Korean J Radiol.  2015 Oct;16(5):1132-1141. 10.3348/kjr.2015.16.5.1132.

Adaptive Statistical Iterative Reconstruction-Applied Ultra-Low-Dose CT with Radiography-Comparable Radiation Dose: Usefulness for Lung Nodule Detection

• Yoon HJ
• Chung MJ
• Hwang HS
• Moon JW
• Lee KS

• KMID: 2160781
• DOI: http://doi.org/10.3348/kjr.2015.16.5.1132

Abstract

OBJECTIVE
To assess the performance of adaptive statistical iterative reconstruction (ASIR)-applied ultra-low-dose CT (ULDCT) in detecting small lung nodules.
MATERIALS AND METHODS
Thirty patients underwent both ULDCT and standard dose CT (SCT). After determining the reference standard nodules, five observers, blinded to the reference standard reading results, independently evaluated SCT and both subsets of ASIR- and filtered back projection (FBP)-driven ULDCT images. Data assessed by observers were compared statistically.
RESULTS
Converted effective doses in SCT and ULDCT were 2.81 +/- 0.92 and 0.17 +/- 0.02 mSv, respectively. A total of 114 lung nodules were detected on SCT as a standard reference. There was no statistically significant difference in sensitivity between ASIR-driven ULDCT and SCT for three out of the five observers (p = 0.678, 0.735, < 0.01, 0.038, and < 0.868 for observers 1, 2, 3, 4, and 5, respectively). The sensitivity of FBP-driven ULDCT was significantly lower than that of ASIR-driven ULDCT in three out of the five observers (p < 0.01 for three observers, and p = 0.064 and 0.146 for two observers). In jackknife alternative free-response receiver operating characteristic analysis, the mean values of figure-of-merit (FOM) for FBP, ASIR-driven ULDCT, and SCT were 0.682, 0.772, and 0.821, respectively, and there were no significant differences in FOM values between ASIR-driven ULDCT and SCT (p = 0.11), but the FOM value of FBP-driven ULDCT was significantly lower than that of ASIR-driven ULDCT and SCT (p = 0.01 and 0.00).
CONCLUSION
Adaptive statistical iterative reconstruction-driven ULDCT delivering a radiation dose of only 0.17 mSv offers acceptable sensitivity in nodule detection compared with SCT and has better performance than FBP-driven ULDCT.

Keyword

Multidetector computed tomography; Image reconstruction; Adaptive statistical iterative reconstruction; Lung; Radiation dosage

MeSH Terms

Adult
Aged
Female
Humans
Lung/pathology/*radiography
Lung Neoplasms/*radiography/secondary
Male
Middle Aged
ROC Curve
Radiation Dosage
Radiographic Image Enhancement
Radiographic Image Interpretation, Computer-Assisted
Rectal Neoplasms/pathology
Retrospective Studies
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Images of 43-year-old woman with metastatic lung nodule from rectal cancer show round pulmonary nodule measuring 5 mm (arrows) in left basal lung. ASIR-driven ultra-low-dose CT (A), FBP-driven ultra-low-dose CT (B), and standard dose CT (C) images. All observers detected nodule on ASIR- and FBP-driven ultra-low-dose CT and on standard dose CT. Using ultra-low-dose CT, ASIR provides more acceptable image noise, better diagnostic acceptability, and visual sharpness of pulmonary nodule than FBP. ASIR = adaptive statistical iterative reconstruction, FBP = filtered back projection

• 

  Fig. 2 Images of 45-year-old man with incidental pulmonary nodule show nodule with ground-glass opacity measuring 6 mm (arrows) in diameter in right upper lobe. ASIR-driven ultra-low-dose CT (A), FBP-driven ultra-low-dose CT (B), and standard dose CT (C) images. Two observers could not detect nodule on ultra-low-dose CT scans with FBP reconstruction; however, all observers detected nodule on ASIR-driven ultra-low-dose CT scan and standard dose CT scan. ASIR = adaptive statistical iterative reconstruction, FBP = filtered back projection

• 

  Fig. 3 Images of 29-year-old man with metastatic nodule from rectal cancer show nodule measuring 3 mm in diameter in right upper lobe. A, B. Nodule was identified as calcified nodule by all observers on ASIR-driven ultra-low-dose CT (A) and FBP-driven ultra-low-dose CT (B) scans (arrow). C. This nodule was correctly read as metastatic nodule on standard dose CT scan (arrow). ASIR = adaptive statistical iterative reconstruction, FBP = filtered back projection

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