Differentiating between atypical adenomatous hyperplasia and bronchioloalveolar carcinoma using the computed tomography number histogram

Background. Both atypical adenomatous hyperplasia (AAH) and bronchioloalveolar carcinoma (BAC) appear as ground glass opacity (GGO) lesions by computed tomography (CT) and are sometimes difficult to differentiate. To aid distinction between the two, we examined their CT number histograms. Methods. Histograms of pixel CT numbers were made for AAH (n = 9) and nonmucinous BAC (n = 8), and the peak and mean CT numbers on the histogram were quantified. Results. Although there was no significant difference in lesion size between AAH and BAC, all AAHs were less than or equal to 1 cm in diameter. All AAHs and BACs manifested one histogram peak. Both the peak and mean CT numbers on the histogram were significantly lower for AAH than for BAC (p < 0.001). However, the degree of overlap between AAH and BAC was less for the peak CT number than for the mean CT number. Conclusions. The peak CT number on the histogram can help the radiologic differentiation between AAH and BAC. GGO lesions less than or equal to 1 cm in diameter that are diagnosed as AAH from the CT number histogram can be safely followed by CT.