Othman Ahmed E, Bongers Malte Niklas, Zinsser Dominik, Schabel Christoph, Wichmann Julian L, Arshid Rami, Notohamiprodjo Mike, Nikolaou Konstantin, Bamberg Fabian
1 Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, 72076, Tübingen, Germany.
2 Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany.
Acta Radiol. 2018 Jan;59(1):4-12. doi: 10.1177/0284185117703152. Epub 2017 Apr 13.
Background Patients with acute non-traumatic abdominal pain often undergo abdominal computed tomography (CT). However, abdominal CT is associated with high radiation exposure. Purpose To evaluate diagnostic performance of a reduced-dose 100 kVp CT protocol with advanced modeled iterative reconstruction as compared to a linearly blended 120 kVp protocol for assessment of acute, non-traumatic abdominal pain. Material and Methods Two radiologists assessed 100 kVp and linearly blended 120 kVp series of 112 consecutive patients with acute non-traumatic pain (onset < 48 h) regarding image quality, noise, and artifacts on a five-point Likert scale. Both radiologists assessed both series for abdominal pathologies and for diagnostic confidence. Both 100 kVp and linearly blended 120 kVp series were quantitatively evaluated regarding radiation dose and image noise. Comparative statistics and diagnostic accuracy was calculated using receiver operating curve (ROC) statistics, with final clinical diagnosis/clinical follow-up as reference standard. Results Image quality was high for both series without detectable significant differences ( P = 0.157). Image noise and artifacts were rated low for both series but significantly higher for 100 kVp ( P ≤ 0.021). Diagnostic accuracy was high for both series (120 kVp: area under the curve [AUC] = 0.950, sensitivity = 0.958, specificity = 0.941; 100 kVp: AUC ≥ 0.910, sensitivity ≥ 0.937, specificity = 0.882; P ≥ 0.516) with almost perfect inter-rater agreement (Kappa = 0.939). Diagnostic confidence was high for both dose levels without significant differences (100 kVp 5, range 4-5; 120 kVp 5, range 3-5; P = 0.134). The 100 kVp series yielded 26.1% lower radiation dose compared with the 120 kVp series (5.72 ± 2.23 mSv versus 7.75 ± 3.02 mSv, P < 0.001). Image noise was significantly higher in reduced-dose CT (13.3 ± 2.4 HU versus 10.6 ± 2.1 HU; P < 0.001). Conclusion Reduced-dose abdominal CT using 100 kVp yields excellent image quality and high diagnostic accuracy for the assessment of acute non-traumatic abdominal pain.
急性非创伤性腹痛患者常需进行腹部计算机断层扫描（CT）。然而，腹部CT会带来较高的辐射暴露。目的：评估采用先进的模型迭代重建技术的100 kVp低剂量CT方案与线性混合120 kVp方案在评估急性非创伤性腹痛方面的诊断性能。材料与方法：两名放射科医生采用五点李克特量表对112例连续的急性非创伤性腹痛（发病时间＜48小时）患者的100 kVp和线性混合120 kVp系列图像的图像质量、噪声及伪影进行评估。两名放射科医生对两个系列图像进行腹部病变及诊断置信度评估。对100 kVp和线性混合120 kVp系列图像的辐射剂量和图像噪声进行定量评估。采用受试者操作特征曲线（ROC）统计计算比较统计量和诊断准确性，以最终临床诊断/临床随访作为参考标准。结果：两个系列图像质量均较高，无明显差异（P = 0.157）。两个系列图像噪声和伪影评级均较低，但100 kVp系列明显更高（P≤0.021）。两个系列诊断准确性均较高（120 kVp：曲线下面积[AUC]=0.950，灵敏度=0.958，特异度=0.941；100 kVp：AUC≥0.910，灵敏度≥0.937，特异度=0.882；P≥0.516），观察者间一致性几乎完美（kappa = 0.939）。两个剂量水平的诊断置信度均较高，无显著差异（100 kVp为5分，范围4 - 5分；120 kVp为5分，范围3 - 5分；P = 0.134）。与120 kVp系列相比，100 kVp系列辐射剂量降低26.1%（5.72±2.23 mSv对7.75±3.02 mSv，P＜0.001）。低剂量CT图像噪声明显更高（13.3±2.4 HU对10.6±2.1 HU；P＜0.001）。结论：采用100 kVp的低剂量腹部CT在评估急性非创伤性腹痛时可产生优异的图像质量和较高的诊断准确性。
