{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T01:17:05Z","timestamp":1792459025204,"version":"4.5.0"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2024,3,14]],"date-time":"2024-03-14T00:00:00Z","timestamp":1710374400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,3,14]],"date-time":"2024-03-14T00:00:00Z","timestamp":1710374400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100013081","name":"Augsburg University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100013081","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Universit\u00e4t Augsburg"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Objectives<\/jats:title>\n                <jats:p>Aim of this study was to assess the value of virtual non-contrast (VNC) reconstructions in differentiating between adrenal adenomas and metastases on a photon-counting detector CT (PCD-CT).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Material and methods<\/jats:title>\n                <jats:p>Patients with adrenal masses and contrast-enhanced CT scans in portal venous phase were included. Image reconstructions were performed, including conventional VNC (VNC<jats:sub>Conv<\/jats:sub>) and PureCalcium VNC (VNC<jats:sub>PC<\/jats:sub>), as well as virtual monochromatic images (VMI, 40\u201390\u00a0keV) and iodine maps. We analyzed images using semi-automatic segmentation of adrenal lesions and extracted quantitative data. Logistic regression models, non-parametric tests, Bland\u2013Altman plots, and a random forest classifier were used for statistical analyses.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The final study cohort consisted of 90 patients (36 female, mean age 67.8\u00a0years [range 39\u201387]) with adrenal lesions (45 adenomas, 45 metastases). Compared to metastases, adrenal adenomas showed significantly lower CT-values in VNC<jats:sub>Conv<\/jats:sub> and VNC<jats:sub>PC<\/jats:sub> (<jats:italic>p<\/jats:italic>\u2009=\u20090.007). Mean difference between VNC and true non-contrast (TNC) was 17.67 for VNC<jats:sub>Conv<\/jats:sub> and 14.85 for VNC<jats:sub>PC<\/jats:sub>. Random forest classifier and logistic regression models both identified VNC<jats:sub>Conv<\/jats:sub> and VNC<jats:sub>PC<\/jats:sub> as the best discriminators. When using 26 HU as the threshold in VNC<jats:sub>Conv<\/jats:sub> reconstructions, adenomas could be discriminated from metastases with a sensitivity of 86.7% and a specificity of 75.6%.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>VNC algorithms overestimate CT values compared to TNC in the assessment of adrenal lesions. However, they allow a reliable discrimination between adrenal adenomas and metastases and could be used in clinical routine in near future with an increased threshold (e.g., 26 HU). Further (multi-center) studies with larger patient cohorts and standardized protocols are required.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Clinical relevance statement<\/jats:title>\n                <jats:p>VNC reconstructions overestimate CT values compared to TNC. Using a different threshold (e.g., 26 HU compared to the established 10 HU), VNC has a high diagnostic accuracy for the discrimination between adrenal adenomas and metastases.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Key Points<\/jats:title>\n                <jats:p><jats:italic>\u2022 Virtual non-contrast reconstructions may be promising tools to differentiate adrenal lesions and might save further diagnostic tests.<\/jats:italic><\/jats:p>\n                <jats:p><jats:italic>\u2022 The conventional and a new calcium-preserving virtual non-contrast algorithm tend to systematically overestimate CT-values compared to true non-contrast images.<\/jats:italic><\/jats:p>\n                <jats:p><jats:italic>\u2022 Therefore, increasing the established threshold for true non-contrast images (e.g., 10HU) may help to differentiate between adrenal adenomas and metastases on contrast-enhanced CT.<\/jats:italic><\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00330-024-10675-x","type":"journal-article","created":{"date-parts":[[2024,3,14]],"date-time":"2024-03-14T07:47:21Z","timestamp":1710402441000},"page":"5944-5953","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Diagnostic performance of photon-counting detector CT for differentiation between adrenal adenomas and metastases"],"prefix":"10.1007","volume":"34","author":[{"given":"Stefanie","family":"Bette","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franka","family":"Risch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Canalini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Becker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva V.","family":"Leithner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Huber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Haerting","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bertram","family":"Jehs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Wollny","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Schwarz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kartikay","family":"Tehlan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Scheurig-Muenkler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Wendler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4889-1036","authenticated-orcid":false,"given":"Thomas","family":"Kroencke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josua A.","family":"Decker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,3,14]]},"reference":[{"key":"10675_CR1","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1148\/radiol.2020192227","volume":"296","author":"Y Nagayama","year":"2020","unstructured":"Nagayama Y, Inoue T, Oda S et al (2020) Adrenal adenomas versus metastases: diagnostic performance of dual-energy spectral CT virtual noncontrast imaging and iodine maps. 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