dose to patients was calculated by the volume CT dose index ($CTDI_{vol}$) and the dose length products (DLP) on each dataset. Results: Of the total 178 adnexal masses, 133 masses were benign and 45 masses were malignant. For both readers, there is no significant difference of AUC values between ECT alone and UE + ECT for the detection of adnexal malignancy (reader 1, 0.93 vs. 0.95; reader 2, 0.92 vs. 0.91) (p > 0.05). The mean $CTDI_{vol}$ ($12.6{\pm}2.2mGy$) and DLP ($641.2{\pm}137.2mGy$) of ECT alone was significantly lower than the mean $CTDI_{vol}$ ($21.5{\pm}2.7mGy$) and DLP ($923.6{\pm}158.8mGy$) of UE + ECT (p < 0.0001). Conclusion: The use of unenhanced CT scan in addition to contrast-enhanced CT scan does not improve the detection of adnexal malignancy, but increases radiation exposure.

Keywords

Acknowledgement

Supported by : Konkuk University

References

  1. Salem S, White LM, Lai J. Doppler sonography of adnexal masses: the predictive value of the pulsatility index in benign and malignant disease. AJR Am J Roentgenol 1994;163:1147-1150 https://doi.org/10.2214/ajr.163.5.7976891
  2. Spencer JA, Ghattamaneni S. MR imaging of the sonographically indeterminate adnexal mass. Radiology 2010;256:677-694 https://doi.org/10.1148/radiol.10090397
  3. Hricak H, Chen M, Coakley FV, Kinkel K, Yu KK, Sica G, et al. Complex adnexal masses: detection and characterization with MR imaging--multivariate analysis. Radiology 2000;214:39-46 https://doi.org/10.1148/radiology.214.1.r00ja3939
  4. Tsili AC, Tsampoulas C, Charisiadi A, Kalef-Ezra J, Dousias V, Paraskevaidis E, et al. Adnexal masses: accuracy of detection and differentiation with multidetector computed tomography. Gynecol Oncol 2008;110:22-31 https://doi.org/10.1016/j.ygyno.2008.03.022
  5. Zhang J, Mironov S, Hricak H, Ishill NM, Moskowitz CS, Soslow RA, et al. Characterization of adnexal masses using feature analysis at contrast-enhanced helical computed tomography. J Comput Assist Tomogr 2008;32:533-540 https://doi.org/10.1097/RCT.0b013e3181568890
  6. Tsili AC, Tsampoulas C, Argyropoulou M, Navrozoglou I, Alamanos Y, Paraskevaidis E, et al. Comparative evaluation of multidetector CT and MR imaging in the differentiation of adnexal masses. Eur Radiol 2008;18:1049-1057 https://doi.org/10.1007/s00330-007-0842-4
  7. Greess H, Nomayr A, Wolf H, Baum U, Lell M, Bowing B, et al. Dose reduction in CT examination of children by an attenuation-based on-line modulation of tube current (CARE Dose). Eur Radiol 2002;12:1571-1576 https://doi.org/10.1007/s00330-001-1255-4
  8. Tack D, De Maertelaer V, Gevenois PA. Dose reduction in multidetector CT using attenuation-based online tube current modulation. AJR Am J Roentgenol 2003;181:331-334 https://doi.org/10.2214/ajr.181.2.1810331
  9. Paterson A, Frush DP, Donnelly LF. Helical CT of the body: are settings adjusted for pediatric patients? AJR Am J Roentgenol 2001;176:297-301 https://doi.org/10.2214/ajr.176.2.1760297
  10. Divrik Gokce S, Gokce E, Cos¸kun M. Radiology residents' awareness about ionizing radiation doses in imaging studies and their cancer risk during radiological examinations. Korean J Radiol 2012;13:202-209 https://doi.org/10.3348/kjr.2012.13.2.202
  11. Goo HW. CT radiation dose optimization and estimation: an update for radiologists. Korean J Radiol 2012;13:1-11 https://doi.org/10.3348/kjr.2012.13.1.1
  12. Hur S, Lee JM, Kim SJ, Park JH, Han JK, Choi BI. 80-kVp CT using Iterative Reconstruction in Image Space algorithm for the detection of hypervascular hepatocellular carcinoma: phantom and initial clinical experience. Korean J Radiol 2012;13:152-164 https://doi.org/10.3348/kjr.2012.13.2.152
  13. Moritz JD, Hoffmann B, Sehr D, Keil K, Eggerking J, Groth G, et al. Evaluation of ultra-low dose CT in the diagnosis of pediatric-like fractures using an experimental animal study. Korean J Radiol 2012;13:165-173 https://doi.org/10.3348/kjr.2012.13.2.165
  14. Park EA, Lee W, Kang JH, Yin YH, Chung JW, Park JH. The image quality and radiation dose of 100-kVp versus 120-kVp ECG-gated 16-slice CT coronary angiography. Korean J Radiol 2009;10:235-243 https://doi.org/10.3348/kjr.2009.10.3.235
  15. Stevens SK, Hricak H, Stern JL. Ovarian lesions: detection and characterization with gadolinium-enhanced MR imaging at 1.5 T. Radiology 1991;181:481-488 https://doi.org/10.1148/radiology.181.2.1924792
  16. Obuchowski NA. Nonparametric analysis of clustered ROC curve data. Biometrics 1997;53:567-578 https://doi.org/10.2307/2533958
  17. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;33:159-174 https://doi.org/10.2307/2529310
  18. Togashi K. Ovarian cancer: the clinical role of US, CT, and MRI. Eur Radiol 2003;13 Suppl 4:L87-L104 https://doi.org/10.1007/s00330-003-1964-y
  19. Liu J, Xu Y, Wang J. Ultrasonography, computed tomography and magnetic resonance imaging for diagnosis of ovarian carcinoma. Eur J Radiol 2007;62:328-334 https://doi.org/10.1016/j.ejrad.2007.02.040
  20. O'Malley ME, Halpern E, Mueller PR, Gazelle GS. Helical CT protocols for the abdomen and pelvis: a survey. AJR Am J Roentgenol 2000;175:109-113 https://doi.org/10.2214/ajr.175.1.1750109
  21. Killius JS, Nelson RC. Logistic advantages of four-section helical CT in the abdomen and pelvis. Abdom Imaging 2000;25:643-650 https://doi.org/10.1007/s002610000053
  22. Urban BA, Fishman EK. Tailored helical CT evaluation of acute abdomen. Radiographics 2000;20:725-749 https://doi.org/10.1148/radiographics.20.3.g00ma12725
  23. Johnstone PA. ACR appropriateness criteria. Int J Radiat Oncol Biol Phys 2008;70:1303-1304 https://doi.org/10.1016/j.ijrobp.2007.08.075
  24. Gatreh-Samani F, Tarzamni MK, Olad-Sahebmadarek E, Dastranj A, Afrough A. Accuracy of 64-multidetector computed tomography in diagnosis of adnexal tumors. J Ovarian Res 2011;4:15 https://doi.org/10.1186/1757-2215-4-15
  25. Tsushima Y, Yamada S, Aoki J, Motojima T, Endo K. Effect of contrast-enhanced computed tomography on diagnosis and management of acute abdomen in adults. Clin Radiol 2002;57:507-513 https://doi.org/10.1053/crad.2001.0925
  26. Guite KM, Hinshaw JL, Ranallo FN, Lindstrom MJ, Lee FT Jr. Ionizing radiation in abdominal CT: unindicated multiphase scans are an important source of medically unnecessary exposure. J Am Coll Radiol 2011;8:756-761 https://doi.org/10.1016/j.jacr.2011.05.011

Cited by

  1. Does the Reporting Quality of Diagnostic Test Accuracy Studies, as Defined by STARD 2015, Affect Citation? vol.17, pp.5, 2016, https://doi.org/10.3348/kjr.2016.17.5.706
  2. Excess of radiation burden for young testicular cancer patients using automatic exposure control and contrast agent on whole-body computed tomography imaging vol.51, pp.2, 2014, https://doi.org/10.1515/raon-2017-0012
  3. Selection and Reporting of Statistical Methods to Assess Reliability of a Diagnostic Test: Conformity to Recommended Methods in a Peer-Reviewed Journal vol.18, pp.6, 2017, https://doi.org/10.3348/kjr.2017.18.6.888
  4. Nouvelles recommandations pour le bilan des masses annexielles indéterminées vol.30, pp.2, 2020, https://doi.org/10.1016/j.femme.2020.05.001
  5. Computer Tomography in the Diagnosis of Ovarian Cysts: The Role of Fluid Attenuation Values vol.8, pp.4, 2014, https://doi.org/10.3390/healthcare8040398
  6. Ultrasonography in the Diagnosis of Adnexal Lesions: The Role of Texture Analysis vol.11, pp.5, 2014, https://doi.org/10.3390/diagnostics11050812