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

  • Computed Tomography
  • Published:
European Radiology Aims and scope Submit manuscript

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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Acknowledgements

The scientific guarantor of this publication is PJ Pickhardt. This research was supported by the National Institutes of Health, grant 1R01 CA169331. Dr. Pickhardt is co-founder of VirtuoCTC and shareholder in Cellectar Biosciences, SHINE, and Elucent. Dr. Kim is co-founder of VirtuoCTC, consultant for Viatronix, and on the medical advisory board for Digital Artforms. All other authors declare no relevant disclosures. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, case-control study, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, University of Wisconsin School of Medicine and Public Health, 750 Highland Avenue, Madison, WI, 53705, USA

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

  2. Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 750 Highland Avenue, Madison, WI, 53705, USA

    Ke Li & Guang-Hong Chen

  3. Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI, 53792-3252, USA

    Perry J. Pickhardt

Authors
  1. B. Dustin Pooler
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  2. Meghan G. Lubner
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  3. David H. Kim
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  4. Oliver T. Chen
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  5. Ke Li
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  6. Guang-Hong Chen
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  7. Perry J. Pickhardt
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Corresponding author

Correspondence to Perry J. Pickhardt.

Appendix

Appendix

Table 5 Patient dose and demographic data
Full size table
Table 6 Standard dose CT parameters
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Table 7 Per-patient performance data by reconstruction algorithm for individual readers
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Pooler, B.D., Lubner, M.G., Kim, D.H. et al. Prospective Evaluation of Reduced Dose Computed Tomography for the Detection of Low-Contrast Liver Lesions: Direct Comparison with Concurrent Standard Dose Imaging. Eur Radiol 27, 2055–2066 (2017). https://doi.org/10.1007/s00330-016-4571-4

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  • DOI: https://doi.org/10.1007/s00330-016-4571-4

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