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Chen L, Cao L, Liu B, Li J, Qu T, Li Y, Li Y, Pan N, Cheng Y, Fan G, Jian Z, Guo J. Relationship between pericoronary adipose tissue attenuation value and image reconstruction parameters. Heliyon 2024; 10:e34763. [PMID: 39149087 PMCID: PMC11325791 DOI: 10.1016/j.heliyon.2024.e34763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 07/15/2024] [Accepted: 07/16/2024] [Indexed: 08/17/2024] Open
Abstract
Rationale and objectives To investigate the relationship between the pericoronary adipose tissue CT mean attenuation (PCATMA) measurement and image reconstruction parameters (adaptive statistical iterative reconstruction-veo (ASIR-V) percentage, kernel, and slice thickness). Materials and methods One hundred and ninety-eight consecutive patients underwent CT coronary angiography at 100 kilovoltage peak (kVp) (n = 102) and 120 kVp (n = 96) were included. All scans were reconstructed by three means: 1. with 11 different ASIR-V percentages, standard kernel and 0.625 mm; 2. with soft, standard, detail, and bone kernels, 60 % ASIR-V, and 0.625 mm; 3. at 0.625 mm and 1.25 mm slice thickness, standard kernel and 60 % ASIR-V. PCATMA of the three main coronary arteries was calculated using a dedicated software. Linear regression, analysis of variance (ANOVA), Friedman test, and paired t-test were used for statistical analysis. Results Linear regression of pooled average data showed that the PCATMA was positively and linearly correlated with the ASIR-V percentage (all R squared >0.99). Regression analysis of individual data showed that most R squared were greater than 0.8 or 0.9, but their slope consisted of a relatively wide range. The difference of PCATMA among different kernels for each coronary artery reached statistically significant levels (P < 0.001), particularly for the difference between standard and bone kernel. Most of the differences between 0.625 mm and 1.25 mm for LAD, LCX, and RCA at 100 kVp and 120 kVp reached statistical significance (P < 0.001). Conclusions PCATMA correlates linearly with the strength of ASIR-V. Reconstruction kernel and slice thickness also affect PCATMA, especially for the sharp kernels.
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Affiliation(s)
- Lihong Chen
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, #277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Le Cao
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, #277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Bing Liu
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, #277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Jianying Li
- CT Imaging Research Center, GE Healthcare, #1 GuangHua Road, Chaoyang District, Beijing, 100010, China
| | - Tingting Qu
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, #277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Yanshou Li
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, #277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Yanan Li
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, #277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Ning Pan
- Bayer Healthcare Company Limited, #88 South Guanzheng Road, Xi'an, 710061, China
| | - Yannan Cheng
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, #277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Ganglian Fan
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, #277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Zhijie Jian
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, #277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Jianxin Guo
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, #277 West Yanta Road, Xi'an, 710061, Shaanxi, China
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Park JH, Salminen P, Tannaphai P, Lee KH. Low-Dose Abdominal CT for Evaluating Suspected Appendicitis in Adolescents and Young Adults: Review of Evidence. Korean J Radiol 2022; 23:517-528. [PMID: 35289145 PMCID: PMC9081692 DOI: 10.3348/kjr.2021.0596] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/18/2021] [Accepted: 11/21/2021] [Indexed: 11/15/2022] Open
Abstract
Due to its excellent diagnostic performance, CT is the mainstay of diagnostic test in adults with suspected acute appendicitis in many countries. Although debatable, extensive epidemiological studies have suggested that CT radiation is carcinogenic, at least in children and adolescents. Setting aside the debate over the carcinogenic risk of CT radiation, the value of judicious use of CT radiation cannot be overstated for the diagnosis of appendicitis, considering that appendicitis is a very common disease, and that the vast majority of patients with suspected acute appendicitis are adolescents and young adults with average life expectancies. Given the accumulated evidence justifying the use of low-dose CT (LDCT) of only 2 mSv, there is no reasonable basis to insist on using radiation dose of multi-purpose abdominal CT for the diagnosis of appendicitis, particularly in adolescents and young adults. Published data strongly suggest that LDCT is comparable to conventional dose CT in terms of clinical outcomes and diagnostic performance. In this narrative review, we will discuss such evidence for reducing CT radiation in adolescents and young adults with suspected appendicitis.
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Affiliation(s)
- Ji Hoon Park
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Paulina Salminen
- Department of Surgery, University of Turku, Turku, Finland, Thailand
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland, Thailand
| | - Penampai Tannaphai
- Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kyoung Ho Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Korea
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Protocol Optimization Considerations for Implementing Deep Learning CT Reconstruction. AJR Am J Roentgenol 2021; 216:1668-1677. [PMID: 33852337 DOI: 10.2214/ajr.20.23397] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE. Previous advances over filtered back projection (FBP) have incorporated model-based iterative reconstruction. The purpose of this study was to characterize the latest advance in image reconstruction, that is, deep learning. The focus was on applying characterization results of a deep learning approach to decisions about clinical CT protocols. MATERIALS AND METHODS. A proprietary deep learning image reconstruction (DLIR) method was characterized against an existing advanced adaptive statistical iterative reconstruction method (ASIR-V) and FBP from the same vendor. The metrics used were contrast-to-noise ratio, spatial resolution as a function of contrast level, noise texture (i.e., noise power spectra [NPS]), noise scaling as a function of slice thickness, and CT number consistency. The American College of Radiology accreditation phantom and a uniform water phantom were used at a range of doses and slice thicknesses for both axial and helical acquisition modes. RESULTS. ASIR-V and DLIR were associated with improved contrast-to-noise ratio over FBP for all doses and slice thicknesses. No dose or contrast dependencies of spatial resolution were observed for ASIR-V or DLIR. NPS results showed DLIR maintained an FBP-like noise texture whereas ASIR-V shifted the NPS to lower frequencies. Noise changed with dose and slice thickness in the same manner for ASIR-V and FBP. DLIR slice thickness noise scaling differed from FBP, exhibiting less noise penalty with decreasing slice thickness. No clinically significant changes were observed in CT numbers for any measurement condition. CONCLUSION. In a phantom model, DLIR does not suffer from the concerns over reduction in spatial resolution and introduction of poor noise texture associated with previous methods.
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Ko Y, Lee WJ, Park JH, Kim HY, Sim JY, Tannaphai P, Lee KH. Diagnostic sensitivity and specificity of 2-mSv CT vs. conventional-dose CT in adolescents and young adults with suspected appendicitis: post hoc subgroup analysis of the LOCAT data. Eur Radiol 2020; 30:4573-4585. [PMID: 32240354 DOI: 10.1007/s00330-020-06811-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 03/02/2020] [Accepted: 03/13/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To test whether the difference in sensitivity or specificity between 2-mSv CT and conventional-dose CT (CDCT) for the diagnosis of appendicitis differs across subgroups of adolescents and young adults with suspected appendicitis. MATERIALS AND METHODS We used the per-protocol analysis data of a trial conducted between Dec 2013 and Aug 2016, including 2773 patients (median age [interquartile range], 28 [21-35] years) and 160 radiologists from 20 hospitals. We defined subgroups by sex, body size, clinical risk scores for appendicitis, time of CT examination (i.e., working vs. after hours), CT machines, radiologists' experience, previous site experience in 2-mSv CT, and site practice volume. We drew forest plots and tested for additive or multiplicative interaction between radiation dose and subgroup attributes. If any subgroup had fewer than 200 patients, we considered the results from that subgroup not meaningful. RESULTS For most subgroups, the 95% CIs for the differences in sensitivity and specificity were 4.0 percentage points or narrower and contained the minute overall between-group differences. There was no significant interaction on sensitivity or specificity. A few subgroups, including those of extreme body sizes, high appendicitis inflammatory response scores, and hospitals with small appendectomy volume, were regarded to have insufficient numbers of patients. CONCLUSIONS There was no notable subgroup heterogeneity, which implies that 2-mSv CT can replace CDCT in diverse populations. Further studies are needed for the subgroups for which we had only small data. KEY POINTS • The minute difference in sensitivity or specificity between the 2-mSv CT and conventional-dose CT (typically 7 mSv) groups were consistent across various patient or hospital characteristics. • These results indicate that 2-mSv CT can replace conventional-dose CT in diverse populations. • Further studies are needed to confirm whether 2-mSv CT can replace conventional-dose CT in patients of extreme body sizes, high appendicitis inflammatory response scores, or hospitals with small appendectomy volume, as those subgroups in our data included limited numbers of patients.
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Affiliation(s)
- Yousun Ko
- Program in Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea.,Biomedical Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, South Korea
| | - Woo Joo Lee
- Department of Statistics, Inha University, Incheon, South Korea
| | - Ji Hoon Park
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
| | - Hae Young Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
| | - Ji Ye Sim
- Department of Radiology, Hanil General Hospital, Seoul, South Korea
| | - Penampai Tannaphai
- Department of Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kyoung Ho Lee
- Program in Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea. .,Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea. .,Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, South Korea.
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Bax T, Macha M, Mayberry J. The utility of CT scan for the diagnostic evaluation of acute abdominal pain. Am J Surg 2019; 217:959-966. [DOI: 10.1016/j.amjsurg.2019.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/16/2019] [Accepted: 02/06/2019] [Indexed: 02/08/2023]
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Cianci R, Delli Pizzi A, Esposito G, Timpani M, Tavoletta A, Pulsone P, Basilico R, Cotroneo AR, Filippone A. Ultra-low dose CT colonography with automatic tube current modulation and sinogram-affirmed iterative reconstruction: Effects on radiation exposure and image quality. J Appl Clin Med Phys 2018; 20:321-330. [PMID: 30586479 PMCID: PMC6333183 DOI: 10.1002/acm2.12510] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 11/03/2018] [Accepted: 11/20/2018] [Indexed: 12/14/2022] Open
Abstract
Objective To assess the radiation dose and image quality of ultra‐low dose (ULD)‐CT colonography (CTC) obtained with the combined use of automatic tube current (mAs) modulation with a quality reference mAs of 25 and sinogram‐affirmed iterative reconstruction (SAFIRE), compared to low‐dose (LD) CTC acquired with a quality reference mAs of 55 and reconstructed with filtered back projection (FBP). Methods Eighty‐two patients underwent ULD‐CTC acquisition in prone position and LD‐CTC acquisition in supine position. Both ULD‐CTC and LD‐CTC protocols were compared in terms of radiation dose [weighted volume computed tomography dose index (CTDIvol) and effective dose], image noise, image quality, and polyp detection. Results The mean effective dose of ULD‐CTC was significantly lower than that of LD‐CTC (0.98 and 2.69 mSv respectively, P < 0.0001) with an overall dose reduction of 63.2%. Image noise was comparable between ULD‐CTC and LD‐CTC (28.6 and 29.8 respectively, P = 0.09). There was no relevant difference when comparing image quality scores and polyp detection for both 2D and 3D images. Conclusion ULD‐CTC allows to significantly reduce the radiation dose without meaningful image quality degradation compared to LD‐CTC.
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Affiliation(s)
- Roberta Cianci
- Department of Neuroscience Imaging and Clinical Sciences, University "G. d'Annunzio", SS. Annunziata Hospital, Chieti, Italy
| | - Andrea Delli Pizzi
- Department of Neuroscience Imaging and Clinical Sciences, University "G. d'Annunzio", SS. Annunziata Hospital, Chieti, Italy
| | - Gianluigi Esposito
- Department of Neuroscience Imaging and Clinical Sciences, University "G. d'Annunzio", SS. Annunziata Hospital, Chieti, Italy
| | - Mauro Timpani
- Department of Neuroscience Imaging and Clinical Sciences, University "G. d'Annunzio", SS. Annunziata Hospital, Chieti, Italy
| | - Alessandra Tavoletta
- Department of Neuroscience Imaging and Clinical Sciences, University "G. d'Annunzio", SS. Annunziata Hospital, Chieti, Italy
| | - Pierluigi Pulsone
- Department of Neuroscience Imaging and Clinical Sciences, University "G. d'Annunzio", SS. Annunziata Hospital, Chieti, Italy
| | - Raffaella Basilico
- Department of Neuroscience Imaging and Clinical Sciences, University "G. d'Annunzio", SS. Annunziata Hospital, Chieti, Italy
| | - Antonio Raffaele Cotroneo
- Department of Neuroscience Imaging and Clinical Sciences, University "G. d'Annunzio", SS. Annunziata Hospital, Chieti, Italy
| | - Antonella Filippone
- Department of Neuroscience Imaging and Clinical Sciences, University "G. d'Annunzio", SS. Annunziata Hospital, Chieti, Italy
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Advanced Modeled Iterative Reconstruction (ADMIRE) Facilitates Radiation Dose Reduction in Abdominal CT. Acad Radiol 2018; 25:1277-1284. [PMID: 29500115 DOI: 10.1016/j.acra.2018.01.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 01/09/2018] [Accepted: 01/11/2018] [Indexed: 12/11/2022]
Abstract
RATIONALE AND OBJECTIVES This study aimed to determine the potential degree of radiation dose reduction achievable using Advanced Modeled Iterative Reconstruction (ADMIRE) in abdominal computed tomography (CT) while maintaining image quality. Moreover, this study compared differences in image noise reduction of this iterative algorithm with radiation dose reduction. METHODS Eleven consecutive patients scheduled for abdominal CT were scanned according to our institute's standard protocol (100 kV, 289 reference mAs). Using a proprietary reconstruction software, CT images of these patients were reconstructed as either full-dose weighted filtered back projections or with simulated radiation dose reductions down to 10% of the full-dose level and ADMIRE at either strength 3 or strength 5. Images were marked with arrows pointing on anatomic structures of the abdomen, differing in their contrast to the surrounding tissue. Structures were grouped into high-, medium-, and low-contrast subgroups. In addition, the intrinsic noise of these structures was measured. That followed, image pairs were presented to observers, with five readers assessing image quality using two-alternative-forced-choice comparisons. In total, 3000 comparisons were performed that way. RESULTS Both ADMIRE 3 and 5 decreased noise of the anatomic structures significantly compared to the filtered back projection, with an additional significant difference between ADMIRE 3 and 5. Radiation dose reduction potential for ADMIRE ranged from 29.0% to 53.5%, with no significant differences between ADMIRE 3 and 5 within the contrast subgroups.The potential levels of radiation dose reduction for ADMIRE 3 differed significantly between high-, medium-, and low-contrast structures, whereas for ADMIRE 5, there was only a significant difference between the high- and the medium-contrast subgroups. CONCLUSION Although ADMIRE 5 permits significantly higher noise reduction potential than ADMIRE 3, it does not facilitate higher levels of radiation dose reduction. ADMIRE nonetheless holds remarkable potential for radiation dose reduction, which features a certain dependency on the contrast of the structure of interest. Applying ADMIRE with a strength of 3 in abdominal CT may permit radiation dose reduction of about 30%.
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Nagayama Y, Tanoue S, Tsuji A, Urata J, Furusawa M, Oda S, Nakaura T, Utsunomiya D, Yoshida E, Yoshida M, Kidoh M, Tateishi M, Yamashita Y. Application of 80-kVp scan and raw data-based iterative reconstruction for reduced iodine load abdominal-pelvic CT in patients at risk of contrast-induced nephropathy referred for oncological assessment: effects on radiation dose, image quality and renal function. Br J Radiol 2018; 91:20170632. [PMID: 29470108 DOI: 10.1259/bjr.20170632] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To evaluate the image quality, radiation dose, and renal safety of contrast medium (CM)-reduced abdominal-pelvic CT combining 80-kVp and sinogram-affirmed iterative reconstruction (SAFIRE) in patients with renal dysfunction for oncological assessment. METHODS We included 45 patients with renal dysfunction (estimated glomerular filtration rate <45 ml per min per 1.73 m2) who underwent reduced-CM abdominal-pelvic CT (360 mgI kg-1, 80-kVp, SAFIRE) for oncological assessment. Another 45 patients without renal dysfunction (estimated glomerular filtration rate >60 ml per lmin per 1.73 m2) who underwent standard oncological abdominal-pelvic CT (600 mgI kg-1, 120-kVp, filtered-back projection) were included as controls. CT attenuation, image noise, and contrast-to-noise ratio (CNR) were compared. Two observers performed subjective image analysis on a 4-point scale. Size-specific dose estimate and renal function 1-3 months after CT were measured. RESULTS The size-specific dose estimate and iodine load of 80-kVp protocol were 32 and 41%,, respectively, lower than of 120-kVp protocol (p < 0.01). CT attenuation and contrast-to-noise ratio of parenchymal organs and vessels in 80-kVp images were significantly better than those of 120-kVp images (p < 0.05). There were no significant differences in quantitative or qualitative image noise or subjective overall quality (p > 0.05). No significant kidney injury associated with CM administration was observed. CONCLUSION 80-kVp abdominal-pelvic CT with SAFIRE yields diagnostic image quality in oncology patients with renal dysfunction under substantially reduced iodine and radiation dose without renal safety concerns. Advances in knowledge: Using 80-kVp and SAFIRE allows for 40% iodine load and 32% radiation dose reduction for abdominal-pelvic CT without compromising image quality and renal function in oncology patients at risk of contrast-induced nephropathy.
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Affiliation(s)
- Yasunori Nagayama
- 1 Department of Radiology, Kumamoto City Hospital , Kumamoto , Japan.,2 Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan
| | - Shota Tanoue
- 1 Department of Radiology, Kumamoto City Hospital , Kumamoto , Japan.,2 Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan
| | - Akinori Tsuji
- 1 Department of Radiology, Kumamoto City Hospital , Kumamoto , Japan
| | - Joji Urata
- 1 Department of Radiology, Kumamoto City Hospital , Kumamoto , Japan
| | | | - Seitaro Oda
- 2 Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan
| | - Takeshi Nakaura
- 2 Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan
| | - Daisuke Utsunomiya
- 2 Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan
| | - Eri Yoshida
- 1 Department of Radiology, Kumamoto City Hospital , Kumamoto , Japan.,2 Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan
| | - Morikatsu Yoshida
- 2 Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan
| | - Masafumi Kidoh
- 2 Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan
| | - Machiko Tateishi
- 1 Department of Radiology, Kumamoto City Hospital , Kumamoto , Japan.,2 Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan
| | - Yasuyuki Yamashita
- 2 Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan
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Accuracy and Radiation Dose Reduction of Limited-Range CT in the Evaluation of Acute Appendicitis in Pediatric Patients. AJR Am J Roentgenol 2017; 209:643-647. [DOI: 10.2214/ajr.16.17496] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Poletti PA, Becker M, Becker CD, Halfon Poletti A, Rutschmann OT, Zaidi H, Perneger T, Platon A. Emergency assessment of patients with acute abdominal pain using low-dose CT with iterative reconstruction: a comparative study. Eur Radiol 2017; 27:3300-3309. [PMID: 28083698 DOI: 10.1007/s00330-016-4712-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 12/15/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To determine if radiation dose delivered by contrast-enhanced CT (CECT) for acute abdominal pain can be reduced to the dose administered in abdominal radiography (<2.5 mSv) using low-dose CT (LDCT) with iterative reconstruction algorithms. METHODS One hundred and fifty-one consecutive patients requiring CECT for acute abdominal pain were included, and their body mass index (BMI) was calculated. CECT was immediately followed by LDCT. LDCT series was processed using 1) 40% iterative reconstruction algorithm blended with filtered back projection (LDCT-IR-FBP) and 2) model-based iterative reconstruction algorithm (LDCT-MBIR). LDCT-IR-FBP and LDCT-MBIR images were reviewed independently by two board-certified radiologists (Raters 1 and 2). RESULTS Abdominal pathology was revealed on CECT in 120 (79%) patients. In those with BMI <30, accuracies for correct diagnosis by Rater 1 with LDCT-IR-FBP and LDCT-MBIR, when compared to CECT, were 95.4% (104/109) and 99% (108/109), respectively, and 92.7% (101/109) and 100% (109/109) for Rater 2. In patients with BMI ≥30, accuracies with LDCT-IR-FBP and LDCT-MBIR were 88.1% (37/42) and 90.5% (38/42) for Rater 1 and 78.6% (33/42) and 92.9% (39/42) for Rater 2. CONCLUSIONS The radiation dose delivered by CT to non-obese patients with acute abdominal pain can be safely reduced to levels close to standard radiography using LDCT-MBIR. KEY POINTS • LDCT-MBIR (<2.5 mSv) can be used to assess acute abdominal pain. • LDCT-MBIR (<2.5 mSv) cannot safely assess acute abdominal pain in obese patients. • LDCT-IR-FBP (<2.5 mSv) cannot safely assess patients with acute abdominal pain.
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Affiliation(s)
- Pierre-Alexandre Poletti
- Department of Radiology, University Hospital of Geneva, 4 rue Gabrielle Perret-Gentil, 1211, Geneva, Switzerland.
| | - Minerva Becker
- Department of Radiology, University Hospital of Geneva, 4 rue Gabrielle Perret-Gentil, 1211, Geneva, Switzerland
| | - Christoph D Becker
- Department of Radiology, University Hospital of Geneva, 4 rue Gabrielle Perret-Gentil, 1211, Geneva, Switzerland
| | - Alice Halfon Poletti
- Department of Community, Primary Care and Emergency Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Olivier T Rutschmann
- Department of Community, Primary Care and Emergency Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Habib Zaidi
- Department of Radiology, University Hospital of Geneva, 4 rue Gabrielle Perret-Gentil, 1211, Geneva, Switzerland
| | - Thomas Perneger
- Division of Clinical Epidemiology, University Hospital of Geneva, Geneva, Switzerland
| | - Alexandra Platon
- Department of Radiology, University Hospital of Geneva, 4 rue Gabrielle Perret-Gentil, 1211, Geneva, Switzerland
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Gandhi NS, Baker ME, Goenka AH, Bullen JA, Obuchowski NA, Remer EM, Coppa CP, Einstein D, Feldman MK, Kanmaniraja D, Purysko AS, Vahdat N, Primak AN, Karim W, Herts BR. Diagnostic Accuracy of CT Enterography for Active Inflammatory Terminal Ileal Crohn Disease: Comparison of Full-Dose and Half-Dose Images Reconstructed with FBP and Half-Dose Images with SAFIRE. Radiology 2016; 280:436-45. [DOI: 10.1148/radiol.2016151281] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Park JH, Kim B, Kim MS, Kim HJ, Ko Y, Ahn S, Karul M, Fletcher JG, Lee KH. Comparison of filtered back projection and iterative reconstruction in diagnosing appendicitis at 2-mSv CT. Abdom Radiol (NY) 2016; 41:1227-36. [PMID: 27315093 DOI: 10.1007/s00261-015-0632-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE To compare radiologists' diagnostic performance and confidence, and subjective image quality between filtered back projection (FBP) and iterative reconstruction (IR) at 2-mSv appendiceal CT. METHODS The institutional review board approved this retrospective study and waived the requirement for informed consent. We included 107 adolescents and young adults (age, 29.8 ± 8.5 years; 64 females) undergoing 2-mSv CT for suspected appendicitis. Appendicitis was pathologically confirmed in 42 patients. Seven readers with different experience levels independently reviewed the CT images reconstructed using FBP and IR (iDose(4), Philips). They rated both the likelihood of appendicitis and subjective image quality on 5-point Likert scales. Diagnostic confidence was assessed using the likelihood of appendicitis, proportion of indeterminate interpretations, and 3-point normal appendix visualization score. We used receiver operating characteristic analyses, Wilcoxon's signed-rank tests, and McNemar's tests. RESULTS The pooled area under the receiver operating characteristic curve (AUC) was 0.96 for both FBP and IR (95% CI for the difference, -0.02, 0.02; P = 0.73). The AUC difference was not significant in any of the individual readers (P ≥ 0.21). For the majority of the readers, the diagnostic confidence was not significantly different between the two reconstruction methods. Subjective image quality tended to be higher with IR for all readers (P ≤ 0.70), showing significant differences for four readers (P ≤ 0.040). CONCLUSION When diagnosing appendicitis at 2-mSv CT in adolescents and young adults, FBP and IR were comparable in radiologists' diagnostic performance and confidence while IR exhibited higher subjective image quality than FBP.
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Debnath J, George RA, Ravikumar R. Imaging in acute appendicitis: What, when, and why? Med J Armed Forces India 2016; 73:74-79. [PMID: 28123249 DOI: 10.1016/j.mjafi.2016.02.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 02/18/2016] [Indexed: 02/07/2023] Open
Abstract
Acute appendicitis (AA) is the commonest cause of pain abdomen requiring surgical intervention. Diagnosis as well as management of acute appendicitis is mired in controversies and contradictions even today. Clinicians often face the dilemma of balancing negative appendectomy rate and perforation rate if the diagnosis is based on clinical scoring alone. Laboratory results are often non-specific. Imaging has an important role not only in diagnosing appendicitis and its complication but also suggesting alternate diagnosis in appropriate cases. However, there is no universally accepted diagnostic imaging algorithm for appendicitis. Imaging of acute appendicitis needs to be streamlined keeping pros and cons of the available investigative modalities. Radiography has practically no role today in the diagnosis and management of acute appendicitis. Ultrasonography (USG) should be the first line imaging modality for all ages, particularly for children and non-obese young adults including women of reproductive age group. If USG findings are unequivocal and correlate with clinical assessment, no further imaging is needed. In case of equivocal USG findings or clinico-radiological dissociation, follow-up/further imaging (computed tomography (CT) scan/magnetic resonance imaging (MRI)) is recommended. In pediatric and pregnant patients with inconclusive initial USG, MRI is the next option. Routine use of CT scan for diagnosis of AA needs to be discouraged. Our proposed version of a practical imaging algorithm, with USG first and always has been incorporated in the article.
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Affiliation(s)
- Jyotindu Debnath
- Professor, Department of Radiodiagnosis, Armed Forces Medical College, Pune 411040, India
| | - R A George
- Senior Adviser (Radiodiagnosis), Command Hospital (Air Force), Bengaluru, India
| | - R Ravikumar
- Professor & Head, Department of Radiodiagnosis, Armed Forces Medical College, Pune 411040, India
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Bodelle B, Isler S, Scholtz JE, Frellesen C, Luboldt W, Vogl TJ, Beeres M. Benefits of sinogram-affirmed iterative reconstruction in 0.4 mSv ultra-low-dose CT of the upper abdomen following transarterial chemoembolisation: comparison to low-dose and standard-dose CT and filtered back projection technique. Clin Radiol 2015; 71:e11-5. [PMID: 26521185 DOI: 10.1016/j.crad.2015.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 09/30/2015] [Accepted: 10/01/2015] [Indexed: 12/16/2022]
Abstract
AIM To evaluate the advantage of sinogram-affirmed iterative reconstruction (SIR) compared to filtered back projection (FBP) in upper abdomen computed tomography (CT) after transarterial chemoembolisation (TACE) at different tube currents. MATERIALS AND METHODS The study was approved by the institutional review board. Written informed consent was obtained from all patients. Post-TACE CT was performed with different tube currents successively varied in four steps (180, 90, 45 and 23 mAs) with 40 patients per group (mean age: 60±12 years, range: 23-85 years, sex: 70 female, 90 male). The data were reconstructed with standard FBP and five different SIR strengths. Image quality was independently rated by two readers on a five-point scale. High (Lipiodol-to-liver) as well as low (liver-to-fat) contrast-to-noise ratios (CNRs) were intra-individually compared within one dose to determine the optimal strength (S1-S5) and inter-individually between different doses to determine the possibility of dose reduction using the Kruskal-Wallis test. RESULTS Subjective image quality and objective CNR analysis were concordant: intra-individually, SIR was significantly (p<0.001) superior to FBP. Inter-individually, regarding different doses (180 versus 23 ref mAs), there was no significant (p=1.00) difference when using S5 SIR at 23 mAs instead of FBP. CONCLUSION SIR allows for an 88% dose reduction from 3.43 to 0.4 mSv in unenhanced CT of the liver following TACE without subjective or objective loss in image quality.
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Affiliation(s)
- B Bodelle
- Department of Diagnostic and Interventional Radiology, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
| | - S Isler
- Department of Diagnostic and Interventional Radiology, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - J-E Scholtz
- Department of Diagnostic and Interventional Radiology, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - C Frellesen
- Department of Diagnostic and Interventional Radiology, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - W Luboldt
- Department of Diagnostic and Interventional Radiology, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - T J Vogl
- Department of Diagnostic and Interventional Radiology, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - M Beeres
- Department of Diagnostic and Interventional Radiology, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
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Alshamari M, Norrman E, Geijer M, Jansson K, Geijer H. Diagnostic accuracy of low-dose CT compared with abdominal radiography in non-traumatic acute abdominal pain: prospective study and systematic review. Eur Radiol 2015; 26:1766-74. [PMID: 26385800 DOI: 10.1007/s00330-015-3984-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 08/13/2015] [Accepted: 08/31/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Abdominal radiography is frequently used in acute abdominal non-traumatic pain despite the availability of more advanced diagnostic modalities. This study evaluates the diagnostic accuracy of low-dose CT compared with abdominal radiography, at similar radiation dose levels. METHODS Fifty-eight patients were imaged with both methods and were reviewed independently by three radiologists. The reference standard was obtained from the diagnosis in medical records. Sensitivity and specificity were calculated. A systematic review was performed after a literature search, finding a total of six relevant studies including the present. RESULTS Overall sensitivity with 95 % CI for CT was 75 % (66-83 %) and 46 % (37-56 %) for radiography. Specificity was 87 % (77-94 %) for both methods. In the systematic review the overall sensitivity for CT varied between 75 and 96 % with specificity from 83 to 95 % while the overall sensitivity for abdominal radiography varied between 30 and 77 % with specificity 75 to 88 %. CONCLUSIONS Based on the current study and available evidence, low-dose CT has higher diagnostic accuracy than abdominal radiography and it should, where logistically possible, replace abdominal radiography in the workup of adult patients with acute non-traumatic abdominal pain. KEY POINTS • Low-dose CT has a higher diagnostic accuracy than radiography. • A systematic review shows that CT has better diagnostic accuracy than radiography. • Radiography has no place in the workup of acute non-traumatic abdominal pain.
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Affiliation(s)
- Muhammed Alshamari
- Department of Radiology, Faculty of Medicine and Health, Örebro University, SE 701 85, Örebro, Sweden.
| | - Eva Norrman
- Department of Medical Physics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Mats Geijer
- Department of Medical Imaging and Physiology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Kjell Jansson
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Håkan Geijer
- Department of Radiology, Faculty of Medicine and Health, Örebro University, SE 701 85, Örebro, Sweden
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18
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Image Quality and Current Techniques for Dose Optimization in Abdominal CT: What Every Radiologist Should Know. CURRENT RADIOLOGY REPORTS 2015. [DOI: 10.1007/s40134-015-0098-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Atema JJ, Gans SL, Van Randen A, Laméris W, van Es HW, van Heesewijk JPM, van Ramshorst B, Bouma WH, Ten Hove W, van Keulen EM, Dijkgraaf MGW, Bossuyt PMM, Stoker J, Boermeester MA. Comparison of Imaging Strategies with Conditional versus Immediate Contrast-Enhanced Computed Tomography in Patients with Clinical Suspicion of Acute Appendicitis. Eur Radiol 2015; 25:2445-52. [PMID: 25903701 PMCID: PMC4495262 DOI: 10.1007/s00330-015-3648-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 12/12/2014] [Accepted: 01/30/2015] [Indexed: 02/07/2023]
Abstract
Objectives To compare the diagnostic accuracy of conditional computed tomography (CT), i.e. CT when initial ultrasound findings are negative or inconclusive, and immediate CT for patients with suspected appendicitis. Methods Data were collected within a prospective diagnostic accuracy study on imaging in adults with acute abdominal pain. All patients underwent ultrasound and CT, read by different observers who were blinded from the other modality. Only patients with clinical suspicion of appendicitis were included. An expert panel assigned a final diagnosis to each patient after 6 months of follow-up (clinical reference standard). Results A total of 422 patients were included with final diagnosis appendicitis in 251 (60 %). For 199 patients (47 %), ultrasound findings were inconclusive or negative. Conditional CT imaging correctly identified 241 of 251 (96 %) appendicitis cases (95 %CI, 92 % to 98 %), versus 238 (95 %) with immediate CT (95 %CI, 91 % to 97 %). The specificity of conditional CT imaging was lower: 77 % (95 %CI, 70 % to 83 %) versus 87 % for immediate CT (95 %CI, 81 % to 91 %). Conclusion A conditional CT strategy correctly identifies as many patients with appendicitis as an immediate CT strategy, and can halve the number of CTs needed. However, conditional CT imaging results in more false positives. Key Points • Conditional CT (CT after negative/inconclusive ultrasound findings) can be used for suspected appendicitis. • Half the number of CT examinations is needed with a conditional strategy. • Conditional CT correctly identifies as many patients with appendicitis as immediate CT. • Conditional imaging results in more false positive appendicitis cases.
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Affiliation(s)
- J J Atema
- Department of Surgery (G4-142), Academic Medical Centre, 1105 AZ, Amsterdam, Netherlands,
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