Efficacy of contrast-enhanced CT in assessing the endometrium

Julia Grossman, Zina J. Ricci, Alla Rozenblit, Kathy Freeman, Fernanda Mazzariol, Marjorie W. Stein

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

OBJECTIVE. The purpose of our study was to determine the efficacy of contrast-enhanced CT in detecting a thickened endometrium. We used transvaginal sonography as the reference standard. MATERIALS AND METHODS. Between March 2005 and January 2007, data from 259 patients (mean age, 47 years; age range, 18-90 years) who underwent transvaginal sonography and contrast-enhanced CT of the pelvis were analyzed retrospectively. The endometrium was quantitatively measured in millimeters on sonography. On CT it was qualitatively categorized as normal, thickened, indeterminate, or not visualized and compared with the sonography findings and original radiology reports. When the endometrium was indeterminate (thickened or triangular in shape on axial images), sagittal reconstructions were performed for final categorization. Two reviewers evaluated the CT scans and sonograms jointly with differences resolved by consensus. Kappa, Wilcoxon's rank sum test, and intraclass correlation statistics were derived. RESULTS. The overall sensitivity and specificity of CT in detecting the thickened endometrium was 53.1% and 93.5%, respectively, relative to transvaginal sonography. The positive and negative predictive values were 66.7% and 89.1%, respectively. Kappa, the statistical measure of agreement between CT and sonography data, was 0.5049. All cases of a triangular endometrium were normal in size on sagittal reconstruction images. CONCLUSION. Routine pelvic CT correctly identifies a normal endometrium in most patients. Sagittal reconstruction images are helpful to further evaluate the endometrium on CT in cases with a prominent or triangular endometrium because these are often related to uterine version. CT is relatively insensitive in detecting the thickened endometrium but better able to identify gross rather than subtle thickening, which must be further characterized by transvaginal sonography.

Original languageEnglish (US)
Pages (from-to)664-669
Number of pages6
JournalAmerican Journal of Roentgenology
Volume191
Issue number3
DOIs
StatePublished - Sep 2008

Fingerprint

Endometrium
Ultrasonography
Computer-Assisted Image Processing
Nonparametric Statistics
Pelvis
Radiology
Sensitivity and Specificity

Keywords

  • CT
  • Endometrium
  • Postmenopausal
  • Premenopausal
  • Transvaginal sonography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Efficacy of contrast-enhanced CT in assessing the endometrium. / Grossman, Julia; Ricci, Zina J.; Rozenblit, Alla; Freeman, Kathy; Mazzariol, Fernanda; Stein, Marjorie W.

In: American Journal of Roentgenology, Vol. 191, No. 3, 09.2008, p. 664-669.

Research output: Contribution to journalArticle

Grossman, Julia ; Ricci, Zina J. ; Rozenblit, Alla ; Freeman, Kathy ; Mazzariol, Fernanda ; Stein, Marjorie W. / Efficacy of contrast-enhanced CT in assessing the endometrium. In: American Journal of Roentgenology. 2008 ; Vol. 191, No. 3. pp. 664-669.
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abstract = "OBJECTIVE. The purpose of our study was to determine the efficacy of contrast-enhanced CT in detecting a thickened endometrium. We used transvaginal sonography as the reference standard. MATERIALS AND METHODS. Between March 2005 and January 2007, data from 259 patients (mean age, 47 years; age range, 18-90 years) who underwent transvaginal sonography and contrast-enhanced CT of the pelvis were analyzed retrospectively. The endometrium was quantitatively measured in millimeters on sonography. On CT it was qualitatively categorized as normal, thickened, indeterminate, or not visualized and compared with the sonography findings and original radiology reports. When the endometrium was indeterminate (thickened or triangular in shape on axial images), sagittal reconstructions were performed for final categorization. Two reviewers evaluated the CT scans and sonograms jointly with differences resolved by consensus. Kappa, Wilcoxon's rank sum test, and intraclass correlation statistics were derived. RESULTS. The overall sensitivity and specificity of CT in detecting the thickened endometrium was 53.1{\%} and 93.5{\%}, respectively, relative to transvaginal sonography. The positive and negative predictive values were 66.7{\%} and 89.1{\%}, respectively. Kappa, the statistical measure of agreement between CT and sonography data, was 0.5049. All cases of a triangular endometrium were normal in size on sagittal reconstruction images. CONCLUSION. Routine pelvic CT correctly identifies a normal endometrium in most patients. Sagittal reconstruction images are helpful to further evaluate the endometrium on CT in cases with a prominent or triangular endometrium because these are often related to uterine version. CT is relatively insensitive in detecting the thickened endometrium but better able to identify gross rather than subtle thickening, which must be further characterized by transvaginal sonography.",
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N2 - OBJECTIVE. The purpose of our study was to determine the efficacy of contrast-enhanced CT in detecting a thickened endometrium. We used transvaginal sonography as the reference standard. MATERIALS AND METHODS. Between March 2005 and January 2007, data from 259 patients (mean age, 47 years; age range, 18-90 years) who underwent transvaginal sonography and contrast-enhanced CT of the pelvis were analyzed retrospectively. The endometrium was quantitatively measured in millimeters on sonography. On CT it was qualitatively categorized as normal, thickened, indeterminate, or not visualized and compared with the sonography findings and original radiology reports. When the endometrium was indeterminate (thickened or triangular in shape on axial images), sagittal reconstructions were performed for final categorization. Two reviewers evaluated the CT scans and sonograms jointly with differences resolved by consensus. Kappa, Wilcoxon's rank sum test, and intraclass correlation statistics were derived. RESULTS. The overall sensitivity and specificity of CT in detecting the thickened endometrium was 53.1% and 93.5%, respectively, relative to transvaginal sonography. The positive and negative predictive values were 66.7% and 89.1%, respectively. Kappa, the statistical measure of agreement between CT and sonography data, was 0.5049. All cases of a triangular endometrium were normal in size on sagittal reconstruction images. CONCLUSION. Routine pelvic CT correctly identifies a normal endometrium in most patients. Sagittal reconstruction images are helpful to further evaluate the endometrium on CT in cases with a prominent or triangular endometrium because these are often related to uterine version. CT is relatively insensitive in detecting the thickened endometrium but better able to identify gross rather than subtle thickening, which must be further characterized by transvaginal sonography.

AB - OBJECTIVE. The purpose of our study was to determine the efficacy of contrast-enhanced CT in detecting a thickened endometrium. We used transvaginal sonography as the reference standard. MATERIALS AND METHODS. Between March 2005 and January 2007, data from 259 patients (mean age, 47 years; age range, 18-90 years) who underwent transvaginal sonography and contrast-enhanced CT of the pelvis were analyzed retrospectively. The endometrium was quantitatively measured in millimeters on sonography. On CT it was qualitatively categorized as normal, thickened, indeterminate, or not visualized and compared with the sonography findings and original radiology reports. When the endometrium was indeterminate (thickened or triangular in shape on axial images), sagittal reconstructions were performed for final categorization. Two reviewers evaluated the CT scans and sonograms jointly with differences resolved by consensus. Kappa, Wilcoxon's rank sum test, and intraclass correlation statistics were derived. RESULTS. The overall sensitivity and specificity of CT in detecting the thickened endometrium was 53.1% and 93.5%, respectively, relative to transvaginal sonography. The positive and negative predictive values were 66.7% and 89.1%, respectively. Kappa, the statistical measure of agreement between CT and sonography data, was 0.5049. All cases of a triangular endometrium were normal in size on sagittal reconstruction images. CONCLUSION. Routine pelvic CT correctly identifies a normal endometrium in most patients. Sagittal reconstruction images are helpful to further evaluate the endometrium on CT in cases with a prominent or triangular endometrium because these are often related to uterine version. CT is relatively insensitive in detecting the thickened endometrium but better able to identify gross rather than subtle thickening, which must be further characterized by transvaginal sonography.

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