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All Journal Medicinus : Jurnal Kedokteran
Wulandari, Mathelda Diah
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Medicine & Pharmacology Public Health

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Quantitative CT Attenuation Cut-off Values for Lesion Characterization: Enostoses in Patients Without Malignancy Versus Osteoblastic Metastases in Breast Cancer Pitri, Novita; Wulandari, Mathelda Diah; Nelwan, Dario Agustino; Jorisal, Patricia; Mulyanto, Ivana Dewi; Wijaya, Ratna Sari
Medicinus Vol. 15 No. 2 (2026): February
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v15i2.10792

Abstract

Background: Incidental osteoblastic bone lesions detected on CT scans, such as enostoses and osteoblastic metastases, often pose diagnostic challenges, especially in patients with or without a history of breast cancer. Hounsfield unit (HU) attenuation values have been proposed to differentiate these lesions non-invasively, however, variability in cut-off values exists in prior studies.   Methods: This observational analytic case-control study included adult patients who underwent CT and FDG PET-CT at MRCCC Siloam Semanggi Hospital, Jakarta from 2020 to 2025. Controls were patients with enostoses and no history of malignancy, while cases were breast cancer patients with PET/CT-confirmed osteoblastic metastases. Mean and maximum HU values were measured and analyzed to determine optimal cut-offs.   Result: Mean and maximum HU values were significantly higher in enostoses than in osteoblastic metastases (mean: 1025 ± 123.66 vs. 449.65 ± 106.93; maximum: 1167.77 ± 106.20 vs. 599.34 ± 134.78; p < 0.001). A mean HU cut-off of 692 achieved 100% sensitivity, 98.36% specificity, and an AUC of 0.992. A maximum HU cut-off of 860 showed 79.61% sensitivity, 100% specificity, and an AUC of 0.898.   Conclusions: Mean and maximum HU values on CT are highly effective for differentiating enostoses from osteoblastic metastases in breast cancer patients.
Co-Authors Jorisal, Patricia Mulyanto, Ivana Dewi Nelwan, Dario Agustino Pitri, Novita Wijaya, Ratna Sari