European Radiology

, Volume 27, Issue 5, pp 2055–2066 | Cite as

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

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

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.

Keywords

Diagnostic imaging Multi-detector computed tomography Radiation dosage Liver Metastases 

Notes

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.

References

  1. 1.
    Eisenhauer EA et al (2009) New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1). Eur J Cancer 45:228–247CrossRefPubMedGoogle Scholar
  2. 2.
    Levin DC, Rao VM, Parker L (2012) The recent downturn in utilization of CT: the start of a new trend? J Am Coll Radiol 9:795–798CrossRefPubMedGoogle Scholar
  3. 3.
    Moreno CC et al (2016) Changing abdominal imaging utilization patterns: perspectives from medicare beneficiaries over two decades. J Am Coll Radiol. 2016 Aug;13(8):894–903Google Scholar
  4. 4.
    Hall EJ, Brenner DJ (2008) Cancer risks from diagnostic radiology. Br J Radiol 81:362–378CrossRefPubMedGoogle Scholar
  5. 5.
    Patino M et al (2015) Iterative reconstruction techniques in abdominopelvic CT: technical concepts and clinical implementation. AJR Am J Roentgenol 205:W19–W31CrossRefPubMedGoogle Scholar
  6. 6.
    Flicek KT et al (2010) Reducing the radiation dose for CT colonography using adaptive statistical iterative reconstruction: a pilot study. Am J Roentgenol 195:126–131CrossRefGoogle Scholar
  7. 7.
    Gervaise A et al (2012) CT image quality improvement using adaptive iterative dose reduction with wide-volume acquisition on 320-detector CT. Eur Radiol 22:295–301CrossRefPubMedGoogle Scholar
  8. 8.
    Lee SJ et al (2011) A prospective comparison of standard-dose ct enterography and 50% reduced-dose ct enterography with and without noise reduction for evaluating Crohn disease. Am J Roentgenol 197:50–57CrossRefGoogle Scholar
  9. 9.
    Sagara Y et al (2010) Abdominal CT: Comparison of low-dose CT with adaptive statistical iterative reconstruction and routine-dose CT with filtered back projection in 53 patients. Am J Roentgenol 195:713–719CrossRefGoogle Scholar
  10. 10.
    Singh S et al (2010) Abdominal CT: comparison of adaptive statistical iterative and filtered back projection reconstruction techniques. Radiology 257:373–383CrossRefPubMedGoogle Scholar
  11. 11.
    Pickhardt PJ et al (2012) Abdominal CT with model-based iterative reconstruction (MBIR): initial results of a prospective trial comparing ultralow-dose with standard-dose imaging. Am J Roentgenol 199:1266–1274CrossRefGoogle Scholar
  12. 12.
    Volders D et al (2013) Model-based iterative reconstruction and adaptive statistical iterative reconstruction techniques in abdominal CT: comparison of image quality in the detection of colorectal liver metastases. Radiology 269:468–473CrossRefGoogle Scholar
  13. 13.
    Chang KJ, Yee J (2013) Dose reduction methods for CT colonography. Abdom Imaging 38:224–232CrossRefPubMedGoogle Scholar
  14. 14.
    Lubner MG et al (2015) Sub-milliSievert (sub-mSv) CT colonography: a prospective comparison of image quality and polyp conspicuity at reduced-dose versus standard-dose imaging. Eur Radiol 25:2089–2102CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Pooler BD et al (2014) Prospective trial of the detection of urolithiasis on ultralow dose (sub mSv) noncontrast computerized tomography: direct comparison against routine low dose reference standard. J Urol 192:1433–1439CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Zilberman DE et al (2011) Low dose computerized tomography for detection of urolithiasis-its effectiveness in the setting of the urology clinic. J Urol 185:910–914CrossRefPubMedGoogle Scholar
  17. 17.
    Laqmani A et al (2016) Reduced-dose abdominopelvic CT using hybrid iterative reconstruction in suspected left-sided colonic diverticulitis. Eur Radiol 26:216–224CrossRefPubMedGoogle Scholar
  18. 18.
    Zacharia TT et al (2006) CT of colon cancer metastases to the liver using modified RECIST criteria: determining the ideal number of target lesions to measure. Am J Roentgenol 186:1067–1070CrossRefGoogle Scholar
  19. 19.
    Dobeli KL et al (2013) Noise-reducing algorithms do not necessarily provide superior dose optimisation for hepatic lesion detection with multidetector CT. British Journal of Radiology, 2013. 86(1023):20120500Google Scholar
  20. 20.
    Schindera ST et al (2013) Iterative reconstruction algorithm for CT: can radiation dose be decreased while low-contrast detectability is preserved? Radiology 269:510–517CrossRefGoogle Scholar
  21. 21.
    Baker ME et al (2012) Contrast-to-noise ratio and low-contrast object resolution on full- and low-dose MDCT: SAFIRE versus filtered back projection in a low-contrast object phantom and in the liver. Am J Roentgenol 199:8–18CrossRefGoogle Scholar
  22. 22.
    Fletcher JG et al (2015) Observer performance in the detection and classification of malignant hepatic nodules and masses with CT image-space denoising and iterative reconstruction. Radiology 276:465–478CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Deak Z et al (2013) Filtered back projection, adaptive statistical iterative reconstruction, and a model-based iterative reconstruction in abdominal CT: an experimental clinical study. Radiology 266:197–206CrossRefPubMedGoogle Scholar
  24. 24.
    Martinsen ACT et al (2012) Iterative reconstruction reduces abdominal CT dose. Eur J Radiol 81:1483–1487CrossRefPubMedGoogle Scholar
  25. 25.
    AAPM (2008) The measurement, reporting, and management of radiation dose in CT. American Association of Physicists in Medicine, College ParkGoogle Scholar
  26. 26.
    Deak PD, Smal Y, Kalender WA (2010) Multisection CT protocols: sex- and age-specific conversion factors used to determine effective dose from dose-length product. Radiology 257:158–166CrossRefPubMedGoogle Scholar
  27. 27.
    Prakash P et al (2010) Reducing abdominal CT radiation dose with adaptive statistical iterative reconstruction technique. Invest Radiol 45:202–210CrossRefPubMedGoogle Scholar
  28. 28.
    Hanley JA, McNeil BJ (1982) The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 143:29–36CrossRefPubMedGoogle Scholar
  29. 29.
    McNeil BJ, Hanley JA (1984) Statistical approaches to the analysis of receiver operating characteristic (ROC) curves. Med Decis Mak 4:137–150CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • B. Dustin Pooler
    • 1
  • Meghan G. Lubner
    • 1
  • David H. Kim
    • 1
  • Oliver T. Chen
    • 1
  • Ke Li
    • 1
    • 2
  • Guang-Hong Chen
    • 1
    • 2
  • Perry J. Pickhardt
    • 1
    • 3
  1. 1.Department of RadiologyUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  2. 2.Department of Medical PhysicsUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  3. 3.Department of RadiologyUniversity of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science CenterMadisonUSA

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