Ji Hoon Park1, Bohyoung Kim2, Mi Sung Kim3, Hyuk Jung Kim4, Yousun Ko1, Soyeon Ahn5, Murat Karul6, Joel G Fletcher7, Kyoung Ho Lee1,8. 1. Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea. 2. Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea. bohyoung@gmail.com. 3. Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea. 4. Department of Radiology, Daejin Medical Center, Bundang Jesaeng General Hospital, Seongnam-si, Gyeonggi-do, Korea. 5. Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea. 6. Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 7. Department of Radiology, Mayo Clinic, Rochester, MN, USA. 8. Program in Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology Seoul National University, Seoul, Korea.
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.
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.
Authors: Ji Hoon Park; Jong-June Jeon; Sung Soo Lee; Amar C Dhanantwari; Ji Ye Sim; Hae Young Kim; Kyoung Ho Lee Journal: Eur Radiol Date: 2017-12-07 Impact factor: 5.315