Imaging quality and diagnostic reliability of low-dose computed tomography lumbar spine for evaluating patients with spinal disorders |
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| Authors: | Cheng-Hui Yang Tung-Hsin Wu Yi-You Chiou Sheng-Che Hung Chung-Jung Lin Ying-Chou Chen Ming-Huei Sheu Wan-Yuo Guo Chen-Fen Chiu |
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| Affiliation: | 1. Department of Cardiology, Poole Hospital NHS Foundation Trust, Centre for Postgraduate Medical Research and Education, Bournemouth University, Dorset, UK;2. Department of Cardiology, Sunshine Coast Hospital and Health Services, University of the Sunshine Coast and University of Queensland, Queensland, Australia;3. Department of Intensive Care, Sunshine Coast Hospital and Health Services and University of Queensland, Queensland, Australia;4. Biomedical Research Unit, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK;5. Molecular and Clinical Sciences Research Institute, St George’s, University of London and Cardiology Clinical Academic Group, St George’s University Hospitals NHS Foundation Trust;6. Centre for Postgraduate Medical Research and Education, Bournemouth University, Dorset, UK;7. Nutrition & Metabolism, Institute for Developmental Sciences, University of Southampton and Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton, Southampton General Hospital, Southampton, UK |
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| Abstract: | Background contextComputed tomography (CT) scans of the lumbar spine (CTLS) have demonstrated a higher level of accuracy than plain films and have been used to assess patients with spinal disorder when magnetic resonance imaging is not available. Nevertheless, radiation exposure remains a serious safety concern. Iterative reconstruction (IR) decreases the CT radiation dose for diagnostic imaging. However, the feasibility of using IR in CTLS is unclear.PurposeTo evaluate the imaging quality and diagnostic reliability of CTLS with IR.Study designA prospective study.Patient sampleAll patients from outpatient departments who suffered from spinal disorders and were referred for CTLS.Outcome measuresIn acquired CT images, the signal-to-noise ratio (SNR) of the dural sac (DS), intervertebral disc (IVD), psoas muscle (PM), and L5 vertebral body, the contrast-to-noise ratio between the DS and IVD (D-D CNR), and the subjective imaging qualities were compared across groups. Interobserver agreement was evaluated with kappa values.MethodsPatients receiving low radiation CTLS were divided into three groups. A 150 mAs tube current with 120 kVp tube voltage was used with Group A and a 230 mAs tube current with 100 kVp tube voltage with Group B. Intended end radiation exposure was 50% less than that of the control group. Tube modulation was active for all groups. The images of the two low-radiation groups were reconstructed by IR; those of the control group by filtered back-projection (FBP).ResultsThe SNRs of the DS, IVD, PM, BM, and D-D CNR of Group A were not inferior to those of the control group. All SNRs and D-D CNRs for Group B were inferior to those of the control group. Except for that of the facet joint, all subjective imaging ratings for anatomic regions were equivalent between Groups A and B. Interobserver agreement was highest for the control group (0.72–0.88), followed by Group A (0.69–0.83) and B (0.55–0.83).ConclusionsFifty percent tube current reduction combined with IR provides equivalent diagnostic accuracy and improved patient safety when compared with conventional CTLS. Our results support its use as a screening tool. With the tube modulation technique, further adjustments in weighting IR and FBP algorithms based on body mass index become unnecessary. |
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| Keywords: | Computed tomography Diagnostic reliability Imaging quality iterative reconstruction Lumbar spine Patient safety Radiation |
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