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European Radiology

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01-05-2017 | Computed Tomography

Prospective Evaluation of Reduced Dose Computed Tomography for the Detection of Low-Contrast Liver Lesions: Direct Comparison with Concurrent Standard Dose Imaging

Authors: B. Dustin Pooler, Meghan G. Lubner, David H. Kim, Oliver T. Chen, Ke Li, Guang-Hong Chen, Perry J. Pickhardt

Published in: European Radiology | Issue 5/2017

Abstract

Objectives

To prospectively compare the diagnostic performance of reduced-dose (RD) contrast-enhanced CT (CECT) with standard-dose (SD) CECT for detection of low-contrast liver lesions.

Methods

Seventy adults with non-liver primary malignancies underwent abdominal SD-CECT immediately followed by RD-CECT, aggressively targeted at 60-70 % dose reduction. SD series were reconstructed using FBP. RD series were reconstructed with FBP, ASIR, and MBIR (Veo). Three readers—blinded to clinical history and comparison studies—reviewed all series, identifying liver lesions ≥4 mm. Non-blinded review by two experienced abdominal radiologists—assessing SD against available clinical and radiologic information—established the reference standard.

Results

RD-CECT mean effective dose was 2.01 ± 1.36 mSv (median, 1.71), a 64.1 ± 8.8 % reduction. Pooled per-patient performance data were (sensitivity/specificity/PPV/NPV/accuracy) 0.91/0.78/0.60/0.96/0.81 for SD-FBP compared with RD-FBP 0.79/0.75/0.54/0.91/0.76; RD-ASIR 0.84/0.75/0.56/0.93/0.78; and RD-MBIR 0.84/0.68/0.49/0.92/0.72. ROC AUC values were 0.896/0.834/0.858/0.854 for SD-FBP/RD-FBP/RD-ASIR/RD-MBIR, respectively. RD-FBP (P = 0.002) and RD-MBIR (P = 0.032) AUCs were significantly lower than those of SD-FBP; RD-ASIR was not (P = 0.052). Reader confidence was lower for all RD series (P < 0.001) compared with SD-FBP, especially when calling patients entirely negative.

Conclusions

Aggressive CT dose reduction resulted in inferior diagnostic performance and reader confidence for detection of low-contrast liver lesions compared to SD. Relative to RD-ASIR, RD-FBP showed decreased sensitivity and RD-MBIR showed decreased specificity.

Key Points

• Reduced-dose CECT demonstrates inferior diagnostic performance for detecting low-contrast liver lesions.

• Reader confidence is lower with reduced-dose CECT compared to standard-dose CECT.

• Overly aggressive dose reduction may result in misdiagnosis, regardless of reconstruction algorithm.

• Careful consideration of perceived risks versus benefits of dose reduction is crucial.

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Title: Prospective Evaluation of Reduced Dose Computed Tomography for the Detection of Low-Contrast Liver Lesions: Direct Comparison with Concurrent Standard Dose Imaging
Authors: B. Dustin Pooler
Meghan G. Lubner
David H. Kim
Oliver T. Chen
Ke Li
Guang-Hong Chen
Perry J. Pickhardt
Publication date: 01-05-2017
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 5/2017
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-016-4571-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Prospective Evaluation of Reduced Dose Computed Tomography for the Detection of Low-Contrast Liver Lesions: Direct Comparison with Concurrent Standard Dose Imaging

Abstract

Objectives

Methods

Results

Conclusions

Key Points

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

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