Characterizing incidental mass lesions in abdominal dual-energy CT compared to conventional contrast-enhanced CT

Background: Incidental findings are common in abdominal computed tomography (CT) and often warrant further investigations with economic implications as well as implications for patients. Purpose: To evaluate the potential of dual-energy CT (DECT) in the identification and/or characterization of abdominal incidental mass lesions compared to conventional contrast-enhanced CT Material and Methods: This retrospective study from a major tertiary hospital included 96 patients, who underwent contrast-enhanced abdominal DECT. Incidental lesions in adrenals, kidneys, liver, and pancreas were evaluated by two board-certified abdominal radiologists. Observer 1 only had access to standard CT reconstructions, while observer 2 had access to standard CT as well as DECT reconstructions. Disagreements were resolved by consensus review and used as a reference for observers using McNemar's test Results: Observers 1 and 2 identified a total of 40 and 34 findings, respectively. Furthermore, observer 1 registered 13 lesions requiring follow-up, of which seven (two renal and five adrenal lesions) were resolved following consensus review using DECT (P = 0.008). The inter-observer agreement was near perfect (κ = 0.82). Conclusion: DECT has the potential to improve the immediate characterization of incidental findings when compared to conventional CT for abdominal imaging.