Diagnostic accuracy of third-generation dual-source dual-energy CT virtual non-contrast vs true non-contrast imaging in adrenal gland masses: a comparative study following the ACR guidelines.

Authors

Zahra Afraz, Ludovica R M Lanzafame, Giuseppe M Bucolo, Tommaso D'Angelo, Luca Saba, Leon D Gruenewald, Vitali Koch, Andreea-Ioana Nica, Ibrahim Yel, Katrin Eichler, Thomas J Vogl, Christian Booz

Published in

La Radiologia medica. Jun 15, 2026. Epub Jun 15, 2026.

Abstract

To assess whether virtual non-contrast (VNC) images are diagnostically equivalent to true non-contrast (TNC) images in differentiating adrenal adenomas from metastases.
Consecutive oncologic patients who underwent staging CT examinations performed on a third-generation dual-source CT scanner between January 2016 and February 2023 with adrenal lesion with histopathologic or MRI confirmation were retrospectively included. Adrenal lesion attenuation values were measured on TNC and VNC reconstructions and directly compared. Subsequently, the diagnostic accuracy of both reconstructions for differentiating adrenal adenomas from metastases was evaluated at predefined attenuation thresholds, including ≤ 10 HU (ACR threshold) and ≤ 20 HU (optimized threshold). Diagnostic performance was assessed using ROC curve analysis, while Bland-Altman analysis was performed to evaluate agreement between TNC and VNC measurements.
A total of 439 patients (mean age: 63 ± 11 years) with incidental adrenal lesions were included. TNC and VNC showed significant difference in attenuation values with clear discrimination between adenomas and metastases based on attenuation distributions (all p < 0.0001). Bland-Altman analysis demonstrated close agreement between techniques (mean difference: - 0.4 HU; LoA: - 3.5-2.8 HU). ROC curve demonstrated excellent diagnostic accuracy for both TNC and VNC, with AUC values of 0.923 and 0.928, respectively. Using ACR threshold (≤ 10 HU), VNC showed slightly higher specificity (94.3% vs 93.3%), while TNC showed marginally higher sensitivity (57.1% vs. 55.5%). At ≤ 20 HU, TNC achieved higher sensitivity (98.8% vs. 96.7%), whereas VNC provided greater specificity (75.8% vs. 54.6%); however, increasing the threshold resulted in a higher number of misclassified lesions.
VNC imaging provides diagnostic accuracy comparable to TNC for adrenal lesion evaluation while enabling substantial radiation dose savings.

PMID:
42295587
Bibliographic data and abstract were imported from PubMed on 15 Jun 2026.

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