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2014 ; 192
(5
): 1433-9
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Prospective trial of the detection of urolithiasis on ultralow dose (sub mSv)
noncontrast computerized tomography: direct comparison against routine low dose
reference standard
#MMPMID24859440
Pooler BD
; Lubner MG
; Kim DH
; Ryckman EM
; Sivalingam S
; Tang J
; Nakada SY
; Chen GH
; Pickhardt PJ
J Urol
2014[Nov]; 192
(5
): 1433-9
PMID24859440
show ga
PURPOSE: In this prospective trial we compared ultralow dose computerized
tomography reconstruction algorithms and routine low dose computerized tomography
for detecting urolithiasis. MATERIALS AND METHODS: A total of 48 consenting
adults prospectively underwent routine low dose noncontrast computerized
tomography immediately followed by an ultralow dose series targeted at a 70% to
90% reduction from the routine low dose technique (sub mSv range). Ultralow dose
series were reconstructed with filtered back projection, and adaptive statistical
and model based iterative reconstruction techniques. Transverse (axial) and
coronal images were sequentially reviewed by 3 relatively inexperienced trainees,
including a radiology resident, a urology fellow and an abdominal imaging fellow.
Three experienced abdominal radiologists independently reviewed the routine low
dose filtered back projection images, which served as the reference standard.
RESULTS: The mean effective dose for the ultralow dose scans was 0.91 mSv (median
0.82), representing a mean ± SD 78% ± 5% decrease compared to the routine low
dose. Overall sensitivity and positive predictive value per stone for ultralow
dose computerized tomography at a 4 mm threshold was 0.91 and 0.98, respectively.
Sensitivity, specificity, positive and negative predictive values, and accuracy
per patient were 0.87, 1.00, 1.00, 0.94 and 0.96, respectively. At a 4 mm
threshold the sensitivity and positive predictive value per stone of the ultralow
dose series for filtered back projection, and adaptive statistical and model
based iterative reconstruction was 0.89 and 0.96, 0.91 and 0.98, and 0.93 and
1.00, respectively. Sensitivity, specificity, positive and negative predictive
values, and accuracy per patient at the 4 mm threshold were 0.82, 1.00, 1.00,
0.91 and 0.94 for filtered back projection, 0.85, 1.00, 1.00, 0.93 and 0.95 for
adaptive statistical iterative reconstruction, and 0.94, 1.00, 1.00, 0.97 and
0.98 for model based iterative reconstruction, respectively. Sequential review of
coronal images changed the final stone reading in 13% of cases and improved
diagnostic confidence in 49%. CONCLUSIONS: At a 4 mm renal calculus size
threshold ultralow dose computerized tomography is accurate for detection when
referenced against routine low dose series with dose reduction to below the level
of a typical 2-view plain x-ray of the kidneys, ureters and bladder. Slight
differences were seen among the reconstruction algorithms. There was mild
improvement with model based iterative reconstruction over filtered back
projection and adaptive statistical iterative reconstruction. Coronal images
improved detection and diagnostic confidence over axial images alone.