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Open Access 09-05-2024 | Post-COVID Syndrome | Chest

Ultra-low-dose vs. standard-of-care-dose CT of the chest in patients with post-COVID-19 conditions—a prospective intra-patient multi-reader study

Authors: Christian Wassipaul, Daria Kifjak, Ruxandra-Iulia Milos, Florian Prayer, Sebastian Roehrich, Melanie Winter, Lucian Beer, Martin L. Watzenboeck, Svitlana Pochepnia, Michael Weber, Dietmar Tamandl, Peter Homolka, Wolfgang Birkfellner, Helmut Ringl, Helmut Prosch, Benedikt H. Heidinger

Published in: European Radiology

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Abstract

Objectives

To conduct an intrapatient comparison of ultra-low-dose computed tomography (ULDCT) and standard-of-care-dose CT (SDCT) of the chest in terms of the diagnostic accuracy of ULDCT and intrareader agreement in patients with post-COVID conditions.

Methods

We prospectively included 153 consecutive patients with post-COVID-19 conditions. All participants received an SDCT and an additional ULDCT scan of the chest. SDCTs were performed with standard imaging parameters and ULDCTs at a fixed tube voltage of 100 kVp (with tin filtration), 50 ref. mAs (dose modulation active), and iterative reconstruction algorithm level 5 of 5. All CT scans were separately evaluated by four radiologists for the presence of lung changes and their consistency with post-COVID lung abnormalities. Radiation dose parameters and the sensitivity, specificity, and accuracy of ULDCT were calculated.

Results

Of the 153 included patients (mean age 47.4 ± 15.3 years; 48.4% women), 45 (29.4%) showed post-COVID lung abnormalities. In those 45 patients, the most frequently detected CT patterns were ground-glass opacities (100.0%), reticulations (43.5%), and parenchymal bands (37.0%). The accuracy, sensitivity, and specificity of ULDCT compared to SDCT for the detection of post-COVID lung abnormalities were 92.6, 87.2, and 94.9%, respectively. The median total dose length product (DLP) of ULDCTs was less than one-tenth of the radiation dose of our SDCTs (12.6 mGy*cm [9.9; 15.5] vs. 132.1 mGy*cm [103.9; 160.2]; p < 0.001).

Conclusion

ULDCT of the chest offers high accuracy in the detection of post-COVID lung abnormalities compared to an SDCT scan at less than one-tenth the radiation dose, corresponding to only twice the dose of a standard chest radiograph in two views.

Clinical relevance statement

Ultra-low-dose CT of the chest may provide a favorable, radiation-saving alternative to standard-dose CT in the long-term follow-up of the large patient cohort of post-COVID-19 patients.
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Metadata
Title
Ultra-low-dose vs. standard-of-care-dose CT of the chest in patients with post-COVID-19 conditions—a prospective intra-patient multi-reader study
Authors
Christian Wassipaul
Daria Kifjak
Ruxandra-Iulia Milos
Florian Prayer
Sebastian Roehrich
Melanie Winter
Lucian Beer
Martin L. Watzenboeck
Svitlana Pochepnia
Michael Weber
Dietmar Tamandl
Peter Homolka
Wolfgang Birkfellner
Helmut Ringl
Helmut Prosch
Benedikt H. Heidinger
Publication date
09-05-2024
Publisher
Springer Berlin Heidelberg
Published in
European Radiology
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-024-10754-z