Virtual non-contrast detector-based spectral CT predictably overestimates tissue density for the characterisation of adrenal lesions compared to true non-contrast CT.

PURPOSE: To establish if virtual non-contrast (VNC) images generated from contrast-enhanced detector-based spectral CT could replace true non-contrast (TNC) imaging for the characterisation of adrenal masses. METHODS: TNC and VNC images were retrospectively reviewed for 39 patients with one or more adrenal lesions who underwent contrast-enhanced spectral CT of the upper abdomen. Lesions were categorised as either 'adenoma' or 'indeterminate/other lesion' based on current reference standards. The CT density of each lesion was measured on both image sets by two readers and compared using Wilcoxon signed-rank test. ROC analysis with Youden's J index method was performed to determine the optimal attenuation cut-off for diagnosing benign adenoma on VNC images. RESULTS: Forty-four lesions were included, 37 of which were diagnosed as adenomas. There were significant differences between TNC and VNC measurements for both readers (mean difference 9.1 HU for reader 1; 9.8 HU for reader 2; p < 0.01). Optimal attenuation thresholds for diagnosing adenomas on VNC were 25.3 HU (reader 1) and 23.9 HU (reader 2) for the entire population, and 18.3 HU (reader 1) and 19.7 HU (reader 2) for lipid-rich adenomas < 10 HU on TNC imaging. CONCLUSION: There is insufficient evidence to support the use of VNC as a substitute for TNC images in the characterisation of adrenal lesions. VNC using a detector-based spectral CT scanner shows a predictable increase in attenuation values compared to TNC. Thus, future studies might be better directed towards finding a new threshold value for diagnosing benign adrenal adenomas on VNC imaging.

Marked differences in the number and type of synapses innervating the somata and primary dendrites of midbrain dopaminergic neurons, striatal cholinergic interneurons, and striatal spiny projection neurons in the rat.

Elucidating the link between cellular activity and goal-directed behavior requires a fuller understanding of the mechanisms underlying burst firing in midbrain dopaminergic neurons and those that suppress activity during aversive or non-rewarding events. We have characterized the afferent synaptic connections onto these neurons in the rat substantia nigra pars compacta (SNpc) and ventral tegmental area (VTA), and compared these findings with cholinergic interneurons and spiny projection neurons in the striatum. We found that the average absolute number of synapses was three to three and one-half times greater onto the somata of dorsal striatal spiny projection neurons than onto the somata of dopaminergic neurons in the SNpc or dorsal striatal cholinergic interneurons. A similar comparison between populations of dopamine neurons revealed a two times greater number of somatic synapses on VTA dopaminergic neurons than SNpc dopaminergic neurons. The percentage of symmetrical, presumably inhibitory, synaptic inputs on somata was significantly higher on spiny projection neurons and cholinergic interneurons compared with SNpc dopaminergic neurons. Synaptic data on the primary dendrites yielded similar significant differences for the percentage of symmetrical synapses for VTA dopaminergic vs. striatal neurons. No differences in the absolute number or type of somatic synapses were evident for dopaminergic neurons in the SNpc of Wistar vs. Sprague-Dawley rat strains. These data from identified neurons are pivotal for interpreting their electrophysiological responses to afferent activity and for generating realistic computer models of neuronal networks of striatal and midbrain dopaminergic function.