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Image quality and pathology assessment in CT Urography: when is the low-dose series sufficient?
Linkoping Univ, Dept Radiol, Linkoping, Sweden.;Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden.;Linkoping Univ, Ctr Med Image Sci & Visualizat CMIV, Linkoping, Sweden..
Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden.;Linkoping Univ, Dept Med Phys, Linkoping, Sweden..
KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems.ORCID iD: 0000-0002-7750-1917
Linkoping Univ, Dept Radiol, Linkoping, Sweden.;Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden.;Linkoping Univ, Ctr Med Image Sci & Visualizat CMIV, Linkoping, Sweden..
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2019 (English)In: BMC Medical Imaging, ISSN 1471-2342, E-ISSN 1471-2342, Vol. 19, no 1, 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
BMC , 2019. Vol. 19, no 1, article id 64
Keywords [en]
Computed tomography, Urography, Low-dose, Optimization, Image quality, Dose
National Category
Medical Image Processing
Identifiers
URN: urn:nbn:se:kth:diva-257446DOI: 10.1186/s12880-019-0363-zISI: 000480486200001PubMedID: 31399078Scopus ID: 2-s2.0-85070460822OAI: oai:DiVA.org:kth-257446DiVA, id: diva2:1347677
Note

QC 20190902

Available from: 2019-09-02 Created: 2019-09-02 Last updated: 2019-09-02Bibliographically approved

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Smedby, Örjan

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