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Image quality and pathology assessment in CT Urography: when is the low-dose seriessufficient?
Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping.ORCID iD: 0000-0002-4013-4615
Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Medical radiation physics.
Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping. Linköping University, Center for Medical Image Science and Visualization (CMIV).ORCID iD: 0000-0002-7750-1917
Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping. Linköping University, Center for Medical Image Science and Visualization (CMIV).ORCID iD: 0000-0002-9446-6981
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2019 (English)In: BMC Medical Imaging, ISSN 1471-2342, E-ISSN 1471-2342, Vol. 19, article id 64Article in journal (Refereed) Published
Abstract [en]

Background

Our aim was to compare CT images from native, nephrographic and excretory phases using image quality criteria as well as the detection of positive pathological findings in CT Urography, to explore if the radiation burden to the younger group of patients or patients with negative outcomes can be reduced.

Methods

This is a retrospective study of 40 patients who underwent a CT Urography examination on a 192-slice dual source scanner. Image quality was assessed for four specific renal image criteria from the European guidelines, together with pathological assessment in three categories: renal, other abdominal, and incidental findings without clinical significance. Each phase was assessed individually by three radiologists with varying experience using a graded scale. Certainty scores were derived based on the graded assessments. Statistical analysis was performed using visual grading regression (VGR). The limit for significance was set at p = 0.05.

Results

For visual reproduction of the renal parenchyma and renal arteries, the image quality was judged better for the nephrogram phase (p < 0.001), whereas renal pelvis/calyces and proximal ureters were better reproduced in the excretory phase compared to the native phase (p < 0.001). Similarly, significantly higher certainty scores were obtained in the nephrogram phase for renal parenchyma and renal arteries, but in the excretory phase for renal pelvis/calyxes and proximal ureters. Assessment of pathology in the three categories showed no statistically significant differences between the three phases. Certainty scores for assessment of pathology, however, showed a significantly higher certainty for renal pathology when comparing the native phase to nephrogram and excretory phase and a significantly higher score for nephrographic phase but only for incidental findings.

Conclusion

Visualisation of renal anatomy was as expected with each post-contrast phase showing favourable scores compared to the native phase. No statistically significant differences in the assessment of pathology were found between the three phases. The low-dose CT (LDCT) seems to be sufficient in differentiating between normal and pathological examinations. To reduce the radiation burden in certain patient groups, the LDCT could be considered a suitable alternative as a first line imaging method. However, radiologists should be aware of its limitations.

Place, publisher, year, edition, pages
BioMed Central, 2019. Vol. 19, article id 64
Keywords [en]
Computed tomography, Urography, Low-dose, Optimization, Image quality, Dose
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
URN: urn:nbn:se:liu:diva-159965DOI: 10.1186/s12880-019-0363-zISI: 000480486200001PubMedID: 31399078Scopus ID: 2-s2.0-85070460822OAI: oai:DiVA.org:liu-159965DiVA, id: diva2:1347122
Projects
Visual grading evaluation of reconstruction methods and dose optimisation in abdominal Computed Tomography
Funder
Region Östergötland, LIO-620341Linköpings universitet, LIO-697941Available from: 2019-08-30 Created: 2019-08-30 Last updated: 2019-09-04Bibliographically approved

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Kataria, BhartiNilsson Althen, JonasSmedby, ÖrjanPersson, AndersSökjer, HannibalSandborg, Michael

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Kataria, BhartiNilsson Althen, JonasSmedby, ÖrjanPersson, AndersSökjer, HannibalSandborg, Michael
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Division of Radiological SciencesFaculty of Medicine and Health SciencesDepartment of Radiology in LinköpingMedical radiation physicsCenter for Medical Image Science and Visualization (CMIV)Department of Medical and Health Sciences
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BMC Medical Imaging
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