Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy; Fondazione IRCCS Istituto Nazionale dei Tumori, Thoracic Surgery, Milan, Lombardia, Italy.
Fondazione IRCCS Istituto Nazionale dei Tumori, Thoracic Surgery, Milan, Lombardia, Italy.
Eur J Radiol. 2023 Apr;161:110760. doi: 10.1016/j.ejrad.2023.110760. Epub 2023 Feb 28.
To compare Low-Dose Computed Tomography (LDCT) with four different Ultra-Low-Dose Computed Tomography (ULDCT) protocols for PN classification according to the Lung Reporting and Data System (LungRADS).
Three hundred sixty-one participants of an ongoing lung cancer screening (LCS) underwent single-breath-hold double chest Computed Tomography (CT), including LDCT (120kVp, 25mAs; CTDIvol 1,62 mGy) and one ULDCT among: fully automated exposure control ("ULDCT"); fixed tube-voltage and current according to patient size ("ULDCT"); hybrid approach with fixed tube-voltage ("ULDCT") and tube current automated exposure control ("ULDCT"). Two radiologists (R1, R2) assessed LungRADS 2022 categories on LDCT, and then after 2 weeks on ULDCT using two different kernels (R1: Qr49; R2: Br49). Intra-subject agreement for LungRADS categories between LDCT and ULDCT was measured by the k-Cohen Index with Fleiss-Cohen weights.
LDCT-dominant PNs were detected in ULDCT in 87 % of cases on Qr49 and 88 % on Br49. The intra-subject agreement was: κULDCT = 0.89 [95 %CI 0.82-0.96]; κULDCT = 0.90 [0.81-0.98]; κULDCT = 0.91 [0.84-0.99]; κULDCT = 0.88 [0.78-0.97] on Qr49, and κULDCT = 0.88 [0.80-0.95]; κULDCT = 0.91 [0.86-0.96]; κULDCT = 0.87 [0.78-0.95]; and κULDCT = 0.88 [0.82-0.94] on Br49. LDCT classified as LungRADS 4B were correctly identified as LungRADS 4B at ULDCT, with the lowest radiation exposure among the tested protocols (median effective doses were 0.31, 0.36, 0.27 and 0.37 mSv for ULDCT, ULDCT, ULDCT, and ULDCT, respectively).
ULDCT by spectral shaping allows the detection and characterization of PNs with an excellent agreement with LDCT and can be proposed as a feasible approach in LCS.
根据肺部报告和数据系统（LungRADS），比较低剂量计算机断层扫描（LDCT）与四种不同的超低剂量计算机断层扫描（ULDCT）方案对肺结节（PN）的分类。
在一项正在进行的肺癌筛查（LCS）中，361 名参与者接受了单呼吸暂停双胸部 CT 检查，包括 LDCT（120kVp，25mAs；CTDIvol 1.62mGy）和以下四种 ULDCT 方案之一：全自动曝光控制（“ULDCT”）；根据患者体型固定管电压和电流（“ULDCT”）；混合方法，固定管电压（“ULDCT”）和管电流自动曝光控制（“ULDCT”）。两位放射科医生（R1、R2）在 LDCT 上评估 2022 年版 LungRADS 类别，然后在 2 周后使用两种不同的内核（R1：Qr49；R2：Br49）在 ULDCT 上进行评估。LDCT 和 ULDCT 之间的 LungRADS 类别通过 Fleiss-Cohen 加权的 k-Cohen 指数测量受试者内一致性。
在 Qr49 和 Br49 上，87%和 88%的 ULDCT 检测到 LDCT 为主的 PN。受试者内一致性为：κULDCT=0.89 [95%CI 0.82-0.96]；κULDCT=0.90 [0.81-0.98]；κULDCT=0.91 [0.84-0.99]；κULDCT=0.88 [0.78-0.97]在 Qr49 上，κULDCT=0.88 [0.80-0.95]；κULDCT=0.91 [0.86-0.96]；κULDCT=0.87 [0.78-0.95]；κULDCT=0.88 [0.82-0.94]在 Br49 上。LDCT 分类为 LungRADS 4B 的在 ULDCT 中被正确识别为 LungRADS 4B，在测试的方案中具有最低的辐射暴露（中值有效剂量分别为 0.31、0.36、0.27 和 0.37mSv，用于 ULDCT、ULDCT、ULDCT 和 ULDCT）。
通过光谱成形的 ULDCT 允许对 PN 进行检测和特征描述，与 LDCT 具有极好的一致性，可作为 LCS 中的一种可行方法。
