B Dustin Pooler1, Meghan G Lubner1, David H Kim1, Oliver T Chen1, Ke Li1,2, Guang-Hong Chen1,2, Perry J Pickhardt3,4. 1. Department of Radiology, University of Wisconsin School of Medicine and Public Health, 750 Highland Avenue, Madison, WI, 53705, USA. 2. Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 750 Highland Avenue, Madison, WI, 53705, USA. 3. Department of Radiology, University of Wisconsin School of Medicine and Public Health, 750 Highland Avenue, Madison, WI, 53705, USA. ppickhardt2@uwhealth.org. 4. Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI, 53792-3252, USA. ppickhardt2@uwhealth.org.
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.
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.
Authors: Yoshiko Sagara; Amy K Hara; William Pavlicek; Alvin C Silva; Robert G Paden; Qing Wu Journal: AJR Am J Roentgenol Date: 2010-09 Impact factor: 3.959
Authors: Priyanka Prakash; Mannudeep K Kalra; Avinash K Kambadakone; Homer Pien; Jiang Hsieh; Michael A Blake; Dushyant V Sahani Journal: Invest Radiol Date: 2010-04 Impact factor: 6.016
Authors: Anne Catrine Trægde Martinsen; Hilde Kjernlie Sæther; Per Kristian Hol; Dag Rune Olsen; Per Skaane Journal: Eur J Radiol Date: 2011-05-02 Impact factor: 3.528
Authors: Mark E Baker; Frank Dong; Andrew Primak; Nancy A Obuchowski; David Einstein; Namita Gandhi; Brian R Herts; Andrei Purysko; Erick Remer; Neil Vachhani; Neil Vachani Journal: AJR Am J Roentgenol Date: 2012-07 Impact factor: 3.959
Authors: Kristina T Flicek; Amy K Hara; Alvin C Silva; Qing Wu; Mary B Peter; C Daniel Johnson Journal: AJR Am J Roentgenol Date: 2010-07 Impact factor: 3.959
Authors: Joel G Fletcher; Lifeng Yu; Zhoubo Li; Armando Manduca; Daniel J Blezek; David M Hough; Sudhakar K Venkatesh; Gregory C Brickner; Joseph C Cernigliaro; Amy K Hara; Jeff L Fidler; David S Lake; Maria Shiung; David Lewis; Shuai Leng; Kurt E Augustine; Rickey E Carter; David R Holmes; Cynthia H McCollough Journal: Radiology Date: 2015-05-26 Impact factor: 11.105
Authors: Sarabjeet Singh; Mannudeep K Kalra; Jiang Hsieh; Paul E Licato; Synho Do; Homer H Pien; Michael A Blake Journal: Radiology Date: 2010-09-09 Impact factor: 11.105
Authors: Corey T Jensen; Shiva Gupta; Mohammed M Saleh; Xinming Liu; Vincenzo K Wong; Usama Salem; Wei Qiao; Ehsan Samei; Nicolaus A Wagner-Bartak Journal: Radiology Date: 2022-01-11 Impact factor: 29.146
Authors: Ruud H H Wellenberg; Jochen A C van Osch; Henk J Boelhouwers; Mireille A Edens; Geert J Streekstra; Harmen B Ettema; Martijn F Boomsma Journal: Skeletal Radiol Date: 2019-04-24 Impact factor: 2.199
Authors: Andreas S Brendlin; Moritz T Winkelmann; Phuong Linh Do; Vincent Schwarze; Felix Peisen; Haidara Almansour; Malte N Bongers; Christoph P Artzner; Jakob Weiss; Jong Hyo Kim; Ahmed E Othman; Saif Afat Journal: Diagnostics (Basel) Date: 2021-01-13